To identify sleep subtypes and associated factors in older people living with HIV (PLWH).
Methods
A cross-sectional study was conducted to recruit older PLWH in Wuxi, China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Latent class analysis was employed to examine sleep patterns, and logistic regression was performed to analyze associated factors.
Results
In total, 830 participants were recruited with a median age of 60.9 years (IQR 55.4–67.9), of whom 79.0% were male, and 25.4% had sleep disorders. Three sleep patterns were identified: optimal sleep (48.3%), poor sleep (39.9%), and bad sleep (11.8%). Compared to the optimal sleep group, housing area (OR = 0.67, 95% CI: 0.50–0.91), social media app usage (OR = 0.57, 95% CI: 0.37–0.87), and years living with HIV (OR = 1.49, 95% CI: 1.05–2.10) were significantly associated with poor sleep. In contrast, age (OR = 1.89, 95% CI: 1.12–3.20), sex (OR = 1.94, 95% CI: 1.15–3.27), exercise frequency (OR = 1.64, 95% CI: 1.02–2.63), polypharmacy (OR = 0.27, 95% CI: 0.14–0.52), and years living with HIV (OR = 1.85, 95% CI: 1.11–3.07) were significantly associated with bad sleep.
Conclusions
Significant heterogeneities were observed across different sleep patterns among older PLWH. Potential associated factors should be considered when developing targeted strategies to improve sleep quality in this population.
The Lancet Healthy Longevity. Ageing with HIV. Lancet Healthy Longev2022; 3: e119.
3.
HouYSJinYCCaiC, et al.Characteristics of the HIV/AIDS epidemic among people aged ≥ 50 years in China during 2018-2021. Biomed Environ Sci2024; 37: 399–405.
4.
YueZZhangYChengX, et al.Sleep quality among the elderly in 21st century shandong province, China: a ten-year comparative study. Int J Environ Res Publ Health2022; 19: 14296.
5.
MinerBKrygerMH. Sleep in the aging population. Sleep Med Clin2020; 15: 311–318.
6.
SallesCCruzMMEFreireIC, et al.Insomnia in older HIV-positive patients. Sleep Sci2022; 15: 363–369.
7.
O'BrienKERiddellNEGómez-OlivéFX, et al.Sleep disturbances in HIV infection and their biological basis. Sleep Med Rev2022; 65: 101571.
8.
JiJZhangYMaY, et al.People who living with HIV/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis. Front Psychiatr2024; 15: 1259290.
9.
FeketeEMWilliamsSLSkintaMD. Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV. Psychol Health2018; 33: 398–415.
10.
LiJJLiuLSZhaoHP, et al.Self-reported sleep disturbances among people living with HIV in China: a systematic review and meta-analysis. Behav Sleep Med2025: 1–14.
11.
FarautBMalmartelAGhosnJ, et al.Sleep disturbance and total sleep time in persons living with HIV: a cross-sectional study. AIDS Behav2018; 22: 2877–2887.
12.
MazzitelliMTrunfioMMilinkovicA, et al.Sleep disturbances and their correlation with cardiovascular risk, obesity, and mood disorders in people with HIV. AIDS2023; 37: 925–934.
13.
ZhouQDingYChenX, et al.Association of insomnia, sleep quality, and sleep duration with risk of physical frailty in middle-aged and older people with HIV. Open Forum Infect Dis2023; 10: ofad566.
14.
HuangXLiHMeyersK, et al.Burden of sleep disturbances and associated risk factors: a cross-sectional survey among HIV-infected persons on antiretroviral therapy across China. Sci Rep2017; 7: 3657.
15.
MeleseMMengistieBADelieAM, et al.Poor sleep quality and its associated factors among HIV/ADIS patients living in sub-saharan African countries: a systematic review and meta-analysis. Sci Rep2024; 14: 16955.
16.
LeeSOhJWParkKM, et al.The prevalence and moderating factors of sleep disturbances in people living with HIV: a systematic review and meta-analysis. Sci Rep2024; 14: 14817.
17.
YanDQHuangYXChenX, et al.Application of the Chinese version of the Pittsburgh sleep quality Index in people living with HIV: preliminary reliability and validity. Front Psychiatr2021; 12: 676022.
18.
WellerBEBowenNKFaubertSJ. Latent class analysis: a guide to best practice. J Black Psychol2020; 46: 287–311.
19.
HuangJSpiraAPPerrinNA, et al.Latent classes of sleep problems and subjective cognitive decline among middle-aged and older adults in the United States. Arch Gerontol Geriatr2025; 129: 105657.
20.
BuysseDJReynoldsCF3rdMonkTH, et al.The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res1989; 28: 193–213.
21.
JusticeACGordonKSRomeroJ, et al.Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study. Lancet Healthy Longev2021; 2: e639–e650.
22.
MuthénLMB. Mplus user’s guide. 7th ed., 2012.
23.
HadavandsiriFShafaatiMMohammad NejadS, et al.Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue. Sci Rep2023; 13: 12730.
24.
