Abstract Background Sleep disturbances are common in people living with HIV, but previous studies have predominantly relied on self-report. While actigraphy offers the ability to evaluate habitual sleep across multiple nights, few have applied this approach in HIV. Methods Wrist actigraphy data from 827 men (459 with HIV (PWH, 96% virologically suppressed and 93% on antiretroviral therapy); 368 without HIV (PWoH) enrolled in the Multicenter AIDS Cohort Study (MACS) were analyzed. A total of 6,013 nights of actigraphy data were collected, with each participant contributing at least five consecutive nights of recording. Random-effects linear regression models were used to adjust for age, body mass index, smoking, socioeconomic status, and sleep-disordered breathing severity. Outcomes included habitual sleep duration, sleep latency, sleep efficiency, wake after sleep onset (WASO), fragmentation index, and night-to-night variability. Results In the overall sample (n = 827 men), 64.6% were White, 27.5% were Black, and 8.0% were of “other” race. The race distribution differed significantly by HIV status (p 0.001), with more PWH in the Black and other race categories. Among White men, PWH slept an average of 16.7 minutes less than PWoH (mean=406.7 vs. 423.4 minutes, p=0.01), had lower sleep efficiency (mean=87.6% vs. 89.3%, p0.001), greater WASO (mean=57.9 vs. 51.6 minutes, p=0.005), and higher sleep fragmentation (mean=26.8 vs. 23.3 events/hour, p0.001). Night-to-night variability analyses revealed higher within-person standard deviations in sleep duration, sleep efficiency, and WASO in White PWH compared to White PWoH. In contrast, Black men exhibited shorter and less efficient sleep overall compared to the other groups, but with minimal HIV-related differences. These differences persisted after accounting for socioeconomic factors and sleep-disordered breathing severity. Conclusions White PWH exhibited shorter, less efficient, and more fragmented sleep, as well as greater night-to-night variability, compared to White PWoH. These effects were evident despite high rates of viral suppression and antiretroviral therapy, underscoring the persistence of HIV-related sleep disturbances in PWH and highlighting variability as a novel dimension of sleep health. This abstract is funded by: NIH
Aldana et al. (Fri,) studied this question.