Sleep Disturbance in the Context of HIV: A Concept Analysis

Hening Pujasari, Min-Huey Chung, Hening Pujasari, Min-Huey Chung

Abstract

Due to the differing definitions of the concept of sleep disturbance among people living with human immunodeficiency virus (HIV), reviewers in this area have not reached any firm conclusions. The study aimed to clarify and provide a stronger foundation for the definition of sleep disturbance in the context of HIV to enhance the concept's development. Following Beth Rodgers' concept analysis guidelines, two leading databases were searched, and 73 articles were used for this concept analysis. The attributes, surrogate terms, antecedents, and consequences of sleep disturbance have been identified using thematic analysis. In this analysis, two main attributes of sleep disturbance in the context of HIV were identified: a) subjective measures, including reduced total sleep time, difficulty falling asleep, nighttime and early morning awakenings, feeling sleepy and poorly rested after a night's sleep, frequent arousals, and irritability, and b) objective measures, including changes in sleep architecture and sleep continuity. Five antecedents of sleep disturbance in the context of HIV were identified. Meanwhile, the consequences of sleep disturbance in HIV are listed based on the frequency the points occur within the reviewed articles. The list is as follows: fatigue and pain; reduced neurocognitive functions; reduced health outcome and quality of life; poor anti-retroviral (ARV) therapy adherence; daytime sleepiness; depression, anxiety, and maladaptive coping; increased disease progression and cardiovascular mortality; and social phobia, living arrangement and sexual dysfunction. An improved understanding of sleep disturbance in the context of HIV will be beneficial in directing analysts to develop research plans. At the same time, the knowledge gaps identified in the analysis provided a solid basis for further study intending to fill in these gaps.

Keywords: HIV; concept analysis; insomnia; sleep disturbance.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Model of concept of sleep disturbance in the context of HIV.

References

    1. Abdu Z., Dule A. (2020). Poor quality of sleep among HIV-positive persons in Ethiopia [article]. HIV/AIDS – Research and Palliative Care, 12(2020), 621–628. 10.2147/HIV.S279372
    1. Alikhani M., Ebrahimi A., Farnia V., Khazaie H., Radmehr F., Mohamadi E., Davarinejad O., Dürsteler K., Sadeghi Bahmani D., Brand S. (2020). Effects of treatment of sleep disorders on sleep, psychological and cognitive functioning and biomarkers in individuals with HIV/AIDS and under methadone maintenance therapy [article]. Journal of Psychiatric Research, 130(2020), 260–272. 10.1016/j.jpsychires.2020.07.043
    1. American Academy of Sleep Medicine. (2014a).
    1. American Academy of Sleep Medicine. (2014b). International classification of sleep disorders (3rd ed.). American Academy of Sleep Medicine.
    1. Aouizerat B. E., Byun E., Pullinger C. R., Gay C., Lerdal A., Lee K. A. (2021). Sleep disruption and duration are associated with variants in genes involved in energy homeostasis in adults with HIV/AIDS [article]. Sleep Medicine, 82(2021), 84–95. 10.1016/j.sleep.2020.08.028
    1. Azimi H., Gunnarsdottir K. M., Sarma S. V., Gamaldo A. A., Salas R. M. E., Gamaldo C. E. (2020). Identifying Sleep Biomarkers to Evaluate Cognition in HIV. Annual International Conference IEEE Engineering in Medicine and Biology Society 2020, 2332–2336. 10.1109/EMBC44109.2020.9176592
