Association between anticholinergic burden and sleep quality in people living with HIV

Background: No studies investigated the association between anticholinergic burden (ACB) and sleep quality (SQ) in people living with HIV. Methods: This study was a cross-sectional single-centre assessment of the relationship between different patient-reported outcomes (PROs) such as SQ (the Pittsburgh Sleep Quality Index [PSQI], the Insomnia Severity Index [ISI] and the Epworth Sleepiness Scale [ESS]) and ACB (ACB scale [ACBS]) in people living with HIV. Data on comorbidities and comedications were also collected and analysed. Generalized linear models investigated the associations after adjusting for relevant factors (eg, psychiatric diagnoses, treatments, comorbidities). Results: Out of 1200 participants (age 52 ± 12 years, 73.5% male, 95.5% undetectable HIV-RNA, median CD4 + 642/μL), 10.0%, 46.8% and 10.2% had ISI, PSQI, and ESS scores suggesting clinically relevant insomnia, poor SQ and significant daily sleepiness. Two hundred and two (16.8%) participants were on one or more AC drugs: 11.0% had ACBS = 1 and 5.8% had ACBS ≥ 2. Higher ACBS was associated with worse sleep metrics. Polypharmacy (20.4%), multimorbidity (63.7%), depressive mood (13.2%) and anxiety symptoms (20.4%) were also prevalent and associated with both SQ and ACB. In models adjusted by these and other confounding variables, higher ACBS was independently associated with worse scores for both ISI (aβ 0.36 [0.21-0.50], P <.0001) and PSQI (aβ 0.28 [0.16-0.41], P <.0001). Conclusions: A complex association exists between ACB and sleep disorders in people living with HIV. Clinicians should take it into account, by investigating SQ (measuring PROs) and routinely reviewing comedications, deprescribing those with a high ACB. This will contribute to pursuit a better quality of life for people living with HIV, as also recently endorsed by EACS guidelines.