Sleep actigraphy results and HIV health outcomes in an urban HIV clinic sample.

Sleep disorders are prevalent and interfering conditions that affect people living with HIV (PLWH) at higher rates than the general population. Lower quality sleep has been associated with poorer health-related quality of life and immune function in PWH, though sleep is typically assessed subjectively. The current study aimed to examine the association between objective sleep/wake patterns measured via actigraphy with HIV outcomes. Participants (N = 87) were recruited from a public, urban HIV clinic located in the Southeastern United States. Participants were instructed to wear actigraphy monitors for one week (Range: 5-8 days). Log viral load and absolute CD4 were obtained via medical chart review. Linear regression analyses predicting HIV RNA Viral Load (log transformed) and CD4 Count were employed with three actigraphy sleep variables: sleep efficiency, wake after sleep onset (WASO), and sleep quantity. Backward entry regression with both significant actigraphy predictors, sleep efficiency and WASO, included as predictors resulted in sleep efficiency remaining in the model and WASO being removed. Separate models revealed that each one-unit increase in sleep efficiency was associated with a b = 0.032-point decrease in the log-transformed HIV RNA viral load (p = 0.03) and for each one-unit increase in wake after sleep onset (WASO) was associated with a b = 0.35-point increase in the log-transformed HIV RNA viral load (p = 0.04). Sleep quantity, however, was not, and none were associated with absolute CD4 count. The findings add to the evidence for an association of objectively measured poorer sleep efficiency being associated with higher HIV RNA viral load. Implications for clinical practice include assessing and addressing sleep efficiency as part of comprehensive clinical HIV care.

Examining the Longitudinal Effects of Insomnia on Depression and Medication Adherence in People Living with HIV.

OBJECTIVE: The management of HIV has shifted from a focus solely on the disease to a broader perspective encompassing co-occurring medical conditions and quality of life. Mental health concerns such as depression and sleep disturbances, particularly insomnia, are often overlooked in HIV care. The aim of the study was to investigate the longitudinal impact of insomnia on depression and medication adherence among (PLWH). METHODS: This study, conducted in an urban HIV clinic, involved active patients and assessed depression, insomnia, and medication adherence at baseline, 3-month, and 6-month intervals. Hierarchical linear models were employed to analyze the fixed and random effects of time, within-person and between-person insomnia on depression, as well as the effects of time, within-person and between-person depression on ART adherence. RESULTS: Within-person effects revealed that each one unit increase in the Insomnia Severity Index (ISI) was associated with a b = 0.267-point rise in Patient Health Questionnaire-9 (PHQ-9) scores (p < .001). Between-person effects revealed that each one-point increase in an individual's average ISI score was associated with a 0.476-point elevation in their PHQ-9 scores (p < .001). The between-person effects of depression on medication adherence indicated significance, with each point increase in an individual's average PHQ-9 score being linked to a 0.36% decrease in adherence (p = .012). CONCLUSION: The study underscores the potential impact of insomnia on mental health and treatment adherence in people living with HIV (PLWH). This study emphasizes the necessity of comprehensive care models considering the interplay between sleep quality, mental health, and medication adherence for PLWH.

What a difference a year makes: Objective rest/activity patterns, circadian phase markers, and sleep quality before and during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic led to numerous changes in sleep duration, quality, and timing. The goal of this study was to examine objective and self-reported changes in sleep and circadian timing before and during the pandemic. METHODS: Data were utilized from an ongoing longitudinal study of sleep and circadian timing with assessments at baseline and 1-year follow-up. Participants had baseline assessment between 2019 and March 2020 (before pandemic) and 12-month follow-up between September 2020 and March 2021 (during pandemic). Participants completed 7 days of wrist actigraphy, self-report questionnaires, and laboratory-collected circadian phase assessment (dim light melatonin onset). RESULTS: Actigraphy and questionnaire data were available for 18 participants (11 women and 7 men, Mean = 38.8 years, SD = 11.8). Dim light melatonin onset was available for 11 participants. Participants demonstrated statistically significant decreases in sleep efficiency (Mean = -4.11%, SD = 3.22, P = .001), worse scores on Patient-Reported Outcome Measurement Information System sleep disturbance scale (Mean increase = 4.48, SD = 6.87, P = .017), and sleep end time delay (Mean = 22.4 mins, SD = 44.4 mins, P = .046). Chronotype was significantly correlated with change in dim light melatonin onset (r = 0.649, P = .031). This suggests that a later chronotype is associated with a greater delay in dim light melatonin onset. There were also non-significant increases in total sleep time (Mean = 12.4 mins, SD = 44.4 mins, P = .255), later dim light melatonin onset (Mean = 25.2 mins, SD = 1.15 hrs, P = .295), and earlier sleep start time (Mean = 11.4 mins, SD = 48 mins, P = .322). CONCLUSION: Our data demonstrate objective and self-reported changes to sleep during the COVID-19 pandemic. Future studies should look at whether some individuals will require intervention to phase advance sleep when returning to previous routines such as returning to office and school settings.