|HIV+ CO-MORBIDITY WITH SLEEP APNEA?
Mar 16, 2007
I was diagnosed sleep apnea in 2005 having been positive for 6 years and on ARV for 3 years then. I had tonsillectomy in May 2006. In the course of this time I have changed my drug regime twice. First was from Stocrin to Nevirapine because of the depression side effect. The second was from Stavudine to AZT (Zidovudine) because of my lipoatrophy. I am presently on the combo of AZT+3TC+Nevirapine. I recently gained more weight from 65kg to 72kg. I used to weigh 75kg pre-ARV.
After my tonsillectomy in 2006 I still experience snoring and daytime somnolence, which is adversely affecting my study. So I had to go back to ENT for consultation. I was sent for polysomnogram (sleep test) on the 22nd of last month and booked for special clinic yesterday (Wednesday).
On my first special clinic just after my tonsillectomy, I was told by the leading specialist, a professor, that my sleep apnea has nothing to do with my HIV. But on my second special clinic and after conducting endoscopic examination on me, I was now informed that the sleep apnea has co-morbidity with my HIV. The exam showed that I have enlarged lymphoid tissue and prominent base of tongue as a result of enlarged lingua tonsil.
Before now, the specialist was contemplating surgery as a last resort but after this examination, the panel of special clinic consisting of two professors, a specialist and several ENT doctors concluded that surgery is not an option and believe that my sleep apnea is due to co-morbidity. The only option, I was advised, is to obtain CPAP.
My concerns are first, I was informed that CPAP is not a permanent solution to sleep apnea; second, if my sleep apnea is left untreated what effect can it have on the progression of my HIV? Or on its own if left untreated what is the worst scenario?
I sleep most during the day with my study suffering in the process. And Im writing semester exam in May in my second year towards LLB.
| Response from Dr. Henry
Some HIV+ persons who are doing well can have persistent enlarged lymphoid tissue including in the oral cavity. Sleep apnea can be a challenging disorder for which CPAP can provide symptomatic improvement and for which surgery is not always the best option depending on the anatomic situation. I have had scores of patients with HIV and sleep apnea. Since sleep apnea and HIV are fairly common they can co-exist in the same patient so it is unclear to me if HIV+ persons are at higher risk for sleep apnea. With markedly improved long term survival and frequent weight gain as a problem in HIV+ persons on effective treatment, it seems like the opportunity to observe increased rates of sleep apnea is there and I believe that I have seen that in my own patients. What I don't know is whether increased size of oral lymphoid tissues contributes more to the problem among HIV+ persons. That is an interesting concept but again I haven't seen much on that from studies of HIV+ populations. Most of my patients with sleep apnea seem to respond to standard treatment approaches similarly to non-HIV+ persons from what I have observed and the feedback I get from our sleep clinic specialists.KH
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