Increased Risk of Depression in Non-Depressed HIV Infected Men with Sleep Disturbance: Prospective Findings from the Multicenter AIDS Cohort Study
26 Pages Posted: 23 Jan 2019More...
Background: Sleep disturbance is a known risk factor for depression, but it is not known whether sleep disturbance contributes to greater risk of depression in those infected with human immunodeficiency virus (HIV) as compared to those uninfected with HIV (HIV-).
Methods: Using data from the Multicenter AIDS Cohort Study, a population-based prospective study of men who have sex with men (MSM), self-reported sleep disturbance (>2 weeks) and depressive symptoms (Clinical Epidemiologic Scale for Depression, CES-D) were assessed every 6 months over 12 years of follow-up. Adjusted mixed effects logistic regression analyses tested whether sleep disturbance predicted depression (CES-D>16) at the immediate subsequent visit, and so on over 12 years, in non-depressed HIV (N=1054; 9,556 person-visits) and non-depressed HIV- (N=1217; 12,680 person-visits). In HIV vs. HIV- MSM, linearly estimated average incidence of depression and normalized cumulative rate of depression over 12 years were compared.
Outcomes: In the HIV MSM, sleep disturbance was associated with a significant increase in likelihood of depression 6 months later (OR=1·6; 95% CI, 1·30, 1·96), which was significantly greater (P<0·05) than in HIV- MSM (OR=1·16; 95% CI, 0·94, 1·44). HIV status and sleep disturbance interacted (P<0.001), such that incidence of depression and normalized cumulative rate of depression were greater in HIV with sleep disturbance than in HIV without sleep disturbance and HIV- groups (all P's<0·001).
Interpretation: HIV persons who report sleep disturbance represent a high risk group to be monitored for depression, and targeted for insomnia treatment to prevent depression.
Funding: Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS). The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID) (grants U01-AI35039, U01-AI35040, U01-AI35041, U01-AI35042, and UM1-AI35043), with additional co-funding from the National Cancer Institute (NCI), National Institute on Drug Abuse (NIDA), and National Institute of Mental Health (NIMH). Funding for these analyses was provided by the Los Angeles MACS site (R. Detels, O. Martinez-Maza, O. Yang, PIs), U01-AI35040. GA is funded by a UK Economic and Social Research Council scholarship. Dr. Patel has received grant funding through his institution from the American Sleep Medicine Foundation, the ResMed Foundation, and Bayer Pharmaceuticals.
Declaration of Interest: The authors have no conflicts of interest and nothing to disclose.
Ethical Approval: The MACS was approved by the Institutional Review Board (IRB) at the four study sites, and each participant provided informed consent.
Keywords: Sleep disturbance, Depression, HIV
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