Sleep traits and associated factors among people living with HIV/AIDS in Iran: a two-step clustering analysis

Sleep plays an essential role in improving the quality of life of people living with HIV (PLWH); however, sleep traits in this population are not well studied. This study aims to evaluate the sleep traits and related associated factors among PLWH in Iran. A nationwide cross-sectional study was conducted with 1185 PLWH who attended Voluntary Counseling and Testing centers in 15 provinces in Iran between April 2021 and March 2022. The Berlin Obstructive Sleep Apnea questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index were used. A two-step clustering method was employed to identify the number of sleep clusters in PLWH. Prevalence of poor sleep quality, sleepiness and insomnia were 49.6%, 21.15% and 42.7% respectively. Three sleep trait clusters were identified: I. minor sleep problems (45.6%); II. Snoring & sleep apnea (27.8%), and III. poor sleep quality and insomnia (26.7%). Age (Odds Ratio (OR) 1.033, 95% Confidence Interval (CI) 1.017-1.050), academic education (OR 0.542, 95% CI 0.294-0.998) and HIV duration were associated with being in Snoring & sleep apnea cluster, while age (OR = 1.027, 95% CI 1.009-1.040) was associated with being in Poor sleep quality and insomnia cluster. PLWH with depression had higher odds of being in Poor sleep quality and insomnia cluster, and those with anxiety had higher odds of being in Snoring & sleep apnea cluster and Poor sleep quality and insomnia cluster. A significant proportion of PLWH have poor sleep quality, sleepiness, and insomnia. The identification of three distinct sleep trait clusters underscores the need for increased attention and tailored interventions to address the specific sleep issues experienced by PLWH.