HIV and Obstructive Sleep Apnea

HIV can have subtle but important effects on the brain, leading to difficulties in memory, concentration or problem solving (cognition). Mild cognitive problems are relatively common in people with longstanding HIV infection. There is currently no treatment for these cognitive problems.

Obstructive sleep apnea (OSA) is a breathing disorder that is characterized by episodes of complete or partial cessation of respiration during sleep. This results in a disruption in sleep and is also frequently associated with cognitive disturbances. In addition to its negative impact on cognition, OSA is associated with health conditions such as hypertension, metabolic disturbances and increased risk of heart disease, stroke and mortality. The presence of OSA is therefore important to detect and treat.

Positive Airway Pressure therapy, also called CPAP (continuous positive airway pressure) is the recommended treatment of choice for OSA. It corrects sleep apnea by gently pushing air through a small “mask” applied at the nose (and sometimes the mouth if the nose is too congested). The pressure generated maintains the breathing passages open, reduces snoring and allows regular breathing throughout the night. In addition to its positive impact on fatigue, CPAP has established efficacy in improving cognition in the general population. While there is no treatment for the cognitive difficulties associated with HIV infection, treatment of OSA in persons living with HIV could potentially improve cognition, in addition to other health benefits. However, its effectiveness in improving cognition in HIV + individuals has never been previously tested.

The goal of this project is to determine the extent to which treatment of OSA with CPAP can improve cognition in individuals living with HIV who experience cognitive difficulties.