IMPACT OF HIV, AIR POLLUTION AND RESPIRATORY SYMPTOMS ON SLEEP IN KENYAN ADOLESCENTS

Sleep plays a critical role in brain development and quality of life in adolescents. While HIV is linked to increased risk of poor sleep quality and sleep- disordered breathing in adults, the impact on adolescent sleep is largely unexamined. Ambient air pollution is associated with higher rates of habitual snoring and poor sleep quality in children and adolescents in urban areas. We explored the relationship of HIV, indoor air pollution and daytime respiratory symptoms with sleep-related outcomes in Kenyan adolescents. We analyzed standardized questionnaire data from 266 participants in the longitudinal BREATHE II Study which examines the impact of HIV and indoor air pollution on the respiratory status of adolescents (10-19 years old) in Nairobi, Kenya. Using logistic regression, we evaluated if HIV status, CD4<200 in HIV+, indoor combustible fuel use, secondhand smoke exposure, and daytime respiratory symptoms (breathlessness, chest tightness, phlegm, wheezing) were associated with reports of poor sleep, poor energy, nighttime wheezing and nighttime cough. Among 167 HIV+ and 99 HIV- adolescents, median age was 14 years and 49% were male. Although we detected no significant associations between HIV status and sleep symptoms, among HIV+ participants, CD4<200 was associated with nighttime cough (OR 3.42 (1.09-10.7)) and poor sleep (OR 5.6 (1.48-21.2)). In the overall cohort, associations (p<0.05) included: greater hours/week of indoor kerosene use with poor sleep (OR 1.05 (1.01-1.08)); secondhand smoke exposure with nighttime cough (OR 2.11 (1.13-3.93) and poor energy (OR 2.00 (1.09-3.62). Daytime respiratory symptoms were associated with sleep-related respiratory symptoms. Among HIV+ adolescents, CD4<200 is associated with poor sleep and nighttime cough. Overall, exposure to secondhand smoke and kerosene combustion products is associated with poor sleep, poor energy, and nighttime cough. Daytime respiratory symptoms may represent clinical findings that could inform detection of poor sleep quality among adolescents in resource-constrained settings. Additional investigation using validated sleep questionnaires is needed to better understand the impact of indoor air pollution, HIV and other exposures on the sleep of adolescents in this setting. K23HL129888