    1. Babson K. A., Heinz A. J., Bonn-Miller M. O. (2013). HIV Medication adherence and HIV symptom severity: The roles of sleep quality and memory. AIDS Patient Care and STDs, 27(10), 544–552. 10.1089/apc.2013.0221
    1. Balthazar M. S., Webel A., Gary F., Burant C. J., Totten V. Y., Voss J. G. (2021a). Sleep and immune function among people living with human immunodeficiency virus (HIV). AIDS Care, 33(9), 1196–1200. 10.1080/09540121.2020.1770180
    1. Balthazar M. S., Webel A., Gary F., Burant C. J., Totten V. Y., Voss J. G. (2021b). Sleep and immune function among people living with human immunodeficiency virus (HIV) [article]. AIDS Care – Psychological and Socio-Medical Aspects of AIDS/HIV, 33(9), 1196–1200. 10.1080/09540121.2020.1770180
    1. Bedaso A., Abraham Y., Temesgen A., Mekonnen N. (2020). Quality of sleep and associated factors among people living with HIV/AIDS attending ART clinic at Hawassa University comprehensive specialized Hospital, Hawassa, SNNPR, Ethiopia. PloS One, 15(6), e0233849. 10.1371/journal.pone.0233849
    1. Buchanan D. T., McCurry S. M., Eilers K., Applin S., Williams E. T., Voss J. G. (2018). Brief behavioral treatment for insomnia in persons living with HIV [article]. Behavioral Sleep Medicine, 16(3), 244–258. 10.1080/15402002.2016.1188392
    1. Burgess H. J., Williams B., Landay A., Engen P., Raeisi S., Naqib A., Fogg L. L., Keshavarzian A., Rasmussen H. E., Zhang X., Hamaker B., Green S. J. (2020). Sleep health should be included as a therapeutic target in the treatment of HIV. AIDS Research and Human Retroviruses, 36(8), 631. 10.1089/AID.2020.0094
    1. Campbell R., Vansteenkiste M., Delesie L., Soenens B., Tobback E., Vogelaers D., Mariman A. (2019). The role of basic psychological need satisfaction, sleep, and mindfulness in the health-related quality of life of people living with HIV. Journal of Health Psychology, 24(4), 535–545. 10.1177/1359105316678305
    1. Chaponda M., Aldhouse N., Kroes M., Wild L., Robinson C., Smith A. (2018). Systematic review of the prevalence of psychiatric illness and sleep disturbance as co-morbidities of HIV infection in the UK. Int J STD AIDS, 29(7), 704–713. 10.1177/0956462417750708
    1. Chen Y. C., Chen C. C., Strollo P. J., Jr., Li C. Y., Ko W. C., Lin C. Y., Ko N. Y. (2021). Differences in sleep disorders between HIV-infected persons and matched controls with sleep problems: A matched-cohort study based on laboratory and survey data. Journal of Clinical Medicine, 10(21), 5206. 10.3390/jcm10215206
    1. Chenxi N., Xiaoxiao C., Haijiang L., Xiaotong Q., Yuanyuan X., Weiwei S., Dan Z., Na H., Yingying D. (2019). Characteristics of sleep disorder in HIV positive and HIV negative individuals: A cluster analysis [article]. Chinese Journal of Endemiology, 40(5), 499–504. 10.3760/cma.j.issn.0254-6450.2019.05.002
    1. Cody S. L., Fazeli P. L., Crowe M., Kempf M. C., Moneyham L., Stavrinos D., Vance D. E., Heaton K. (2020). Effects of speed of processing training and transcranial direct current stimulation on global sleep quality and speed of processing in older adults with and without HIV: A pilot study [article]. Applied Neuropsychology. Adult, 27(3), 267–278. 10.1080/23279095.2018.1534736
    1. Cody S. L., Hobson J. M., Gilstrap S. R., Gloston G. F., Riggs K. R., Justin Thomas S., Goodin B. R. (2021). Insomnia severity and depressive symptoms in people living with HIV and chronic pain: associations with opioid use. AIDS Care, 1–10. 10.1080/09540121.2021.1889953
    1. Cormier R. E. (1990). Sleep disturbances. In Walker H. K., Hall W. D., Hurst J. W. (Eds.), Clinical methods: the history, physical, and laboratory examinations. Butterworths Copyright © 1990, 398–403. Butterworth Publishers, a division of Reed Publishing.
