Sleep Patterns and Related Risk Factors Among People Living with
HIV/AIDS in Iran: A Two-Step Clustering Analysis
Abstract
Background: Sleep plays an essential role in improving the
quality of life of people living with HIV (PLWH); however, sleep
patterns in this population are not well studied. This study aims to
evaluate the sleep patterns and related risk factors among PLWH in Iran.
Methods: 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. Results: The study found that 49.6% of PLWH
had poor sleep quality, 21.15% reported sleepiness, and 42.7% had
insomnia. Three sleep pattern clusters were identified: I. minor sleep
problems (45.6%); II. sleep apnea, snoring at night, and sleepiness
(27.8%), and III. poor sleep quality and insomnia (26.7%). Age
(OR:1.03, 95%CI:1.01-1.05), academic education (OR:0.52,
95%CI:0.28-0.97), HIV duration, and CD4 (OR: 0.99, 95%CI:0.99-0.999)
were associated with being in cluster two, while age (OR=1.02,
95%CI:1.007-1.04) and CD4 (OR=0.99, 95%CI:0.996-0.999) were associated
with being in cluster three. PLWH with depression had higher odds of
being in cluster three, and those with anxiety had higher odds of being
in clusters two and three. Conclusion: Our findings suggest
that a significant proportion of PLWH have poor sleep quality,
sleepiness, and insomnia. The identification of three distinct sleep
pattern clusters underscores the need for increased attention and
tailored interventions to address the specific sleep issues experienced
by PLWH.