Exploring the Link Among Sleep Disorders, Chronic Inflammation and Heart Disease Risk in Patients with HIV

Innovations in Pulmonology, Critical Care & Sleep Medicine | Fall 2024

Sleep disorders such as obstructive sleep apnea (OSA) and insufficient sleep are extremely common in people with HIV and are associated with a greater risk of developing heart disease. Priya Borker, MD, pulmonology and sleep medicine specialist at University Hospitals Cleveland Medical Center, is studying the link between sleep health and monocyte dysregulation to discern how sleep affects immune function and may contribute to cardiovascular risk. 

Priya Borker, MD

“People with HIV are an interesting cohort to research because up to 70 percent of this population reports some sort of sleep complaint, whether that is insomnia, obstructive sleep apnea or insufficient sleep,” Dr. Borker says. “These individuals are also at greater risk than the general population for comorbidities, probably due to a baseline level of abnormal inflammation.”

Dr. Borker recently returned to Cleveland a decade after graduating from Case Western Reserve University School of Medicine. She is fellowship-trained in internal medicine, sleep medicine and pulmonary/critical care medicine and comes to UH Cleveland Medical Center from the University of Pittsburgh Medical Center (UPMC).

“I knew I loved the culture and people here and wanted sleep medicine to be my primary interest,” she says. “University Hospitals has leading experts conducting a tremendous amount of high-quality research in both sleep medicine and HIV/infectious disease.”

Case Western Reserve University also partners with the University of Pittsburgh to form the National Institutes of Health (NIH)-sponsored Center for Aids Research (Rustbelt CFAR). The collaboration promotes interdisciplinary basic and clinical research in HIV infection and AIDS.

Targeting Monocytes

Through an NIH K23 award, Dr. Borker is working to understand how sleep contributes to inflammation in HIV and how that chronic inflammation may contribute to risk profiles.

“There are strong signals that disordered sleep is associated with a greater risk of cardiovascular disease, stroke and early death, but the biological basis is not yet known,” she says. “We are asking whether sleep disorders in a background of chronic inflammation increase the risk of cardiovascular disease in this cohort.”

Monocytes are an element of the innate immune system patrolling the human body for areas of infection or damage. When monocytes become activated, they release inflammatory cytokines and other substances that help recruit other cells to the area of damage, Dr. Borker says. “There has been some research that suggests that people with HIV have ongoing monocyte dysregulation, which may increase their risk of cardiovascular disease.” 

In 2022, Dr. Borker and Sanjay R. Patel, MD, MS, her mentor at UPMC, wrote an editorial in the American Journal of Respiratory and Critical Care Medicine discussing monocyte activation and the link between OSA and cardiovascular disease. At UH Cleveland Medical Center, she hopes to expand on preliminary findings that indicate OSA or sleep deprivation may exacerbate the production of inflammatory monocytes. Utilizing a multidimensional construct that considers several dimensions of sleep disturbance, she is assessing whether there is worsening monocyte activation in people with HIV-related poor sleep health and following sleep deprivation. 

Studying OSA treatment in patients with HIV

A clinical study starting in 2025 will look at monocyte activation in patients with HIV before and after initiation of continuous positive airway pressure (CPAP) treatment for OSA. “We would like to capture people before they start treatment and ask them to undergo a standardized sleep study and blood draw,” Dr. Borker says. After four to six weeks of CPAP use, trial participants will return for repeat sleep studies and blood draws. 

While patients will receive their CPAP machine and mask through their sleep medicine provider, Dr. Borker will offer one-on-one motivational interview sessions to see if individuals are responding well and help them make treatment adjustments. She plans to begin recruiting patients in the new year, with an enrollment target of at least 30 participants. 

“The nice thing about sleep medicine is that it works very well to see patients virtually,” Dr. Borker says. “If providers have patients they would like to refer to a sleep specialist, we are more than willing to see those patients — even if they can't easily travel to University Hospitals.”

For more information or to refer a patient, contact Dr. Borker at Priya.Borker@UHhospitals.org.

Contributing Expert:
Priya Borker, MD
Division of Pulmonology, Critical Care and Sleep Medicine
University Hospitals Cleveland Medical Center
Clinical Assistant Professor of Medicine
Case Western Reserve University School of Medicine