Abstract
Background: The Pittsburgh Sleep Quality Index (PSQI) has been a widely used instrument measuring sleep quality among people living with HIV (PLWH) in China while its psychometric properties have yet to be examined in this population. We aimed to assess the reliability and validity of the Chinese version of PSQI in PLWH and identify factors associated with sleep quality.Methods: This study was based on a longitudinal study of newly diagnosed PLWH, among whom the PSQI was used to measure sleep quality 5 years after HIV diagnosis (n = 386). To evaluate internal consistency, Cronbach's alpha and corrected item-total correlation were calculated. To assess construct validity, Pearson's correlation coefficients were calculated between PSQI scores and depression, anxiety, stress, and health-related quality of life (HRQoL). Known group validity was evaluated by comparing PSQI scores between participants with probable depression and those without. Binary logistic regression was conducted to identify factors associated with sleep disturbances.Results: The internal consistency Cronbach's alpha for the Chinese version of PSQI in PLWH was 0.713. Construct validity was established by significant relationships between PSQI and depression, anxiety, stress, and HRQoL. The PSQI scores in participants with probable depression were significantly higher than those without, indicating good known-group validity. Sleep disturbances were associated with less income, higher CD4 counts, antiretroviral treatment (ART) initiation, exercise, depression, and higher stress levels.Conclusions: The Chinese version of PSQI is feasible for use among Chinese PLWH. Over a third of PLWH reported sleep disturbances. More attention should be given to individuals with less income and on ART. Intervention aimed at improving mental health or facilitating exercise may improve sleep quality.
Highlights
Receiving diagnosis of HIV infection is considered as an extremely stressful experience for most individuals, accompanied with considerable stressors such as stigma, disclosure, emotional distress, medication side effects, and declines in physical function [1, 2], which are known to be strong predictors of sleep disturbances among people living with HIV (PLWH) [3, 4]
A meta-analysis estimating the prevalence of self-reported sleep disturbances among PLWH found that approximately more than half of PLWH report sleep disturbances after diagnosis [5], while PLWH complaining of poor sleep quality have been shown to be less likely to adhere to recommended treatment and more likely to suffer multiple mental disorders [6, 7], which may negatively impact the immune and virologic responses [8], leading to treatment failure [9] and, influencing the quality of life in this population [10]
Factors Associated With Sleep Quality in PLWH In the multivariate regression analysis, we found participants with less income (p = 0.002), CD4 >350 cells/mm3 (p = 0.024), antiretroviral treatment (ART) initiation (p = 0.047), exercise behavior (p = 0.008), depressive symptoms (p = 0.006), and higher stress levels (p = 0.032) were more likely to experience sleep disturbances (Table 5)
Summary
Receiving diagnosis of HIV infection is considered as an extremely stressful experience for most individuals, accompanied with considerable stressors such as stigma, disclosure, emotional distress, medication side effects, and declines in physical function [1, 2], which are known to be strong predictors of sleep disturbances among people living with HIV (PLWH) [3, 4]. Sleep quality is evaluated either by self-reported or interviewerrated scales or objective measures (such as polysomnography and actigraphy) [11]. Of the different measures on sleep quality, the Pittsburgh Sleep Quality Index (PSQI) is the most widely used [5]. The Chinese version of the PQSI was translated in 1996 by Liu et al and have been subsequently examined in different populations including the civil servants, college students, and rural elderly [13], all indicating the Chinese version PSQI is a reliable and valid instrument for evaluating sleep quality [14,15,16]. The Pittsburgh Sleep Quality Index (PSQI) has been a widely used instrument measuring sleep quality among people living with HIV (PLWH) in China while its psychometric properties have yet to be examined in this population. We aimed to assess the reliability and validity of the Chinese version of PSQI in PLWH and identify factors associated with sleep quality
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