While many studies have shown the effects of drug and alcohol use on sleep quality and sleep disorders, few studies have examined the effects of psychological issues on sleep quality, especially in PLWH. Therefore, the present study has examined sleep quality and related factors among Iranian PLWH.
About 72% of our participants had poor sleep quality, according to PSQI results. In a study conducted by Oshinaike et al., about 60% of patients with HIV had poor sleep quality (15). A study conducted in Brazil reported that 47% of PLWH had poor sleep quality (16). A study conducted among PLWH in Tehran showed that 47.5% of them suffered from sleep disorders (4). The differences observed in the reported prevalence of sleep disturbance among PLWH in different studies can be attributed to differences in geographical areas of study, participants’ demographic characteristics, inclusion and exclusion criteria, or different tools in data collection, but it seems that poor sleep quality is a significant problem for a significant proportion of PLWH, affecting the patients’ quality of life and impairing their social and physical functioning.
In our study, no relationship was found between participants’ gender, age, educational status, marital status, and BMI and their sleep quality, which contrasts with the results of other studies (4, 17, 18). Some similar studies showed an association between an increase in BMI and sleep disorders. There are hypotheses that abdominal fat and difficulty in achieving a comfortable sleeping position in people with higher BMI may lead to poor sleep quality, but the reason for this association remains unclear (19, 20). A study in China showed that age affects sleep quality among the general population, as younger people had more sleep disorders reflecting the significance of psychological issues among them (21).
Almost all components related to sleep quality were significantly different in people with good, and poor sleep quality, similar to previous studies as PLWH typically have sleep disturbances such as reduced sleep hours, waking up at night, and waking up early, overturning short brain waves, and rapid eye movements (22).
The results clearly show the effect of stress on sleep quality. People with stress are more likely to have trouble sleeping, and psychological disorders such as stress are among the leading causes of sleep disorders in PLWH (23). Studies on the effects of stress on PLWH show associations between stress and anxiety, depression, sleep quality, and fatigue during the day (24, 25). HIV is a significant source of stress in patients due to several reasons, including fear of infecting others, exposing the HIV status, job changes, interpersonal relationships, and changes in personal life. Stress can reduce their immunity in the long term and accelerate the progression of the disease. One of the effective ways to reduce stress and increase patients’ health is social support, which ultimately improves the quality of life (26).
In our study, employment status was a variable, which independently affected sleep quality, and unemployed people were more likely to have poor sleep quality. Unemployment in PLWH and health-related characteristics were also associated with demographic and social factors, including younger age, lower levels of education, and the presence of stigma in the community (27, 28). In a study conducted by Jabbari et al., occupational status and educational levels were associated with sleep quality among PLWH (29). Poverty is also a chronic stressor that can cause irreparable damage to a person’s physical and mental health (30). Poverty and unemployment affect individuals’ quality of life and, consequently, sleep quality (31).