Short Sleep Duration and Correlates among Sero-positive HIV Patients in Nigeria, West Africa

Introduction: Short sleep duration is a salient issue because it is a major public health concern and has more wide-reaching problems among HIV/AIDS patients. Short sleep duration was said to be associated with lower CD4 count, higher viral load values, depression, high blood pressure, high body mass index and disease progression. It was also documented that patients receiving efavirenz had shorter duration of deep sleep. Incidentally there is paucity of data in Nigeria to support these claims hence the need to investigate.

Methods: Four hundred HIV zero-positive patients were recruited at the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, after institutional ethical approval and informed consent was obtained. Blood pressure was measured. Classification of hypertension was made according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7). Body Mass Index was calculated as (kg/m2). The Patient Health Questionnaire (PHQ-9) was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. The respondents were categorized into four groups viz, sleeping more than 7 hours, 6-7 hours, 5-6 hours and less than 5 hours. Subjects with <5hrs are poor sleepers while those with >7hrs were good sleepers.

Results: Four hundred HIV-infected patients were recruited with a mean age of 39yrs (SD 9). Eighty four (21%) were male, while 316 (79%) were female. The mean body mass index was 22.0 (SD 4.6), mean present CD4 count was 339.0 (SD 180.6). One hundred and eighty three respondents (45.8%) slept less than 5 hours, while 58 (14.5%) sleep more than 7hours. Short sleep was commoner in the age group 31-40 73(39.9%), among the female 145(79.2%) and those that were married 103(56.7%), and those with non-formal education 84(45.9%). Traders 80(43.7%) had highest number than other occupation. Short sleepers of less than 5 hours were prone to high blood pressure; higher body mass index and depression. This was statistically significant. The lower the CD4 count, the more the short sleep duration observed among the respondents. Patients receiving HAART containing efavirenz had shorter duration of deep sleep.

Conclusion: Almost half of the respondents were poor sleepers with associated high blood pressure and increased body mass index (BMI). Both effects of the virus and antiretroviral drugs may cause short sleep duration. Health providers managing HIV positive patients, need to take complaints of short sleep duration seriously, because they can indicate an increased risk for low CD4 counts, high viral load, depression, high blood pressure and increase body mass index. There is the need for targeting efforts to improve short sleep duration for the majority of adults living with HIV/AIDS and tailoring appropriate interventions.