Mechanisms and Health Impact of Insomnia as an HIV Comorbidity

University Of Miami Coral Gables, Coral Gables FL

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Abstract

Project Summary. Background: Insomnia is a highly prevalent and interfering comorbidity to HIV infection. Nearly 70% of PLWHA experience significant sleep difficulties characteristic of insomnia. Efforts have been made to identify factors that contribute to the development and maintenance of insomnia in PLWHA. Extant studies have studied sleep problems, but not clinical insomnia. The purpose of the current study is to specifically study insomnia (by including insomnia specific measures) as a comorbidity of HIV. Further, we will test a behavioral and biological pathway that could explain the relationship between sleep, HIV health, and quality of life. If significant, findings may suggest that treatment of insomnia (either behavioral or pharmacological) could improve HIV health outcomes and quality of life. Research Strategy: Linked to my career development plans to become an independent investigator in the area of HIV/AIDS and sleep, the proposed project seeks to examine whether insomnia (assessed via wrist actigraphy, diary, and interviews) is associated with HIV-related health and quality of life in PLWHA (Aim 1). Secondly, this grant seeks to examine whether a behavioral and/or biological model may explain the relationship between insomnia and HIV health (Aim 2). To achieve these aims, PLWHA (N=100) recruited from the Miami Jackson HIV clinic (N=3,000; 33% Hispanic, 60% African American/Black Caribbean), will complete self-report and biological measures of sleep (e.g.1-week actigraphy); mental and behavioral health (e.g. depression, medication adherence); and immunity (e.g. as measured by biomarkers IL-6 and CRP). We will use existing medical records to identify coexisting conditions, medications, viral load, and CD4. Next Steps: Using similar methodology for assessment of sleep, the next step in my anticipated research program is to design and test evidence-based interventions for insomnia in PLWHA to help improve sleep quality and quantity, and also overall HIV-related health and quality of life. Training Plan: As an NRSA proposal, this study will lay the groundwork for my career goals of studying HIV/AIDS and sleep. The short-term goal of the enclosed training plan is to develop the skills necessary to study the impact of insomnia on HIV-related health and quality of life in PLWHA, using state of the art assessment methods. The next step (ideally, for a post-doctoral F32 and/or early career K award) is to build on these findings to develop an area of research in sleep and quality of life for PLWHA. Improved sleep (and reduced insomnia symptoms) in other chronically ill populations with several comorbidities has improved not only sleep itself, but also, other health outcomes and quality of life. Ultimately, my goal is to improve not only HIV-related health by reducing insomnia, but also quality of life.