Sleep and Rest-Activity Rhythms are Delayed and Less Robust in People Living With HIV

People living with HIV (PLWH) commonly have sleep disturbances, but little is known about their habitual sleep patterns and rest-activity rhythms (RARs). We sought to compare sleep and RAR metrics between people living with and without HIV.

Adult participants with (n = 106) and without HIV (n = 105) underwent evaluation with 14 days of wrist actigraphy. PLWH were virally suppressed and on stable antiretroviral therapy for at least 1 year before evaluation. Sleep duration, timing, regularity, and RAR metrics were derived from actigraphy. Differences in sleep and RAR metrics by HIV status were compared using multivariable regression adjusting for age, sex, race, body mass index, education, employment, smoking, alcohol, and sleep apnea severity.

In adjusted analyses, PLWH had later timing of sleep and activity compared with those without HIV (sleep midpoint 38.9 ± 12.7 minutes later, P = .003, acrophase 44.3 ± 13.1 minutes later, P = .0009) and less consolidated nighttime sleep (sleep efficiency 2.4 ± 0.9% lower, P = .007; daytime napping 10.5 ± 3.9 minutes greater, P = .007). In addition, PLWH had less robust rhythms with more variable nightly sleep (standard deviation of nocturnal sleep duration 18.1 ± 5.3 minutes greater, P = .0007; standard deviation of sleep midpoint 26.0 ± 7.8 minutes greater, P = .001), lower RAR peak (relative amplitude 0.07 ± 0.02 lower, P = .002), and less regular rhythm (pseudo-F statistic 858 ± 426 lower, P = .046; interdaily stability 0.06 ± 0.02 lower, P = .003).

PLWH have delayed, less consolidated, and less robust sleep and RARs compared with those without HIV, suggesting intrinsic differences in circadian rhythms. Future research should evaluate the impact of these abnormalities on long-term health outcomes in PLWH.