# Prevalence of sleep apnea and sleepiness in adults with and without HIV in Mwanza, Tanzania: Baseline results from an ongoing cohort study

## TL;DR

This study found similar rates of sleep apnea in adults with and without HIV in Tanzania, but higher daytime sleepiness in those without HIV.

## Contribution

The study is the first to compare sleep apnea and sleepiness in HIV-positive and HIV-negative adults in Tanzania.

## Key findings

- Sleep apnea prevalence was 17% in people with HIV and 19% in those without.
- Excessive daytime sleepiness was higher in people without HIV (21%) compared to those with HIV (13%).
- Risk factors for sleep apnea included obesity, older age, and hypertension.

## Abstract

We conducted a cross-sectional analysis of the baseline survey of participants aged >30 years enrolled in the Mwanza HIV&CVD Cohort in Tanzania. Our primary objective was to examine the association between HIV status and sleep apnea (SA). Secondary objectives were (1) to examine the association between HIV status and excessive daytime sleepiness (EDS) and (2) to identify risk factors associated with SA and with EDS. The cohort enrolled 500 people living with HIV (PLWH) and 500 people without HIV (PWoH) in 2021–2023. Participants completed overnight oximetry; SA was defined as an oxygen desaturation index (ODI) of ≥5 events/hour. EDS was defined as an Epworth Sleepiness Scale score (ESS) of ≥11. The median age was 46 and 43 in PLWH and PWoH, respectively. The prevalence of sleep apnea was similar between PLWH and PWoH (17% and 19%, respectively; adjusted odds ratio (aOR)=0.84. 95% confidence interval (CI)=0.60–1.17). In contrast, the prevalence of EDS (ESS score ≥ 11) was higher in PWoH (21%) than PLWH (13%) (aOR=0.58, 95%CI=0.41–0.83). In a multivariable model, factors associated with SA were older age, alcohol use, higher BMI category, hypertension and depression. Both objectively measured SA and subjectively reported EDS are common in Tanzanian adults. SA was strongly associated with overweight or obesity, suggesting that the prevalence of SA will grow with projected increases in age and obesity rates in Tanzania.