HIV Patients Show Accelerated Aging Related to Altered Sleep
April 20, 2021 (Medscape.com) — Accelerated brain aging among HIV-infected adults might be due in part to altered deep sleep patterns, new research suggests.
Using a measure known as the brain age index (BAI) — a machine-learning model that measures deviations in brain activity during sleep relative to healthy individuals — investigators identified 34 sleep electroencephalogram (EEG) features that were significantly altered by HIV infection. The most notable of these was the decline in slow wave activity during nonrapid eye movement (NREM) sleep, which has been previously associated with MRI markers of brain aging in healthy adults.
“One of the functions of slow wave sleep appears to be its association with the glymphatic system, which clears [metabolic] waste products and supports memory consolidation,” study coauthor Brandon Westover, MD, PhD, associate professor of neurology at Massachusetts General Hospital/Harvard Medical School, Boston, told Medscape Medical News. “It’s also believed to be associated with an accelerated risk for dementia and other cognitive issues.”
Previous work conducted at Johns Hopkins and other institutions confirm Westerson’s hypothesis. Charlene Gamaldo, MD, medical director of Johns Hopkins Sleep Disorders Center in Baltimore, pointed to other study findings in patients with neurodegenerative disease that have shown a link between predominant habitual sleep positions and dementia, potentially driven by inefficient glymphatic transport. Gamaldo was not involved in the current study.
Threefold Acceleration vs Healthy Volunteers
“We’ve been grappling with whether people with HIV on ART experience accelerated aging or accentuated aging,” coauthor Shibani Mukerji, MD, PhD, associate director of the neuro-infectious diseases unit at Massachusetts General, told Medscape Medical News. “We have yet to have biomarkers to address this question, and most of the tools are limited to invasive or expensive diagnostics. “In general, sleep and its influence on health have been understudied in the HIV population,” she said.
To address this question, the researchers retrospectively examined a Massachusetts General Hospital database of diagnostic sleep study participants from 2008 to 2018, identifying 3155 healthy, HIV-negative control subjects and 43 HIV-positive (HIV+) participants. Thirty-four (79%) of the HIV+ participants were men, 30 (70%) were white, and 38 (93%) were virally suppressed at the time of their sleep study. Four patients were taking efavirenz, 13 were taking an integrase strand transfer inhibitor (INSTI), and all were adherent to antiretroviral therapy (ART) at the time of their sleep study.
HIV Patients Show Accelerated Aging Related to Altered Sleep – Medscape – Apr 20, 2021.