Daytime Sleepiness, Nighttime Sleep Quality, Stressful Life Events, and HIV-Related Fatigue

In this report we describe the relationships between daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue in a sample of 128 individuals; we are reporting the baseline results of a longitudinal observational study. We examined sleep using the Pittsburg Sleep Quality Index (PSQI) (a measure of the quality of nighttime sleep), and the Epworth Sleepiness Scale (ESS), (a measure of daytime sleepiness). Recent stressful life events were measured via a methodology developed in a previous 9-year HIV study. Poor nighttime sleep was significantly correlated with fatigue intensity (r = 0.46, p < 0.05), as was daytime sleepiness (r = 0.20, p < 0.05). However, in multiple regression models, the association between stress and fatigue intensity was not explained by daytime sleepiness and was only partially explained by nighttime sleep quality. Further research is needed to better elucidate these relationships

Demographic and Illness-Related Variables Associated With HIV-Related Fatigue

Fatigue is one of the most debilitating symptoms suffered by those with HIV infection, yet little is known about its correlates. Our primary aims are to describe the degree to which fatigue affects daily functioning and the demographic and illness-related predictors of fatigue. The sample (n = 128) was composed of primarily poor, unemployed people of color. Fatigue most often interfered with the ability to think quickly, perform household chores, exercise, work, engage in recreational activities, walk, plan activities, and think clearly. The consequences of fatigue were highest for lowered motivation, difficulty concentrating, increased drowsiness, losing patience, and interference with work, family, and social life. Multiple linear regression analyses revealed statistically significant associations of employment status, monthly income, current antidepressant use, and number of years living with HIV infection as predictors of fatigue. These must be better understood in order to develop interventions to successfully ameliorate HIV-related fatigue

Physiological and Psychosocial Factors that Predict HIV-Related Fatigue

Fatigue is one of the most common and debilitating symptoms experienced by HIV-infected people. We report the results of our longitudinal analysis of physiological and psychosocial factors that were thought to predict changes in HIV-related fatigue in 128 participants over a 1-year period, in an effort to sort out the complex interplay among a comprehensive set of physiological and psychosocial variables. Physiological measures included hepatic function (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, total bilirubin, hepatitis C status), thyroid function (thyroid stimulating hormone, thyroxine), HIV viral load, immunologic function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, dehydroepiandrosterone), hematologic function (hemoglobin, hematocrit, serum erythropoietin), and cellular injury (lactic acid). Psychosocial measures included childhood and adult trauma, anxiety, depression, social support, stressful life events, and post-traumatic stress disorder (PTSD). Unemployment, not being on antiretroviral therapy, having fewer years since HIV diagnosis, more childhood trauma, more stressful life events, less social support, and more psychological distress (e.g., PTSD, anxiety and depression) put HIV-infected persons at risk for greater fatigue intensity and fatigue-related impairment in functioning during 1-year follow-up. Physiological variables did not predict greater fatigue. Stressful life events had both direct and indirect effects on fatigue

Physiological Correlates of HIV-Related Fatigue

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Chronicity and Remission of Fatigue in Patients with Established HIV Infection

Fatigue is one of the most common and debilitating complaints of HIV-positive individuals, potentially leading to important functional limitations. We recruited 128 HIV-positive individuals (fatigued and nonfatigued) between March 2005 and May 2006; 66% were male, 66% were African American, 45% had greater than a high school education, 67% were unemployed, and ages ranged from 26–66 (median, 44). Every 3 months for 15 months, participants completed a 56-item self-report fatigue scale developed and validated by the authors. Participants were classified as fatigued or not fatigued at each assessment and received scores for fatigue intensity and impact of fatigue on functioning. We used linear mixed-effects models to assess longitudinal variation in fatigue scores and generalized estimating equations for binary outcomes to model predictors of fatigue remission among those fatigued at baseline. At baseline, 88% of the sample was fatigued. Fatigue measures were highly correlated across time points (ρ 0.63–0.85 [intensity], 0.63–0.80 [functioning]) and showed no evidence of overall improvement, deterioration, or convergence over time. Predictors of lower fatigue scores included higher income, employment, longer time since HIV diagnosis, and antiretroviral therapy use. Those employed at baseline were likely to show improvements in fatigue while those unemployed were not. Of those fatigued at baseline, 11% experienced remission during follow-up; remission was associated with Caucasian race and employment. In summary, fatigue intensity and related functional limitations were persistent, stable, and unlikely to remit over 15 months of follow-up in this sample of patients with established HIV infection