SLEEP - The Association of Fatigue with Depression and Insomnia in HIV-Seropositive Patients: A Pilot Study

VOLUME 34, ISSUE 12

FATIGUE, DEPRESSION AND INSOMNIA IN HIV-SEROPOSITIVIE PATIENTS
The Association of Fatigue with Depression and Insomnia in HIV-Seropositive Patients: A Pilot Study

http://dx.doi.org/10.5665/sleep.1446

Yinghui Low, BSc¹^,²; Xavier Preud'homme, MD²^,⁴; Harold W. Goforth, MD²^,³^,⁴; Toma Omonuwa, MD²; Andrew D. Krystal, MD, MS²

¹Duke-National University of Singapore School of Medicine, Duke University School of Medicine, Durham, NC; ²Duke Insomnia and Sleep Research Program, Department of Psychiatry, Duke University School of Medicine, Durham, NC; ³Durham VA Medical Center, Durham, NC, GRECC – Division of Geriatric Medicine, Duke University School of Medicine, Durham, NC; ⁴Department of Internal Medicine, Duke University School of Medicine, Durham, NC

Table of Contents

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Objective:

Fatigue is a pervasive symptom associated with HIV, resulting in significant functioning impairment; but little is known about its etiology or treatment. In patients with primary insomnia, data have shown improvement in fatigue following successful treatment of insomnia. However, little is known about the role of insomnia in patients with fatigue in HIV. This manuscript seeks to test the hypothesis that insomnia severity is correlated with increased fatigue in HIV-seropositive patients.

Methods:

Fifty-seven ambulatory HIV-seropositive patients, aged 18-60 years, with a DSM-IV-TR diagnosis of insomnia, were administered the Insomnia Severity Index (ISI), Piper Fatigue Scale (PFS), Hospital Anxiety and Depression scale, and Hamilton Depression Rating Scale (HAM-D). Their most recent CD4 count and time since diagnosis of HIV were recorded. Regression analysis was carried out with PFS as the dependent variable.

Results:

A higher ISI score correlated with higher PFS score, (R² = 0.1713, P = 0.0042). Overall depression severity was not significantly correlated with PFS score, except in the most severely depressed subgroup, in which the HADS depression score was the strongest predictor of PFS (R² = 0.182, P = 0.0009). In participants without depression, ISI accounted for most of the variance in fatigue (R² = 0.6035, P = 0.0011).

Conclusions:

Greater insomnia severity is associated with greater fatigue severity in HIV seropositive patients. Depression may contribute to both fatigue and insomnia. In the absence of depression, the treatment of insomnia may emerge as a treatment strategy to help alleviate fatigue. Further studies are needed to confirm these data.

Clinical Trial Information:

Clinical Trials.Gov: The Treatment of Insomnia in Patients with HIV Disease. Registry Number: NCT00465972. URL: http://www.clinicaltrials.gov/ct2/show/NCT00465972?term = HIV+insomnia&rank = 1

Citation:

Low Y; Preud'homme X; Goforth HW; Omonuwa T; Krystal AD. The association of fatigue with depression and insomnia in hiv-seropositive patients: a pilot study. SLEEP 2011;34(12):1723-1726.