Types of Sleep Problems in Adults Living with HIV/AIDS

Abstract

Objective: To characterize specifi c types of sleep problems experienced by adults with HIV. Method: The design was cross-sectional involving sleep questionnaires, diaries, and wrist actigraphy. The convenience sample included 290 adults living with HIV, 22-77 years of age. Measures included self-report for sleep onset latency, and wrist actigraphy estimates of total sleep time at night, wake after sleep onset, and daytime sleep. Results: Nearly half (45%) of the sample slept < 6 h per night. Diffi culty falling asleep was reported by 34%, and 56% had fragmented sleep according to actigraphy; 20% had both problems, and 30% were good sleepers. Participants reporting diffi culty falling asleep had actigraphy and clinical measures similar to the good sleepers, but subjectively they experienced greater sleep disturbance and symptom burden (particularly anxiety and morning fatigue) and reported more use of sleep medication. Participants with fragmented sleep reported low levels of sleep disturbance and symptom burden similar to the good sleepers, despite actigraphy measures indicating they obtained less sleep both at night and during the day. Sleep fragmentation was also associated with sociodemographic factors and slightly lower CD4+ T-cell counts. Participants reporting both sleep problems had actigraphy and clinical profi les similar to those who had only fragmented sleep, but their symptom experience was similar to participants with only sleep initiation diffi culties. Types of Sleep Problems in Adults Living with HIV/AIDS S C I E N T I F I C I N V E S T I G A T I O N SS leep problems affect about 30% of the population in the United States and are associated with higher healthcare utilization and use of sleep medication, as well as poor work performance and mood disorders.1 Adults living with a chronic illness are at higher risk for sleep problems, and depending on the definition, sleep problems are experienced by 30% to 100% of HIVpositive adults. [2][3][4][5][6][7][8][9] It is unclear what type of sleep problem adults with HIV experience, or whether their sleep disturbance is related to the infection itself or to the medical treatment and side effects of medications. Sleep disturbance is not only prevalent, but also one of the more intense and distressful symptoms experienced in this population. [8][9][10] In HIV infection, poor sleep has been associated with disease progression, medication therapy, employment status, and lack of knowledge about behaviors that promote good sleep. [11][12][13][14] The specifi c type of sleep disturbance experienced by this population needs to be better understood in order to provide the most effective intervention to improve symptoms, daytime functioning, and quality of life. 8,[15][16][17][18] Fragmented sleep occurs in chronic health conditions and may not even be perceived by the patient. 19,20 With this type of sleep loss, it is rare to fi nd complaints of initiation insomnia, but complaints of daytime sleepiness or fatigue are common and can lead to diffi culty concentrat...

Oxytocin, Social Support, and Sleep Quality in Low-Income Minority Women Living With HIV

“…A significant proportion of individuals with HIV experience sleep problems (Hand et al, 2003; Lee et al, 2012; Rubenstein & Selwyn, 1998), which may be linked to a less efficient immune response or impaired immune function (Gómez-González et al, 2012). Understanding how various psychosocial and biological factors are related to sleep disturbances in individuals living with HIV may help to prevent or delay disease progression.…”

“…Over 70% of individuals with HIV report sleep related issues including fatigue, difficulties falling asleep, and early morning awakening (Hand, Phillips, Sowell, Rojas, & Becker, 2003; Lee et al, 2012; Rubenstein & Selwyn, 1998). Individuals living with HIV report longer sleep latency (time spent falling asleep), shorter sleep duration (time spent asleep), reduced sleep efficiency (ratio of minutes slept to minutes spent in bed), higher rates of daytime sleepiness, and fatigue (Pence, Barroso, Leserman, Harmon, & Salhuddin, 2008; Salhuddin, Barroso, Leserman, Harmon, & Pence, 2009; Wiegand et al, 1991).…”

Characteristics of sleep disorders in Romanian adults infected with human immunodeficiency virus

“…Lee KA & all characterized the types of sleep problems on 290 adults with HIV, aged between 22 and 77 years old. They reported 34% difficulty falling asleep, 56% fragmented sleep, 45% less than 6 hours sleep per night and 30% good sleepers [4]. Regularly, sleep disturbances are associated with depression, fatigue and have a negative influence on antiretroviral therapy adherence in HIV patients [4,5].…”

“…They reported 34% difficulty falling asleep, 56% fragmented sleep, 45% less than 6 hours sleep per night and 30% good sleepers [4]. Regularly, sleep disturbances are associated with depression, fatigue and have a negative influence on antiretroviral therapy adherence in HIV patients [4,5]. Consequently, sleep disorders increase the risk of developing psychiatric disorders, cardiovascular diseases, healthcare utilization and general mortality [6].…”

Cytokine polymorphisms and plasma levels are associated with sleep onset insomnia in adults living with HIV/AIDS

“…More specifically, IL6 has been associated with poor sleep in cancer populations (Clevenger et al, 2012; Miaskowski et al, 2010), and among adults living with HIV/AIDS, tumor necrosis factor – alpha (TNFA), IL1R2, and IL2 have been associated with poor sleep maintenance and short sleep duration (Lee et al, 2014a), and IL1B and IL17A have been associated with symptoms of restless legs syndrome (Hennessy et al, 2014). Although difficulty falling asleep is also a commonly reported sleep problem among adults with HIV/AIDS (Lee et al, 2012) and among the general population (Roth, 2007), associations with cytokine genetic markers and plasma biomarkers have not been adequately studied. This is a particularly relevant issue for individuals with HIV who are known to have impaired cytokine function, which could contribute to their sleep problems (Zielinski and Krueger, 2011).…”