Obstructive sleep apnea-related hypoxemia and heart rate dynamics are associated with systemic inflammation in people living with HIV

Abstract

People living with HIV (PLWH) have elevated systemic inflammation, even while adherent to anti-retroviral therapy (ART), contributing to high burden of cardiometabolic diseases. Obstructive sleep apnea (OSA), which promotes inflammation, is more prevalent in this population, yet its contribution to increased morbidity is unclear. In this cohort study, PLWH on ART (n = 106) completed an overnight polysomnogram. Sleep metrics were calculated, including apnea hypopnea index (AHI), sleep apnea-specific hypoxic burden, heart rate response to arousal (ΔHR), and average heart rate. Inflammatory and immunomodulatory cytokines were quantified in serum, with IFNγ, TNFα, and IL-6 designated as primary outcomes, along with an additional 27 exploratory markers. Regression analyses were performed to assess associatations between sleep metrics and biomarker outcomes, adjusting for age and sex. Seventy-six percent of study participants met criteria for OSA (AHI > 5 events/hour). After adjusting for age and sex, hypoxic burden (β = 0.15, 95% CI: 0.05–0.26, p = 0.006) and average heart rate (β = 0.14, 95% CI: 0.04–0.25, p = 0.008) were positively associated with circulating IFNɣ. No associations were found between OSA metrics and serum TNFα. While IL-6 was only detectable in 12 participants, elevated heart rate (Odds ratio (OR) = 2.53, 95% CI: 1.29–4.94, p = 0.007), and lower ΔHR (OR = 0.23, 95% CI: 0.07–0.79, p = 0.019), were associated with increased odds of detectable IL-6. These data further underscore the high prevalence of OSA in PLWH and suggest OSA-related inflammation in this population. Further research is needed to examine whether treatment of OSA in PLWH reduces systemic inflammation and associated risks such as cardiovascular disease.