    1. Costa M., Rojas T. R., Lacoste D., Villes V., Aumaitre H., Protopopescu C., Yaya I., Wittkop L., Krause J., Salmon-Ceron D., Marcellin F., Sogni P., Carrieri M. P., Group A. C. H. S. (2019). Sleep disturbances in HIV-HCV coinfected patients: Indications for clinical management in the HCV cure era (ANRS CO13 HEPAVIH cohort). European Journal of Gastroenterology and Hepatology, 31(12), 1508–1517. 10.1097/MEG.0000000000001441
    1. Daubert E., French A. L., Burgess H. J., Sharma A., Gustafson D., Cribbs S. K., Weiss D. J., Ramirez C., Konkle-Parker D., Kassaye S., Weber K. M. (2022). Association of poor sleep with depressive and anxiety symptoms by HIV disease Status: women’s interagency HIV study. Journal of Acquired Immune Deficiency Syndromes, 89(2), 222–230. 10.1097/QAI.0000000000002847
    1. De Francesco D., Sabin C. A., Winston A., Mallon P. W. G., Anderson J., Boffito M., Doyle N. D., Haddow L., Post F. A., Vera J. H., Sachikonye M., Redline S., Kunisaki K. M. (2021a). Agreement between self-reported and objective measures of sleep in people with HIV and lifestyle-similar HIV-negative individuals. AIDS (London, England), 35(7), 1051–1060. 10.1097/QAD.0000000000002852
    1. De Francesco D., Sabin C. A., Winston A., Mallon P. W. G., Anderson J., Boffito M., Doyle N. D., Haddow L., Post F. A., Vera J. H., Sachikonye M., Redline S., Kunisaki K. M. (2021b). Agreement between self-reported and objective measures of sleep in people with HIV and lifestyle-similar HIV-negative individuals [article]. AIDS (London, England), 35(7), 1051–1060. 10.1097/QAD.0000000000002852
    1. De Francesco D., Sabin C. A., Winston A., Rueschman M. N., Doyle N. D., Anderson J., Vera J. H., Boffito M., Sachikonye M., Mallon P. W. G., Haddow L., Post F. A., Redline S., Kunisaki K. M. (2021c). Sleep health and cognitive function among people with and without HIV: The use of different machine learning approaches. Sleep, 44(8), 1–13. 10.1093/sleep/zsab035
    1. Ding Y., Lin H., Zhou S., Wang K., Li L., Zhang Y., Yao Y., Gao M., Liu X., He N. (2018). Stronger association between insomnia symptoms and shorter telomere length in old HIV-infected patients compared with uninfected individuals. Aging and Disease, 9(6), 1010–1019. 10.14336/AD.2018.0204
    1. dos Santos I. K., de Azevedo K. P. M., Melo F. C. M., de Lima K. K. F., Pinto R. S., Dantas P. M. S., de Medeiros H. J., Knackfuss M. I. (2018). Lifestyle and sleep patterns among people living with and without HIV/AIDS [article]. Revista da Sociedade Brasileira de Medicina Tropical, 51(4), 513–517. 10.1590/0037-8682-0235-2017
    1. Downing M. J., Millar B. M., Hirshfield S. (2020). Changes in sleep quality and associated health outcomes among gay and bisexual men living with HIV. Behavioral Sleep Medicine, 18(3), 406–419. 10.1080/15402002.2019.1604344
    1. Duncan C., Cloutier J. D., Bailey P. H. (2007). Concept analysis: The importance of differentiating the ontological focus. Journal of Advanced Nursing, 58(3), 293–300. 10.1111/j.1365-2648.2007.04277.x
    1. Faraut B., Malmartel A., Ghosn J., Duracinsky M., Leger D., Grabar S., Viard J. P. (2018a). Sleep disturbance and total sleep time in persons living with HIV: A cross-sectional study [article]. AIDS and Behavior, 22(9), 2877–2887. 10.1007/s10461-018-2179-1
    1. Faraut B., Malmartel A., Ghosn J., Duracinsky M., Leger D., Grabar S., Viard J. P. (2018b). Sleep disturbance and total sleep time in persons living with HIV: A cross-sectional study. AIDS and Behavior, 22(9), 2877–2887. 10.1007/s10461-018-2179-1
    1. Faraut B., Tonetti L., Malmartel A., Grabar S., Ghosn J., Viard J. P., Natale V., Leger D. (2021). Sleep, prospective memory, and immune status among people living with HIV. International Journal of Environmental Research and Public Health, 18(2), 1–15. 10.3390/ijerph18020438
