# Sleep Disorders Are Associated with Mental Health, Quality of Life and Stigma in an Italian Cohort of People Living with HIV

## TL;DR

This study explores how sleep disorders affect mental health, quality of life, and stigma among people living with HIV in Italy.

## Contribution

The study identifies sleep quality as a significant indicator of psychosocial challenges in people living with HIV.

## Key findings

- Poor sleep quality is strongly associated with higher levels of depression, anxiety, and stress in people living with HIV.
- Sleep disturbances correlate with lower quality of life and increased internalized stigma among participants.
- The study highlights the importance of addressing sleep disorders to improve mental and physical health outcomes in this population.

## Abstract

Objectives: The aim of this study was to assess sleep quality in people living with HIV (PLWH), and to examine how the sleep sphere interacts with mental health, quality of life and internalized stigma. Methods: A total of 250 PLWH were consecutively enrolled during routine outpatient visits. Each participant completed a 67-item questionnaire. Sleep disturbances were measured using the Pittsburgh Sleep Quality Index (PSQI). The Depression, Anxiety and Stress Scale (DASS-21) was used to measure the mental health status. The Short Form 12 (SF-12) questionnaire was used to measure participants’ quality of life. Internalized HIV-related stigma was evaluated using the modified six-item internalized AIDS-related stigma scale. Results: Many of the PLWH were male (69.2%) and the time between HIV diagnosis and first antiretroviral therapy (ART) was over 10 years (69.2% and 64%, respectively). The PSQI component most-cited as problematic by PLWH was habitual sleep efficiency (52.4%). In multivariate analysis models, a higher mean in the PSQI total score was significantly associated with internalized stigma (mean change 1.10), depression (mean change 6. 20), anxiety (mean change 12.15), stress (mean change 6.24), physical (mean change 7.54) and mental (mean change 3.56) quality of life, health status (mean change −6.04), ART adherence (mean change −5.08) and physical activity (mean change −6.20). Conclusions: Our results confirm the role of sleep quality in both mental and physical health and suggest that sleep disorders might also be a significant indicator of psychosocial challenges faced by PLWH.