OBSTRUCTIVE SLEEP-APNEA IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS(HIV) DISEASE

Adenotonsillar hypertrophy has been identified as an early manifestati on of human immunodeficiency virus (HIV) disease. Three patients with HIV disease were identified with obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy. In order to examine the relationship betwe en HIV-induced adenotonsillar hypertrophy and OSA, 134 patients with a symptomatic HIV disease were screened with a self-administered sleep s urvey designed to detect OSA and excessive daytime somnolence. Patient s meeting trigger score criteria were studied with overnight polysomno graphy and nine additional patients were identified with OSA. The only consistent risk factor for OSA in this young and primarily nonobese p opulation was the presence of adenotonsillar hypertrophy, found in 11 of 12 patients with OSA. Three patients had tonsillar biopsy or tonsil lectomy and all displayed benign follicular lymphoid hyperplasia. Scor es on the Epworth Sleepiness Scale (ESS) were significantly higher for patients with OSA, indicating a greater degree of hypersomnolence (me an ESS scores: OSA + = 11.4 +/- 3.6, OSA- = 7.8 +/- 4.6, p = 0.012). I n our population, patients with HIV disease had a prevalence of OSA of 7%. HIV-induced adenotonsillar hypertrophy is a risk factor for the d evelopment of OSA. HIV patients with complaints of excessive daytime s leepiness and snoring who are found to have adenotonsillar hypertrophy on exam should undergo a sleep evaluation to rule out the presence of OSA.