Sleep alterations in patients with the human immunodeficiency virus and chronic pain

Aguiar, Glória Pinto Soares de; Dussán-Sarria, Jairo Alberto; Souza, Andressa de

doi:10.5935/2595-0118.20190023

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ORIGINAL ARTICLE • BrJP 2 (2) • Apr-Jun 2019 • https://doi.org/10.5935/2595-0118.20190023 copy

Sleep alterations in patients with the human immunodeficiency virus and chronic pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

In patients with chronic pain, insomnia is reported between 50 and 88% of them. It is essential to recognize sleep disorders to estimate its repercussions on the quality of life and to seek knowledge that supports the necessary interventions. This study aims to identify the possible factors that influence sleep quality, as well as its prevalence in these patients.

METHODS:

Sample consisting of 68 patients (58 women, 10 men), the mean age of 45.3±10.3 years, with a positive diagnosis of human immunodeficiency virus undergoing antiretroviral and chronic pain treatment in Porto Alegre, RS. The Pittsburgh Sleep Quality Index was used to assess the components of the scale as well as their overall score. For the classification of the type of chronic pain, the Leeds Assessment of Neuropathic Symptoms and Signs scale was used, which differentiates nociceptive and neuropathic pain.

RESULTS:

Patients classified with no pain, nociceptive pain and neuropathic pain. Overall score divided into good sleep, bad sleep and sleep disorder, where patients without pain accounted for 8.8%, 16.2 and 2.9% respectively. With nociceptive pain 4.4, 11.8 and 5.9%, respectively. With neuropathic pain 4.4, 23.5 and 22.1% respectively. Patients with neuropathic pain had the highest rates of poor sleep and sleep disorder, accounting for 50.0% and using more sleeping pills compared to the control group (p<0.05).

CONCLUSION:

There is a high prevalence of sleep disorders or poor sleep in patients with the human immunodeficiency virus with neuropathic pain. The importance of assessing the sleep as an essential part of the clinical assessment should be recognized and incorporated without delay by health professionals.

Keywords:
Chronic pain; Human immunodeficiency virus; Nursing; Sleep

Variables		Frequency	%
Gender	Male	10	14.7
Gender	Female	58	85.3
Age (years)	Between 35 and 55	46	67.7
	More than 55	13	19.1
	Less than 35	9	13.2
Housing	Living alone	15	22.0
	Living with family	49	72.0
	Other types of housing	4	6.0
Schooling	Mean years of study	5.9
Schooling	Median years of study	5
Professional work	Active	14	21.0
	Unemployed	27	40.0
	Social allowance	25	37.0
Viral load	Undetectable	31	45.6
	Not informed	3	4.4
	Detectable	34	50.0
Use of Efavirenz	Using	17	25.0
Use of Efavirenz	Not using	51	75.0

Variables	Characteristics	Control (No pain)	Nociceptive pain	Neuropathic pain	Total	p-value
Gender	Female	13 (19.1%)	13 (19.1%)	32 (47.1%)	58 (85.3%)	0.033^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
Gender	Male	6 (8.8%)	2 (2.9%)	2 (2.9%)	10 (14.7%)
Age (years) ^# # variable shown as mean±SD of the mean.	-	45.83±9.53	44.93±11.23	44.50±10.48	-	0.838^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
Education (years) ^# # variable shown as mean±SD of the mean.	-	6.94±3.37	4.93±2.67	5.78±2.90	-	0.122^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
Smoking	Yes	4 (6.1%)	4 (6.1%)	11 (16.7%)	19 (28.8%)	0.938^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
	No	12 (18.2%)	10 (15.2%)	22 (33.3%)	44 (66.7%)
	Not informed	1 (1.5%)	1 (1.5%)	1 (1.5%)	3 (4.5%)
Alcohol consumption	Yes	7 (10.6%)	5 (7.6%)	12 (18.2%)	24 (36.4%)	0.096^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
	No	8 (12.1%)	7 (10.6%)	22 (33.3%)	37 (56.1%)
	Not informed	2 (3%)	3 (4.5%)	0 (0.0%)	5 (7.6%)
Viral load	Detectable	8 (11.8%)	10 (14.7%)	16 (23.5%)	34 (50%)	0.138^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
	Undetectable	9 (13.2%)	4 (5.9%)	18 (26.5%)	31 (45.6%)
	No information	2 (2.9%)	1 (1.5%)	0 (0%)	3 (4.4%)
Use of Efavirenz	Yes	7 (10.3%)	3 (4.4%)	7 (10.3%)	17 (25%)	0.409^* * Exact Fisher and Kruskal-Wallis tests. p<0.05 was considered a significant difference.
Use of Efavirenz	No	12 (17.6%)	12 (17.6%)	27 (39.7%)	51 (75%)

Usual sleep characteristics	Control (no pain)			Nociceptive pain			Neuropathic pain			p-value
Usual sleep characteristics	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median	p-value
Time to go to bed	23.000	1.452	23.000	22.666	2.160	22.000	23.029	1.678	23.000	0.701^* * Kruskal Wallis test.
Latency (minutes)	43.421	65.448	15.000	57.400	61.719	30.000	51.323	48.073	30.000	0.218^* * Kruskal Wallis test.
Wake-up time	7.105	1.696	7.000	6.933	1.944	7.000	7.088	1.896	7.000	0.820^* * Kruskal Wallis test.
Sleep duration (hours)	7.111	1.449	7.000	7.400	1.993	8.000	6.650	2.281	6.000	0.225^* * Kruskal Wallis test.
Usual sleep efficiency
>85%	12 (17.6%)			8 (11.8%)			15 (22.1%)			0.336^# # Fisher's Exact test; p<0.05 was considered a significant difference.
75 to 84%	3 (4.4%)			3 (4.4%)			7 (10.3%)
65 to 74%	2 (2.9%)			0 (0.0%)			8 (11.8%)
<65%	2 (2.9%)			4 (5.9%)			4 (5.9%)
Total	19 (27.9%)			15 (22.1%)			34 (50.0%)