ScottWArkuterCKioskliK, et al.Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis. Pain (Amst)2018; 159: 2461–2476.
25.
HidakaTKasugaHEndoS, et al.Are lifestyle pattern changes associated to poor subjective sleep quality? A cross-sectional study by gender among the general Japanese population underwent specified medical check-ups in 2014 and 2015. BMJ Open2020; 10: e037613.
26.
FrangopoulosFZannetosSNicolaouI, et al.The complex interaction between the major sleep symptoms, the severity of obstructive sleep apnea, and sleep quality. Front Psychiatr2021; 12: 630162.
27.
BrandaoGSCamelierFWRSampaioAAC, et al.Association of sleep quality with excessive daytime somnolence and quality of life of elderlies of community. Multidiscip Respir Med2018; 13: 8.
28.
TaibiDM. Sleep disturbances in persons living with HIV. J Assoc Nurses AIDS Care2013; 24: S72–S85.
29.
TakaesuYKomadaYAsaokaS, et al.Factors associated with long-term use of hypnotics among patients with chronic insomnia. PLoS One2014; 9: e113753.
30.
TadesseABadassoKEdmealemA. Poor sleep quality and associated factors among people living with HIV/AIDS attending ART clinic at Tirunesh Beijing hospital, Addis Ababa, Ethiopia. AIDS Res Treat2023; 2023: 6381885.
31.
MazzitelliMTrunfioMScaglioneV, et al.Multidimensional program for insomnia in a cohort of people with HIV. AIDS2024; 38: 2040–2049.
32.
MengJZhengCWangH, et al.Non-pharmacological interventions for improving sleep in people living with HIV: a systematic narrative review. Front Neurol2023; 14: 1017896.
33.
MazzitelliMAgostiniEVaniaE, et al.Impact of switching to injectables cabotegravir and rilpivirine on sleep disturbances in a cohort of people living with HIV. HIV Res Clin Pract2024; 25: 2351258.
34.
LapadulaGBernasconiDPBaiF, et al.Switching from efavirenz to rilpivirine improves sleep quality and self-perceived cognition but has no impact on neurocognitive performances. AIDS2020; 34: 53–61.
35.
NguyenVGeorgeTBrewsterGS. Insomnia in older adults. Curr Geriatr Rep2019; 8: 271–290.
36.
MengistuNAzaleTYimerS, et al.Quality of sleep and associated factors among people living with HIV/AIDS on follow up at Ethiopian Zewditu memorial hospital, 2018. Sleep Sci Pract2021; 5: 2.
37.
ScofieldDMoseholmE. HIV-related stigma and health-related quality of life in women living with HIV in developed countries: a systematic review. AIDS Care2022; 34: 7–15.
38.
LiuHHeXLevyJA, et al.Psychological impacts among older and younger people living with HIV/AIDS in nanning, China. J Aging Res2014; 2014: 576592.
39.
QinPHeJYangX, et al.The role of depressive symptoms and physical activity levels in mediating the association between HIV status and neurocognitive functions among individuals aged at least 50 years in China: cross-sectional study. JMIR Public Health Surveill2022; 8: e32968.
40.
PetrakisVSteiropoulosPPapanasN, et al.Quality of sleep in people living with HIV in the era of highly active antiretroviral treatment. Int J STD AIDS2023; 34: 191–202.
41.
EmmittS. Exploring the nexus between bedroom design and sleep quality in a warming climate. Urban Clim2023; 51: 101635.
42.
ZhuXGaoMChengX, et al.Sleep-the guarantee of health! Does the environmental perception characteristics of urban residential areas affect residents’ sleep quality?Front Public Health2022; 10: 1017790.
43.
MorenoMABingerKSZhaoQ, et al.Effect of a family media use plan on media rule engagement among adolescents: a randomized clinical trial. JAMA Pediatr2021; 175: 351–358.
44.
HanXLiBQuJ, et al.Weibo friends with benefits for people live with HIV/AIDS? The implications of Weibo use for enacted social support, perceived social support and health outcomes. Soc Sci Med2018; 211: 157–163.
45.
SiddiqHTeklehaimanotSGuzmanA. Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019-2020. Soc Psychiatr Psychiatr Epidemiol2024; 59: 969–977.
46.
WinstonAUnderwoodJ. Emerging concepts on the use of antiretroviral therapy in older adults living with HIV infection. Curr Opin Infect Dis2015; 28: 17–22.
47.
AllavenaCGuimardTBillaudE, et al.Prevalence and risk factors of sleep disturbance in a large HIV-infected adult population. AIDS Behav2016; 20: 339–344.
48.
MousaviMENejadSMShafaatiM, et al.Association between psychological discomforts and sleep quality among people living with HIV/AIDS. AIDS Res Ther2023; 20: 78.
49.
XieMWangAWangK, et al.Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr2022; 22: 728.
50.
DelRossoLWaltersASSalamatinaA, et al.0916 sleep diagnosis, polysomnography findings, and CPAP adherence in people living with HIV and controls. Sleep2024; 47: A393.
