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Treating sleep apnea in people with HIV

Some people with HIV, even those with a suppressed viral load, report persistent issues with sleep. When people do not have restful sleep, they can feel tired and sleepy during the daytime. Cases of persistent sleeping problems require consultation with a healthcare professional so that they can be investigated.

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One issue that can cause people to feel tired upon awakening is disordered breathing—sleep apnea. During sleep apnea, the throat partially or wholly closes for a short time. This results in a low level or even lack of oxygen to the lungs, which can interrupt sleep and cause snoring.

Over the medium and long term, sleep apnea can have other consequences, including the following:

  • reduced flow of oxygen from the lungs to the tissues
  • a buildup of carbon dioxide in the lungs
  • headaches
  • severe fatigue
  • memory problems

Some studies in people without HIV have found a link between an increased risk for cardiovascular disease and diabetes and the presence of sleep apnea. There is not comparatively as much research on sleep apnea in people with HIV.

Sleep apnea can be diagnosed when doctors request a sleep study evaluation. In the evaluation, patients spend the night in a sleep clinic with sensors affixed to their body. The sensors can reveal the presence or absence of breathing problems.

In San Diego

A team of researchers at the University of California, San Diego campus conducted a study assessing participants for sleep apnea and, when diagnosed, offering treatment with a small machine that delivers a constant flow of air to the mouth/nose via a tube and mask. 

Researchers enrolled 120 participants, all of whom were on HIV treatment (antiretroviral therapy; ART) and had a suppressed viral load (researchers defined viral suppression as a viral load less than 200 copies/mL). Participants were in their 50s and had not previously been diagnosed with sleep apnea. 

According to the researchers, 41 out of 70 participants diagnosed with sleep apnea chose to be treated with a small machine that supplied a continuous flow of air; it is called a CPAP machine (continuous positive airway pressure). The researchers did not provide information as to why not everyone with sleep apnea was treated. However, outside of studies, anecdotal information suggests that some people (without HIV) who are diagnosed with sleep apnea choose to not accept treatment or persevere with treatment because they find wearing the mask that supplies air uncomfortable.

At any rate, in the present study, even among the 41 out of 70 (59%) people who were treated for sleep apnea, interviews revealed that only 60% of these people used the CPAP machine for at least four hours per night.

Over the course of three months (the length of the study), researchers found that the use of CPAP was associated with significant decreases in fatigue (a common symptom of persistent sleep apnea). In addition, they found that cardiovascular health improved (similar in magnitude to what is seen in people without HIV who are treated for sleep apnea) when they assessed changes in the flow of blood. There was no appreciable change in blood pressure during the study.

Bear in mind

The study enrolled a small number of people and was of relatively short duration. It did not have a comparison group of people without HIV. Longer studies are needed to determine the long-term impact of treating sleep apnea. Although standard therapy is CPAP, emerging research suggests that a new class of medicines called GLP-1 agonists (glucagon-like peptide-1 receptor agonists), such as tirzepatide (Mounjaro), could be used to help treat sleep apnea in some people. 

Some people with sleep apnea are also overweight, obese and/or have diabetes. This is why GLP-1 agonists may be able to help them. 

—Sean R. Hosein

REFERENCES:

  1. Berry DL, Orr JE, Schmickl CN, et al. Effects of treating obstructive sleep apnea on common symptoms of HIV. JAIDS. 2025 Aug 26; in press.
  2. Cowie MR, Linz D, Redline S, et al. Sleep disordered breathing and cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology. 2021 Aug 10;78(6):608-624. 
  3. Tasali E, Pamidi S, Covassin N, et al. Obstructive sleep apnea and cardiometabolic disease: Obesity, hypertension, and diabetes. Circulation Research. 2025 Aug 15;137(5):764-787. 
  4. Alharbi AM, Alotaibi N, Uysal ÖF, et al. Cognitive outcomes in chronic obstructive pulmonary disease (COPD)/OSA overlap syndrome compared to obstructive sleep apnea (OSA) alone: a systematic review. Sleep and Breathing. 2025 Sep 1;29(5):275. 
  5. Trzepizur W, Boursier J, Poilane J, et al. Association between obstructive sleep apnoea and liver fibrosis in patients with suspected nonalcoholic fatty liver disease. Sleep. 2025; in press.
  6. D’Annibale DA, Mimoto M, McCowen KC, et al. Glucagon-like peptide-1 receptor agonists for the treatment of obstructive sleep apnea. Current Opinion in Pulmonary Medicine. 2025; in press.
  7. Henney AE, Riley DR, Anson M, et al. Comparative efficacy of tirzepatide, liraglutide, and semaglutide in reduction of risk of major adverse cardiovascular events in patients with obstructive sleep apnea and type 2 diabetes: Real-world evidence. Annals of the American Thoracic Society. 2025 Jul;22(7):1042-1052.