Symptom-level associations among sleep quality, depression, and social rhythm in people living with HIV: a network analysis

Sleep disturbance, depression, and social rhythm irregularity commonly co-occur in people living with HIV (PLWH), yet their symptom-level associations remain insufficiently understood. This study aimed to examine the network structure linking sleep quality, depressive symptoms, and social rhythm in PLWH and to identify central and bridge symptoms within this system. A cross-sectional sample of 737 people living with HIV (PLWH) in Changsha, China, was assessed using the Pittsburgh Sleep Quality Index, Self-Rating Depression Scale, and Brief Social Rhythm Scale. A 32-node Gaussian graphical model was estimated using EBICglasso, with correlation types selected according to variable measurement levels. Expected influence (EI) and bridge expected influence (BEI) identified central and bridge symptoms, respectively, and were z-standardized for presentation. Community-size-normalized BEI was calculated to account for unequal community sizes, and its agreement with raw BEI rankings was assessed using Spearman’s rank correlation. Node predictability was estimated using a separate Gaussian model, with the regularization parameter selected by 10-fold cross-validation. Edge-weight accuracy and centrality stability were evaluated using nonparametric and case-dropping bootstraps, respectively. Goldbricker screening and reduced-network sensitivity analysis assessed node redundancy and the robustness of centrality findings. The network consisted of 32 nodes and 174 nonzero edges, indicating substantial interconnections among sleep quality, depression, and social rhythm. Subjective sleep quality had the highest z-standardized expected influence (EI = 2.40) and bridge expected influence (BEI = 2.87). After community-size normalization, depressive sleep disturbance had the highest community-size-normalized bridge expected influence (nBEI = 0.045). Subjective sleep quality, daytime dysfunction, depressive sleep disturbance, and fatigue consistently comprised the four leading bridge nodes in both the bridge expected influence and community-size-normalized bridge expected influence analyses, although their ordering differed. Sleep quality, depression, and social rhythm were closely interconnected at the symptom level among PLWH. Subjective sleep quality, daytime dysfunction, depressive sleep disturbance, and fatigue may warrant prioritization in clinical assessment. Longitudinal and interventional studies are needed to determine whether targeting these symptoms can improve other symptoms across the network.