    1. Fekete E. M., Williams S. L., Skinta M. D. (2018). Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV. Psychology & Health, 33(3), 398–415. 10.1080/08870446.2017.1357816
    1. González-Tomé M. I., García-Navarro C., Ruiz-Saez B., Sainz T., Jiménez De Ory S., Rojo P., Mellado Peña M. J., Prieto L., Muñoz-Fernandez M. A., Zamora B., Cuéllar-Flores I., Velo C., Martin-Bejarano M., Ramos J. T., Navarro Gómez M. L. (2018). Sleep profile and self-reported neuropsychiatric symptoms in vertically HIV-infected adolescents on cART [article]. Journal of Pediatric Infectious Diseases, 13(4), 300–307. 10.1055/s-0038-1673416
    1. Gutierrez J., Tedaldi E. M., Armon C., Patel V., Hart R., Buchacz K. (2019). Sleep disturbances in HIV-infected patients associated with depression and high risk of obstructive sleep apnea [article]. SAGE Open Medicine, 7(2019), 1–11. 10.1177/2050312119842268
    1. Han S., Hu Y., Pei Y., Zhu Z., Qi X., Wu B. (2021). Sleep satisfaction and cognitive complaints in Chinese middle-aged and older persons living with HIV: The mediating role of anxiety and fatigue. AIDS Care, 33(7), 929–937. 10.1080/09540121.2020.1844861
    1. Happe S. (2020). HIV Infection and sleep disturbances [review]. Nervenheilkunde, 39(9), 548–550. 10.1055/a-1213-6750
    1. Hixon B., Burgess H. J., Wilson M. P., MaWhinney S., Jankowski C. M., Erlandson K. M. (2020). A supervised exercise intervention fails to improve subjective and objective sleep measures among older adults with and without HIV. HIV Res Clin Pract, 21(5), 121–129. 10.1080/25787489.2020.1839708
    1. Horne J. (1988). Why we sleep: the functions of sleep in humans and other mammals In (pp. 310–311). Oxford University Press.
    1. Huang F., Chen W. T., Shiu C. S., Sun W., Radaza A., Toma L., . . . Ah-Yune J. (2021). Physical symptoms and sleep disturbances activate coping strategies among HIV-infected Asian Americans: a pathway analysis. AIDS Care, 33(9), 1201–1208. 10.1080/09540121.2021.1874270
    1. Knafl K. A., Deatrick J. A. (2000). Knowledge synthesis and concept development in nursing. In Rodgers B. L., Knafl K. A. (Eds.), Concept development in nursing: foundations, techniques, and applications (2nd ed., pp. 39–53). Saunders.
    1. Leone M. J., Sun H., Boutros C. L., Liu L., Ye E., Sullivan L., Thomas R. J., Robbins G. K., Mukerji S. S., Westover M. B. (2021). HIV Increases sleep-based brain age despite antiretroviral therapy. Sleep, 44(8), 1–9. 10.1093/sleep/zsab058
    1. Low Y., Goforth H. W., Omonuwa T., Preud‘homme X., Edinger J., Krystal A. (2012). Comparison of polysomnographic data in age-, sex- and axis I psychiatric diagnosis matched HIV-seropositive and HIV-seronegative insomnia patients. Clinical Neurophysiology, 123(12), 2402–2405. 10.1016/j.clinph.2012.05.004
    1. Luu B. R., Nance R. M., Delaney J. A. C., Ruderman S. A., Heckbert S. R., Budoff M. J., Mathews W. C., Moore R. D., Feinstein M. J., Burkholder G. A., Eron J. J., Mugavero M. J., Saag M. S., Kitahata M. M., Crane H. M., Whitney B. M. (2022). Insomnia and risk of myocardial infarction among people with HIV. Journal of Acquired Immune Deficiency Syndromes, 90(1), 50–55. 10.1097/QAI.0000000000002910
    1. Mahmood Z., Hammond A., Nunez R. A., Irwin M. R., Thames A. D. (2018). Effects of sleep health on cognitive function in HIV + and HIV- adults. Journal of the International Neuropsychological Society, 24(10), 1038–1046. 10.1017/S1355617718000607
    1. Meleis A. I. (2012). Theory: metaphors, symbols, definitions. In Theoretical nursing: development & progress (5th ed., pp. 23–38). Wolters Kluwer/Lippincott Williams & Wilkins. P
