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

<b>Objectives</b>: 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. <b>Methods:</b> 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. <b>Results</b>: 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). <b>Conclusions</b>: 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.