Daytime Sleep Behaviors and Cognitive Performance in Middle- to Older-Aged Adults Living with and without HIV Infection

Abstract

Purpose

We investigated whether daytime sleep behaviors (DSBs) such as frequent daytime sleepiness or napping are associated with worse cognitive performance, and whether HIV infection moderates this relationship.

Methods

Among 502,507 participants in the UK Biobank study, we identified 562 people living with HIV infection (PLWH; M_age= 50.51±7.81; 25.09% female; 78.83% white) and extracted 562 uninfected controls who matched on age, sex, ethnic background, social-economic status, and comorbidities. DSB burden was assessed based on answers to two questions on DSBs. Participants who answered “sometimes” or “often/usually” to one of them were considered to have poor DSB burden, or otherwise were considered not having any. A composite cognition score was computed by averaging the available standardized individual test results from four neurocognitive tests: ie, a reaction time test for information processing speed, a pairs matching test for visual episodic memory, a fluid intelligence test for reasoning, and a prospective memory test. Mixed-effects models with adjustment for the variables used in extracting matched uninfected controls were performed to test the hypotheses.

Results

Having poor DSB burden was associated with a 0.15 – standard deviation (SD) decrease in cognitive performance (p = 0.006). People living with HIV infection (PLWH) also performed worse on the cognitive tasks than uninfected controls, with an effect size similar to that of having poor DSB burden (p = 0.003). HIV infection significantly modified the negative association between DSB burden and cognition (p for interaction: 0.008). Specifically, the association between DSB burden and cognition was not statistically significant in uninfected controls, whereas PLWH who reported having poor DSB burden had a 0.28 – SD decrease in cognitive performance compared to PLWH who did not.

Conclusion

HIV infection significantly increased the adverse association between DSBs and cognitive performance. Further studies are needed to investigate the potential mechanisms that underlie this interaction effect and whether poor DSBs and worse cognitive performance are causally linked.

Keywords:

• aging
• cognition
• daytime napping
• daytime sleepiness
• risk factors
• sleep

Abbreviations

ART, antiretroviral therapy; CI, confidence interval; DSB, daytime sleep behavior; FI, fluid intelligence; HIV, human immunodeficiency virus; ICD-10, International Classification of Disease version 10; PLWH, people living with HIV; PM, prospective memory; PT, pairs matching test; PS, propensity score; RT, reaction time; SD, standard deviation; TDI, Townsend deprivation index.

Acknowledgments

This research has been conducted using the UK Biobank Resource under Application Number 33883.

Disclosure

Dr Peng Li reports grants from Harvard University Center for AIDS Research, grants from HIV and Aging Research Consortium, grants from The BrightFocus Foundation, during the conduct of the study.

Dr Robert A Parker reports grants from NIH, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research was funded in part by a 2021 developmental grant (to P.L.) from the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30AI060354) which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIMHD, NIDCR, NINR, OAR, and FIC, by a Pilot Grant (to P.L.) sponsored by the AIDS and Aging Research Platform (NIH R33AG067069-02), and in part by NIA grants (RF1AG064312 and RF1AG059867; to K.H.). P.L. is also supported by the BrightFocus Foundation Alzheimer’s Disease Research Program (A2020886S). L.G. is also supported by the National Institute on Aging (NIA) grant (R03AG067985). R.A.P. is supported by the CFAR grant (P30AI060354). M.A.M. is supported by the CFAR grant (P30AI060354) and the Pepper Center, an NIA funded program (P30AG031679). K.H. is supported by NIA grants (RF1AG064312 and RF1AG059867).