    1. Milinkovic A., Singh S., Simmons B., Pozniak A., Boffito M., Nwokolo N. (2020). Multimodality assessment of sleep outcomes in people living with HIV performed using validated sleep questionnaires. International Journal of STD & AIDS, 31(10), 996–1003. 10.1177/0956462420941693
    1. Moore S. E., Voss J. G., Webel A. R. (2020). Sex-Based differences in plasma cytokine concentrations and sleep disturbance relationships among people living with HIV. Journal of the Association of Nurses in AIDS Care, 31(2), 249–254. 10.1097/JNC.0000000000000125
    1. Najafi A., Mahboobi M., Sadeghniiat Haghighi K., Aghajani F., Nakhostin-Ansari A., Soltani S., Jafarpour A., Afsar Kazerooni P., Bazargani M., Ghodrati S., Akbarpour S. (2021). Sleep disturbance, psychiatric issues, and employment status of Iranian people living with HIV [article]. BMC Research Notes, 14(1), 338. 10.1186/s13104-021-05755-w
    1. Ning C., Lin H., Chen X., Qiao X., Xu X., Xu X., Shen W., Liu X., He N., Ding Y. (2020). Cross-sectional comparison of various sleep disturbances among sex- and age-matched HIV-infected versus HIV-uninfected individuals in China. Sleep Medicine, 65(2020), 18–25. 10.1016/j.sleep.2019.06.020
    1. Nogueira L. F. R., da Fonseca T. C., Paterlini P. H., Duarte A. S., Pellegrino P., Barros C., Moreno C. R. C., Marqueze E. C. (2019). Influence of nutritional status and gastrointestinal symptoms on sleep quality in people living with HIV. International Journal of STD & AIDS, 30(9), 885–890. 10.1177/0956462419846723
    1. Ogunbajo A., Restar A., Edeza A., Goedel W., Jin H., Iwuagwu S., Williams R., Abubakari M. R., Biello K., Mimiaga M. (2020). Poor sleep health is associated with increased mental health problems, substance use, and HIV sexual risk behavior in a large, multistate sample of gay, bisexual and other men who have sex with men (GBMSM) in Nigeria, Africa [article]. Sleep Health, 6(5), 662–670. 10.1016/j.sleh.2020.02.010
    1. Pujasari H., Culbert G. J., Levy J. A., Steffen A., Carley D. W., Kapella M. C. (2020). Prevalence and correlates of insomnia in people living with HIV in Indonesia: A descriptive, cross-sectional study. Journal of the Association of Nurses in AIDS Care, 31(5), 606–614. 10.1097/JNC.0000000000000192
    1. Pujasari H., Levy J., Culbert G., Steffen A., Carley D., Kapella M. (2021). Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 33(1), 39–46. 10.1080/09540121.2020.1748868
    1. Redman K. N., Karstaedt A. S., Scheuermaier K. (2018). Increased CD4 counts, pain and depression are correlates of lower sleep quality in treated HIV positive patients with low baseline CD4 counts [article]. Brain, Behavior, and Immunity, 69(2018), 548–555. 10.1016/j.bbi.2018.02.002
    1. Ren J., Zhao M., Liu B., Wu Q., Hao Y., Jiao M., Qu L., Ding D., Ning N., Kang Z., Liang L., Liu H., Zheng T. (2018). Factors associated with sleep quality in HIV. Journal of the Association of Nurses in AIDS Care, 29(6), 924–931. 10.1016/j.jana.2018.04.006
    1. Robbins J. L., Phillips K. D., Dudgeon W. D., Hand G. A. (2004). Physiological and psychological correlates of sleep in HIV infection. Clinical Nursing Research, 13(1), 33–52. 10.1177/1054773803259655
    1. Rodgers B. L. (2000). Concept analysis: an evolutionary view. In Rodgers B. L., Knafl K. A. (Eds.), Concept development in nursing: foundations, techniques, and applications (2nd ed., pp. 77–102). Saunders.
    1. Rodgers B. L., Knaf L. A. (2000). Applications and future directions for concept development in nursing. In Rodgers B. L., Knafl K. A. (Eds.), Concept development in nursing: foundations, techniques, and applications (2nd ed., pp. 401–409). PA Saunders.
