Articlebronze2011

The Association of Fatigue with Depression and Insomnia in HIV-Seropositive Patients: A Pilot Study

Yinghui Low · Xavier Preudʼhomme · Harold W. Goforth · Toma Omonuwa · Andrew D. Krystal

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Abstract

OBJECTIVE: Fatigue is a pervasive symptom associated with HIV, resulting in significant functioning impairment; but little is known about its etiology or treatment. In patients with primary insomnia, data have shown improvement in fatigue following successful treatment of insomnia. However, little is known about the role of insomnia in patients with fatigue in HIV. This manuscript seeks to test the hypothesis that insomnia severity is correlated with increased fatigue in HIV-seropositive patients. METHODS: Fifty-seven ambulatory HIV-seropositive patients, aged 18-60 years, with a DSM-IV-TR diagnosis of insomnia, were administered the Insomnia Severity Index (ISI), Piper Fatigue Scale (PFS), Hospital Anxiety and Depression scale, and Hamilton Depression Rating Scale (HAM-D). Their most recent CD4 count and time since diagnosis of HIV were recorded. Regression analysis was carried out with PFS as the dependent variable. RESULTS: A higher ISI score correlated with higher PFS score, (R2 = 0.1713, P = 0.0042). Overall depression severity was not significantly correlated with PFS score, except in the most severely depressed subgroup, in which the HADS depression score was the strongest predictor of PFS (R2 = 0.182, P = 0.0009). In participants without depression, ISI accounted for most of the variance in fatigue (R2 = 0.6035, P = 0.0011). CONCLUSIONS: Greater insomnia severity is associated with greater fatigue severity in HIV seropositive patients. Depression may contribute to both fatigue and insomnia. In the absence of depression, the treatment of insomnia may emerge as a treatment strategy to help alleviate fatigue. Further studies are needed to confirm these data. CLINICAL TRIAL INFORMATION: Clinical Trials.Gov: The Treatment of Insomnia in Patients with HIV Disease. Registry Number: NCT00465972. URL: http://www.clinicaltrials.gov/ct2/show/NCT00465972?term = HIV+insomnia&rank = 1.

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References

1960A RATING SCALE FOR DEPRESSION 2002The validity of the Hospital Anxiety and Depression Scale 2001Validation of the Insomnia Severity Index as an outcome measure for insomnia research 2007Insomnia: Definition, Prevalence, Etiology, and Consequences 2002NREM Sleep EEG Frequency Spectral Correlates of Sleep Complaints in Primary Insomnia Subtypes 2007Nightly Treatment of Primary Insomnia With Eszopiclone for Six Months: Effect on Sleep, Quality of Life, and Work Limitations 1997Fatigue and sleep disorders 1998High Prevalence of Insomnia in an Outpatient Population With HIV Infection

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2016Brief Behavioral Treatment for Insomnia in Persons Living with HIV

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