Abstract Body

Poor sleep quality can affect physical, mental and emotional function and has been frequently reported in people with HIV (PWH). We explored dimensions of sleep health, derived from objectively-measured sleep/wake activity, and their associations with health- and sleep-related quality of life (QoL) in PWH and lifestyle-matched controls.

A subset of PWH (18-49 and ≥50 yo) and HIV-negative controls (≥50 yo) participating in the POPPY study wore an actigraphy device for 7 days/nights. Physical and mental QoL, sleep-related impairment (perceptions of daytime functional impairment associated with sleep) and disturbance (perceptions of sleep quality) were derived from the SF-36 and PROMIS questionnaires. Exploratory factor analysis of 27 actigraphy variables was performed and 7 dimensions of sleep health were obtained. Linear regression was used to test associations of sleep dimensions with HIV-status and QoL measures (separately in PWH and controls) and whether they differed by HIV-status. All analyses accounted for age, gender and ethnicity.

The 343 PWH and 117 HIV-negative controls were predominantly male (87% and 68%) with a median (IQR) age of 57 (52-62) and 61 (57-66) years, respectively. The 7 actigraphy-derived dimensions of sleep health were fragmentation, irregularity in duration/timing, sleep duration, duration/variability of awake periods (after initial sleep), irregularity in fragmentation, onset latency and timing. None of these significantly differed between PWH and controls (all p’s>0.1). In PWH, longer duration and/or greater variability of awake periods was associated with poorer physical (p=0.01) and mental (p=0.04) health and greater sleep-related impairment (p<0.001). Greater irregularity in duration/timing and longer onset latency were both associated with greater sleep-related impairment (p<0.001 and p=0.004) and disturbance (p<0.001 and p=0.03). Irregularity in duration/timing was also associated with poorer mental health (p=0.03). Associations were generally similar to those seen among the HIV-negative controls; only the associations of onset latency and sleep-related QoL appeared to differ (p-interaction=0.01 and 0.003, Figure).

We found seven dimensions of sleep health based on objective actigraphy measures. Whilst these dimensions have differential impacts on self-reported health, the effects are generally similar between people with and without HIV. These findings could inform targeted strategies to improve sleep health and, in turn, QoL of PWH.