Insomnia symptoms and HIV infection among participants in the Women's Interagency HIV Study

Abstract

Objectives: This study assessed the prevalence of insomnia symptoms among women with and without HIV-infection and examined factors associated with insomnia.

Design: Participants (n = 1682) were enrolled in the Women's Interagency HIV Study (WIHS); 69% were infected with HIV. This was a cross-sectional analysis of data from standardized interviewer-administered instruments and physical/gynecological exams. Analysis focused on sociodemographics, sleep measures, depressive symptoms, drug use, alcohol consumption, medications, and HIV-related clinical variables. Women were classified as having symptoms of insomnia if they reported either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening ≥ 3 times a week in the past 2 weeks.

Results: Overall, HIV-infected women were 17% more likely to endorse insomnia symptoms than uninfected women (OR = 1.17, 95% CI: 1.04-1.34, P < 0.05). The adjusted prevalence of insomnia symptoms varied by HIV status and age groups. Among women ages 31-40 years, those with HIV infection were 26% more likely to endorse insomnia symptoms than their counterparts (OR = 1.26, 95% CI: 1.01-1.59, P < 0.05). No significant differences were observed in the likelihood of reporting insomnia symptoms based on HIV treatment type. Multivariate-adjusted regression analyses showed that depression was the most consistent and significant independent predictor of the likelihood of reporting insomnia symptoms across all age strata.

Conclusions: Insomnia symptoms are common among both HIV-infected and uninfected women. Prevalence of insomnia did not vary significantly by HIV status, except among younger women. Younger women with HIV infection are at greater risk for experiencing insomnia symptoms.

Keywords: HIV infection; Insomnia; sleep; women.

Figure 1

Illustration of age-related associations with insomnia symptoms, contrasting women with HIV infection and uninfected women. The insomnia symptom variable represented an aggregate of women reporting either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening, relative to those reporting no symptoms. Significant difference was noted for women ages 31-40 years.

Figure 2

Depiction of estimated insomnia symptoms based on HIV treatment type: (1) no antiretroviral (ARV) therapy, (2) higly active antiretroviral therapy (HARRT), and (3) non-HAART ARV therapy.