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

Abstract Background People living with HIV (PLWH) commonly have sleep disturbances, but little is known about their habitual sleep patterns and rest-activity rhythms (RAR). We sought to compare sleep and RAR metrics between people living with and without HIV. Methods 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 one 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. Results In adjusted analyses, PLWH had later timing of sleep and activity compared to those without HIV (sleep midpoint 38.9±12.7 min later, p=0.003, acrophase 44.3±13.1 min later, p=0.0009) and less consolidated nighttime sleep (sleep efficiency 2.4±0.9% lower, p=0.007; daytime napping 10.5±3.9 min greater, p=0.007). In addition, PLWH had less robust rhythms with more variable nightly sleep (standard deviation of nocturnal sleep duration 18.1±5.3 min greater, p=0.0007; standard deviation of sleep midpoint 26.0±7.8 min greater, p=0.001), lower RAR peak (relative amplitude 0.07±0.02 lower, p=0.002), and less regular rhythm (pseudo-F statistic 858±426 lower, p=0.046; inter-daily stability 0.06±0.02 lower, p=0.003). Conclusions PLWH have delayed, less consolidated, and less robust sleep and rest-activity rhythms compared to 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.