High rates of sleep disturbance in the context of HIV and trauma

Background: As HIV has been transformed from a life-threatening to a chronic disease, factors that impact the mental and physical health of people living with HIV (PLH) have become increasingly relevant. Sleep disturbance has been both linked with negative health outcomes in non-HIV-positive populations and associated with exposure to trauma. Given the high rates of trauma experienced by PLH, it is critical to explore this relationship among PLH. To our knowledge, the current study represents the first examination of sleep disturbance and trauma among PLH. Methods: 339 PLH (249 men, 90 women, 38.3% Caucasian, mean age 45.7) who also reported symptoms of trauma were recruited for a randomized clinical trial of group-based therapy; they completed baseline measures assessing sleep, mental and physical health, and trauma symptoms before randomization into intervention conditions. Results: 74.6% of PHL reported moderate or higher levels of sleep disturbance. No differences emerged by age or gender; individuals diagnosable with post traumatic stress disorder reported significantly fewer hours of sleep and poorer sleep overall (p<0.01). More sleep disturbance was associated with more HIV-related symptoms (r=0.36, p<0.001), cognitive and affective symptoms of depression (r=0.38, p<0.001), and difficulties with emotion regulation (r=0.26, p<0.001). Furthermore, trauma symptoms represented a significant predictor of sleep disturbance (β=0.55, p<0.001), accounting for 30% of the variance in this outcome. Discussion: Trauma symptoms may predict sleep disturbance, and sleep disturbance is associated with multiple negative outcomes. Targeting sleep disturbance in PLH is a public health priority. Interventions should be developed to address this issue.