Insomnia symptoms and biomarkers of monocyte activation, systemic inflammation, and coagulation in HIV: Veterans Aging Cohort Study

• Type of Material: Article
• Authors: Brittanny M. Polanka, Johns Hopkins University; Suman Kundu, Vanderbilt University; Kaku A. So-Armah, Boston University; Matthew S. Freiberg, Vanderbilt University; Samir K. Gupta, Indiana University; Tamika C. B. Zapolski, Indiana University; Adam T. Hirsh, Indiana University; Roger J. Bedimo, VA North Texas Healthcare System; Matthew J. Budoff, Lundquist Institute; Adeel A. Butt, VA Pittsburgh Healthcare System; Chung-Chou. H. Chang, University of Pittsburgh; Stephen S. Gottlieb, University of Maryland; Vincent Marconi, Emory University; Julie A. Womack, VA Connecticut Healthcare System; Jesse C. Stewart, Indiana University
• Language: English
• Date: 2021-02-09
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
• License: Creative Commons Attribution 1.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0246073
• Title of Journal or Parent Work: PLoS One
• Volume: 16
• Issue: 2
• Start Page: e0246073
• End Page: e0246073
• Grant/Funding Information: This analysis was funded by grant R01HL126557 from the National Heart, Lung, and Blood Institute/National Institutes of Health awarded to MF, SG, and JS.; The Veterans Aging Cohort Study was funded by grant U10AA13566 from the National Institute on Alcohol Abuse and Alcoholism and Veterans Health Administration Public Health Strategic Health Core Group.
• Keywords: D-Dimer; Altered coagulation; Science & Technology; Metaanalysis; Cardiovascular disease; Antiretroviral therapy; Physical activity; Science & Technology - Other Topics; Risk; Sleep disturbances; People; Severity index; Multidisciplinary Sciences
• Research Categories: Health Sciences, Immunology; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Background Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated. Methods We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, “Difficulty falling or staying asleep?,” with the following response options: “I do not have this symptom” or “I have this symptom and…” “it doesn’t bother me,” “it bothers me a little,” “it bothers me,” “it bothers me a lot.” Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (CI). Results We observed no significant associations between insomnia symptoms and sCD14 or IL-6. For D-dimer, veterans in the “Bothers a Lot” group had, on average, 17% higher D-dimer than veterans in the “No Difficulty Falling or Staying Asleep” group in the demographic-adjusted model (exp[b] = 1.17, 95%CI = 1.01–1.37, p = .04). This association was nonsignificant in the fully-adjusted model (exp[b] = 1.09, 95%CI = 0.94–1.26, p = .27). Conclusion We observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.