Abstract
This study evaluated the prevalence and factors associated with sleep disturbance in a large cohort of HIV-infected patients across China. A cross-sectional study was conducted among HIV-infected patients on antiretroviral therapy at 20 AIDS clinics. The Pittsburgh Sleep Quality Index was self-administered by subjects. Socio-demographic characteristics, medical history and HIV-related clinical data were collected. 4103 patients had complete data for analysis. Sleep disturbances were observed in 43.1% of patients. Associated factors in multivariable analysis included psychological factors: anxiety (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.44–4.00; P < 0.001), depression (OR, 2.09; 95% CI, 1.70–2.57; P < 0.001), and both anxiety and depression (OR, 5.90; 95% CI, 4.86–7.16; P < 0.001); sociodemographic factors: MSM (OR, 1.26; 95% CI, 1.04–1.52; P = 0.018), being single (OR, 1.45; 95%CI 1.21–1.74; P < 0.001), higher education (OR, 1.25; 95% CI, 1.03–1.53; P = 0.025); and clinical factors: suboptimal adherence (OR,1.51; 95% CI,1.23–1.85; P < 0.001), regimen-switching (OR, 1.94; 95% CI, 1.12–3.35; P = 0.018), and antidepressant use (OR, 1.98; 95% CI, 1.47–2.67; P = 0.044). Prevalence of sleep disturbance is high in this large Chinese cohort. Associated factors appear related to psychological and social-demographic factors. Health workers may consider routinely assessing sleep disturbances among HIV-infected patients, especially in the first three months after HIV diagnosis, and referring for mental health services, which may positively impact adherence to treatment.
Highlights
HIV-infected individuals appear to be more vulnerable to sleep disturbances than the general population[1,2,3,4]
Over 40% (43.1%, 95% confidence interval [CI], 41.5%–44.7%) of participants had a Pittsburg Sleep Quality Index (PSQI) score >5, suggestive of sleep disturbance
The PSQI is a standardized questionnaire frequently used in studies of HIV-positive persons, which has a cut-off score indicative of sleep disturbance, it lacks specificity for insomnia[11, 27,28,29,30]
Summary
HIV-infected individuals appear to be more vulnerable to sleep disturbances than the general population[1,2,3,4]. Sleep disturbances occur throughout all stages of infection, and may be associated with the virus itself, antiretroviral drugs, or antidepressants. It may increase the risk for psychiatric disorders, cardiovascular morbidity, and mortality, but the degree and direction of causality are unclear[15, 16]. Regardless of its etiology, sleep disturbances is clinically important in this population due to potential impact on quality of life, adherence to ART cognition impairment, comorbid psychiatric disorders like anxiety/depression and immune system function[6, 23, 24].
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