PSQI-BR components	Control (no pain)			Nociceptive pain			Neuropathic pain			p-value
	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median	p-value
Subjective sleep quality	1.500	0.730	1.000	1.500	0.650	1.000	1.727	0.801	2.000	0.529^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Sleep latency	1.263	1.284	1.000	1.666	1.234	2.000	1.970	1.086	2.000	0.148^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Sleep duration	0.736	0.933	0.000	0.866	1.125	0.000	1.294	1.268	1.000	0.276^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Sleep efficiency	0.684	1.056	0.000	1.000	1.309	0.000	1.029	1.086	1.000	0.477^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Sleep disorders	1.578	0.507	2.000	2.000	0.755	2.000	1.911	0.621	2.000	0.119^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Sleeping pills	0.157	0.688	0.000	1.000	1.463	0.000	1.058	1.412	0.000	0.038^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Daytime sleepiness	0.894	0.936	1.000	0.866	0.743	1.000	1.323	1.000	1.006	0.192^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
Overall score (%)
Good sleep	6 (8.8%)			3 (4.4%)			3 (4.4%)			0.059^# # Fisher's Exact test;
Poor sleep	11 (16.2%)			8 (11.8%)			16 (23.5%)
Sleep disorder	2 (2.9%)			4 (5.9%)			15 (22.1%)
Total	19 (27.9%)			15 (22.1%)			34 (50.0%)			0.059

Variables	Occurrence	Control (no pain)	Nociceptive pain	Neuropathic pain	p-value
Cough or snore very loud	Never	13 (19.1%)	9 (13.2%)	15 (22.1%)	0.592^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	1 (1.5%)	1 (1.5%)
	Once-twice a week	2 (2.9%)	2 (2.9%)	6 (8.8%)
	3 times/week or more	3 (4.4%)	4 (4.4%)	12 (17.6%)
Take more than 30 minutes to fall asleep	Never	7 (10.3%)	4 (5.9%)	8 (11.8%)	0.647^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	2 (2.9%)	2 (2.9%)	1 (1.5%)
	Once-twice a week	3 (4.4%)	3 (4.4%)	6 (8.8%)
	3 times/week or more	7 (10.3%)	6 (8.8%)	19 (27.9%)
Get up to go to the bathroom	Never	2 (2.9%)	3 (4.4%)	4 (5.9%)	0.694^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	0 (0.0%)	1 (1.5%)
	Once-twice a week	4 (5.9%)	1 (1.5%)	9 (13.2%)
	3 times/week or more	12 (17.6%)	11 (16.2%)	20 (29.4%)
Waking up in the middle of the night or early morning	Never	5 (7.4%)	1 (1.5%)	2 (2.9%)	0.114^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	0 (0.0%)	6 (8.8%)
	Once-twice a week	5 (7.4%)	2 (2.9%)	7 (10.3%)
	3 times/week or more	8 (11.8%)	12 (17.6%)	19 (27.9%)
Difficult breathing	Never	14 (20.6%)	9 (13.2%)	23 (33.9%)	0.928^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	2 (2.9%)	1 (1.5%)
	Once-twice a week	2 (2.9%)	2 (2.9%)	6 (8.8%)
	3 times/week or more	2 (2.9%)	2 (2.9%)	4 (5.9%)
Feel very cold	Never	12 (17.6%)	4 (5.9%)	15 (22.1%)	0.504^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	2 (2.9%)	2 (2.9%)
	Once-twice a week	3 (4.4%)	4 (5.9%)	7 (10.3%)
	3 times/week or more	3 (4.4%)	5 (7.4%)	10 (14.7%)
To feel very hot	Never	11 (16.2%)	3 (4.4%)	15 (22.1%)	0.088^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	2 (2.9%)	5 (7.4%)	2 (2.9%)
	Once-twice a week	4 (5.9%)	3 (4.4%)	6 (8.8%)
	3 times/week or more	2 (2.9%)	4 (5.9%)	11 (16.2%)
Have bad dreams or nightmares	Never	15 (22.1%)	7 (10.3%)	13 (19.1%)	0.051^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	4 (5.9%)	4 (5.9%)
	Once-twice a week	2 (2.9%)	3 (4.4%)	7 (10.3%)
	3 times/week or more	1 (1.5%)	1 (1.5%)	10 (14.7%)
To feel pain	Never	15 (22.1%)	8 (11.8%)	12 (17.6%)	0.007^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	0 (0.0%)	1 (1.5%)	2 (2.9%)
	Once-twice a week	4 (5.9%)	2 (2.9%)	6 (8.8%)
	3 times/week or more	0 (0.0%)	4 (5.9%)	14 (20%)
Other reasons	Never	14 (20.5%)	9 (13.2%)	21 (30.8%)	0.668^* * Kruskal-Wallis test; p<0.05 was considered a significant difference.
	Less than once a week	1 (1.5%)	1 (1.5%)	0 (0.0%)
	Once-twice a week	2 (2.9%)	1 (1.5%)	5 (7.4%)
	3 times/week or more	2 (2.9%)	4 (5.9%)	8 (11.8%)

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[1] Correspondence to: Av. Victor Barreto, 2288, Prédio 7, 92010-000 Canoas, RS, Brasil. E-mail: andressasz@gmail.com