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Evaluating Sleep and Cognition in HIV

Gamaldo, Charlene E. MD*; Gamaldo, Alyssa PhD; Creighton, Jason BA*; Salas, Rachel E. MD*; Selnes, Ola A. PhD*; David, Paula M.*; Mbeo, Gilbert MD*; Parker, Benjamin S. BS*; Brown, Amanda PhD*; McArthur, Justin C. MBBS, MPH*,‡; Smith, Michael T. PhD§

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p 609–616
doi: 10.1097/QAI.0b013e31829d63ab
Clinical Science

Objective: To examine the relationship between measures of sleep quality and cognitive performance in HIV-positive individuals stable on combination antiretroviral therapy.

Design: Multimethod assessments of sleep quality, patterns, and cognitive performance were assessed in a predominantly black HIV-positive cohort.

Methods: Sleep quality and patterns were characterized in 36 subjects by polysomnogram, 2-week actigraphy monitoring, and validated sleep questionnaires. Cognitive performance was assessed with a battery of neuropsychological tests.

Results: The majority of participants were cognitively impaired [based on Frascati (75%) criteria]. Self-reported mean scores on the Pittsburgh sleep quality index and the insomnia severity scale suggested poor sleep quality. Better cognitive performance, particularly on tasks of attention, frontal/executive function, and psychomotor/motor speed, was associated with polysomnogram sleep indices (ie, reduced wake after sleep onset, greater sleep efficiency, greater sleep latency, and greater total sleep time). Thirty-seven percent of participants had sleep patterns suggestive of chronic partial sleep deprivation, which was associated with significantly worse performance on the digit symbol test (P = 0.006), nondominant pegboard (P = 0.043), and verbal fluency tests (P = 0.044).

Conclusions: Our results suggest that compromised sleep quality and duration may have a significant impact on cognitive performance in HIV-positive individuals. Future studies are warranted to determine the utility of sleep quality and quantity indices as potential predictive biomarkers for development and progression of future HIV-associated neurocognitive disorder.

*Department of Neurology, Johns Hopkins University, Baltimore, MD;

Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD;

Departments of Pathology, Epidemiology, and Medicine, Johns Hopkins University, Baltimore, MD; and

§Department of Psychiatry and Behavioral Medicine, Johns Hopkins University, Baltimore, MD.

Correspondence to: Charlene E. Gamaldo, MD, The Johns Hopkins Hospital, 600 N. Wolfe St., Meyer 6-119, Baltimore, MD 21287 (e-mail:

Supported by grant number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. This study was also supported by award 5P30MH075673-S02 from the National Institute of Mental Health (NIMH) (principal investigator, J.C.M.), a Developmental Grant from JHU NIMH Center for Novel Therapeutics of HIV-associated Cognitive Disorders (to author C.E.G., principal investigator, J.C.M.), and a Developmental Grant from JHU Center for Mind-Body Research (PI Jennifer Haythornthwaite PI to author C.E.G.). The recruitment of participants was assisted by an existing cohort, funded by NIMH, the Central Nervous System HIV Antiretroviral Therapy Effects Research (CHARTER). The project described was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 RR 025005.

Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at

The authors have no conflicts of interest to disclose.

Received February 27, 2013

Accepted May 20, 2013

© 2013 by Lippincott Williams & Wilkins