Sleep Disturbance in Individuals Who Are Living with HIV

Despite adequate usage of antiretroviral therapy and a healthy CD4 count, sleep disturbance can sometimes be a concern for people with HIV. A recent study demonstrated at the 2020 HIV Gaslow Conference found that providing sleep hygiene resources and adjusting antiretroviral medications can significantly improve the quality of sleep in individuals who are HIV positive.

Use of the Pittsburgh Sleep Quality Index

The Pittsburgh Sleep Quality Index, also known as PSQI, is a tool used to measure sleep disturbance in clinical populations. It consists of 19 self-rated questions and 5 rated by a partner (if applicable).

In this study, Dr. Benjamin Goorney from Salford Sexual Health Clinic utilized the Pittsburgh Sleep Quality Index to assess the sleep quality of 40 patients over a one-month interval. Participants who demonstrated a score of 6 or higher were determined to experience sleep disturbance.

Sleep hygiene resources

Dr. Goorney and colleagues discovered that out of the 40 participants, 37 (92.5 percent) demonstrated a score greater than or equal to 6. These participants then received additional sleep hygiene resources to help improve their quality of sleep. Some resources included but not limited to:¹

• limiting caffeine intake after 3:00 pm
• limiting screen time one hour prior to bedtime
• possibly switching antiretroviral medication. 41 percent of the participants decided to try alternative antiretroviral therapy treatments.

Factors related to sleep disturbance

The study concluded that there appears to be a strong association between mental health and sleep disturbance. Results revealed the average PSQI score was 12, which is considered a “moderately severe sleep disturbance.”¹

In addition, 60 percent of the participants exhibited past or current mental health conditions. These patients demonstrated a PSQI score of 13.5. Those with a PSQI score of 14.85 also stated taking antidepressants. Patients who stated having a recent STI similarly displayed a higher PSQI (13.5) in comparison to those who did not (a PSQI of 12).¹

Taking antiretrovirals with dolutegravir

Out of the 37 participants, 22 received sleep hygiene materials only, and 15 switched to alternative antiretroviral medication. Prior to the intervention, 68 percent of the antiretroviral regimens included dolutegravir (an antiretroviral medication). Dolutegravir “was [founded] to be significantly associated with greater sleep disturbance than other integrase inhibitors (PSQI 12.6 vs 9.8).”¹

Interventions that helped with sleep problems

Overall, both interventions of utilizing sleep hygiene materials and alternative antiretroviral medication reduced the average PSQI by 31 percent.¹ When 15 patients switched their antiretroviral regimens, the sleep disturbance was reduced by 52 percent.¹ However, no significant changes were demonstrated by using sleep hygiene material alone.

The study has discovered that the PSQI questionnaire has proven to be a valuable tool. Routine assessments of sleep disturbance will help further assist in the improvement of quality sleep in individuals who are HIV positive.