P52 Investigating excessive day time sleepiness in adults living with HIV in the UK

Background The widespread availability of effective and tolerable antiretroviral therapy (ART) means that the life expectancy of people living with HIV (PLWH) is now approaching that of the general population. As a result, non-communicable comorbidities are increasingly important. Sleepiness and fatigue, once the hallmark of advanced HIV infection, are still commonly reported, even in patients with well-controlled HIV. The relative importance of underlying obstructive sleep apnoea (OSA) as a cause of sleepiness in this population has not been fully established. We aimed to document the prevalence and aetiologies of excessive day time sleepiness (EDS) within a large HIV service. Methods Adults attending a UK ambulatory HIV service were approached and recruited to achieve a sample representative of the clinic population. Following consent, participants completed validated clinical questionnaires to determine the prevalence of EDS (Epworth Score >10) and associated symptoms. Participants with EDS then had a home sleep study to determine the proportion with OSA. Results The study population to date (n=122) is 77% male with a median age of 53 years (IQR 48.3–56.0), CD4 count 638 cells/mm3 (473–752) and a mean BMI 26.6±5.4 kg/m2. 100% are taking ART, 97.5% with an undetectable HIV load. 24/122 (20%) of participants reported EDS. Only 17% of those with EDS had significant OSA (Apnoea/Hypopnoea Index≥15). There was no difference in the above baseline characteristics between somnolent and non-somnolent participants. However, somnolent participants had significantly higher scores of depression, anxiety and fatigue; reduced quality of life and more impaired sleep quality (table 1). A higher proportion of somnolent participants reported recreational drug usage (29.2% v 14.3%, p=0.15) and taking ART regimen containing medications known to frequently cause insomnia (66.7% v 51.0%, p=0.17), though these differences did not reach significance. Conclusion EDS is common in a UK adult HIV population, with 1 in 5 affected. Sleep disordered breathing does not appear to be a frequent explanation for this. Investigating and managing somnolence in this population requires a comprehensive review of lifestyle, medication and psychological health in addition to performing routine sleep studies.