Sleep and Cognition in an HIV+ Cohort: A Multi-Method Approach

C.GamaldoCharlene Gamaldo is an Associate Professor within the Departments of Neurology, Medicine, Psychiatry and School of Public Health – Johns Hopkins School of Medicine. She is a board certified Neurologist and board certified Sleep Specialist.

Her research interest is studying the impact of sleep on manifestation and progression of neurological diseases. Looking at this relationship between sleep and disease progression in HIV will serve as the foundation for future work focused on the impact of sleep loss on other aspects of neurobiological function. This project has served as a model for conducting sleep research utilizing the efforts of a diverse group of interdisciplinary collaborators and as a result has led to ongoing and evolving research projects that now include a growing list of collaborators (Neurology, OB/Gyn, Psychiatry, Urology, School of Nursing and Public Health along with the NIA). She recently published a paper titled: ‘Sleep and cognition in an HIV+ cohort: a multi-method approach’ in the Journal of Acquired Immune Deficiency Syndromes.

Background of the study

I have always been interested as a sleep expert and neurologist about the impact of sleep on the progression of neurological disease. I first discussed this with my department chair, Dr. Justin McArthur, an expert in neuro HIV, almost 8 years ago. He mentioned his experience clinically with patients with HIV is that they often complain of sleep disruptions but this relationship has not been studied in the HIV population particularly in the post –CART era. As such a research interest and avenue was born, as I was very interested in comprehensively studying the impact of sleep disruption, patterns, and presence of sleep disorders and its relationship with standard measures of functioning and disease management in HIV (e.g., Cognitive status, mood, daytime functioning, viral load etc).

Findings

Our study found that the majority of participants were cognitively impaired. Questionnaires completed by participants suggested poor sleep quality. Participants with better cognitive performance, particularly on tasks of attention, frontal/executive function, and psychomotor/motor speed, were associated with better sleep indices (i.e., reduced wake-after-sleep. Thirty-seven percent of participants had sleep patterns suggestive of chronic partial sleep deprivation which was associated with significantly worse performance on several cognitive tests. Our results suggest that compromised sleep quality and duration may have a significant impact on cognitive performance in HIV+ individuals.

Implications

We see this study as potential foundation for highlighting the importance of assessing sleep for the optimal management of HIV from a disease progression, stabilization, and overall quality of life and daytime functioning. Ideally standard of practice can include sleep assessment. We hope that this can provide insight for health professionals caring for HIV population as well as their patients.

Further research

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. We also plan to develop and study effective objective and nonobjective screening and assessment tools to cost effectively identify and monitor response to potential behavioral and treatment algorithms that are specific to variables that impact sleep in HIV populations.

Advice from the field

Constantly look to technology and interdisciplinary experts to help study your scientific question since medicine and medical conditions often manifest as result of a complex interplay of genetic, environmental, societal, physical conditions as just a few of the elements etc. Thus, seek the help of experts if possible in the key related fields that you feel your disease of interest is likely impacted by.

About the department

I was appointed director of a newly developed division within my department (Neurology) in 2011 which is Neuro-Sleep. Focus recently of our division had been spreading the importance of all medical providers to be in tune with their patients regarding potential sleep problems that can exacerbate current medical issues and even cause others.