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J Res Med Sci. 2019 Jul 24;24:65. doi: 10.4103/jrms.JRMS_892_17. eCollection 2019.

Effect of the duration of protease inhibitor therapy in HIV-infected individuals on the severity of obstructive sleep apnea.

Author information

Department of Pulmonary, Mercy Hospital, Fort Smith, AR 72903, USA.
Department of Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
Department of Internal Medicine, Mercy Hospital, Fort Smith, AR 72903, USA.
Department of Internal Medicine, Saint Michael's Medical Center, Newark, NJ, USA.
Department of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ, USA.
Department of Pulmonary Medicine, Saint Michael's Medical Center, Newark, NJ, USA.



Protease inhibitors (PIs) are a vital part of the antiretroviral therapy. Long-term use of PIs may cause lipodystrophy, a clinical syndrome characterized by peripheral lipoatrophy and central fat accumulation, which may increase the risk of developing obstructive sleep apnea (OSA) in HIV-infected patients. We hypothesize that a longer duration of PIs' use might be associated with increasing severity of OSA in HIV-infected patients.

Materials and Methods:

This was a retrospective cohort study of HIV-infected patients who were treated with PIs, who presented with symptoms suggestive of OSA, and underwent nocturnal polysomnography. The primary objective of the study is to evaluate the association between the duration of PIs' use and the severity of OSA. The duration of PIs' use measured in months was recorded for each patient. The primary outcome of interest was the apnea-hypopnea index (AHI) obtained at the time of the sleep study. Data were analyzed using univariate and multivariate linear regression between AHIs with PIs' use as well as other predictors.


A total of 54 patients diagnosed with HIV and OSA were included in the study cohort for the analysis. Sleep study body mass index (BMI; P = 0.042) and change in BMI (ΔBMI; P = 0.027) were the only statistically significant independent predictors of AHI. The association between AHI and PIs' use duration was found to be nonlinear and nonsignificant. Gender differences evaluation suggested possible duration-related effect relationship between PIs and OSA severity among HIV-infected men exposed to PIs within a 66-month duration.


We did not observe a significant association between PIs' use duration and the severity of OSA.


HIV; lipodystrophy; obstructive sleep apnea; protease inhibitors

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