    1. Rogers B. G., Bainter S. A., Smith-Alvarez R., Wohlgemuth W. K., Antoni M. H., Rodriguez A. E., Safren S. A. (2021). Insomnia, health, and health-related quality of life in an urban clinic sample of people living with HIV/AIDS. Behavioral Sleep Medicine, 19(4), 516–532. 10.1080/15402002.2020.1803871
    1. Rogers B. G., Lee J. S., Bainter S. A., Bedoya C. A., Pinkston M., Safren S. A. (2020). A multilevel examination of sleep, depression, and quality of life in people living with HIV/AIDS. Journal of Health Psychology, 25(10-11), 1556–1566. 10.1177/1359105318765632
    1. Sabin C. A., Harding R., Doyle N., Redline S., de Francesco D., Mallon P. W. G., Post F. A., Boffito M., Sachikonye M., Geressu A., Winston A., Kunisaki K. M. (2020). Associations between widespread pain and sleep quality in people with HIV. Journal of Acquired Immune Deficiency Syndromes, 85(1), 106–112. 10.1097/QAI.0000000000002410
    1. Santos I. K. D., Azevedo K. P. M., Melo F. C. M., Lima K. K. F., Pinto R. S., Dantas P. M. S., Medeiros H. J., Knackfuss M. I. (2018). Lifestyle and sleep patterns among people living with and without HIV/AIDS. Revista da Sociedade Brasileira de Medicina Tropical, 51(4), 513–517. 10.1590/0037-8682-0235-2017
    1. Shi Y., Yang C., Xu L., He Y., Wang H., Cao J., Wen M., Chen W., Wu B., Chen S., Chen H. (2020). CD4 + T Cell count, sleep, depression, and anxiety in people living with HIV: A growth curve mixture modeling. Journal of the Association of Nurses in AIDS Care, 31(5), 535–543. 10.1097/JNC.0000000000000112
    1. Shikuma C. M., Kohorn L., Paul R., Chow D. C., Kallianpur K. J., Walker M., Souza S., Gangcuangco L. M. A., Nakamoto B. K., Pien F. D., Duerler T., Castro L., Nagamine L., Soll B. (2018). Sleep and neuropsychological performance in HIV + subjects on efavirenz-based therapy and response to switch in therapy [article]. HIV Clinical Trials, 19(4), 139–147. 10.1080/15284336.2018.1511348
    1. Sun-Suslow N., Campbell L. M., Tang B., Fisher A. C., Lee E., Paolillo E. W., Moore R. C.. (2022). Use of digital health technologies to examine subjective and objective sleep with next-day cognition and daily indicators of health in persons with and without HIV. Journal of Behavioral Medicine, 45(1), 62–75. 10.1007/s10865-021-00233-x
    1. Taibi D. M. (2013). Sleep disturbances in persons living with HIV. Journal of the Association of Nurses in AIDS Care, 24(1 Suppl), S72–S85. 10.1016/j.jana.2012.10.006
    1. Taibi D. M., Price C., Voss J. (2013). A pilot study of sleep quality and rest-activity patterns in persons living with HIV. Journal of the Association of Nurses in AIDS Care, 24(5), 411–421. 10.1016/j.jana.2012.08.001
    1. Thorarinsdottir E. H., Bjornsdottir E., Benediktsdottir B., Janson C., Gislason T., Aspelund T., Kuna S. T., Pack A. I., Arnardottir E. S. (2019). Definition of excessive daytime sleepiness in the general population: feeling sleepy relates better to sleep-related symptoms and quality of life than the epworth sleepiness scale score. Results from an epidemiological study. Journal of Sleep Research, 28(6), e12852. 10.1111/jsr.12852
    1. Venkataraman A., Zhuang Y., Marsella J., Tivarus M. E., Qiu X., Wang L., Zhong J., Schifitto G. (2021). Functional MRI correlates of sleep quality in HIV. Nature and Science of Sleep, 13(2021), 291–301. 10.2147/NSS.S291544
    1. Voss J. G., Barroso J., Wang T. (2021). A critical review of symptom management nursing science on HIV-related fatigue and sleep disturbance. International Journal of Environmental Research and Public Health, 18(20), 1–18. 10.3390/ijerph182010685
    1. Wang N., Wang M., Xin X., Zhang T., Wu H., Huang X., Liu H. (2021). Exploring the relationship between anxiety, depression, and sleep disturbance among HIV patients in China from a network perspective [article]. Frontiers in Psychiatry, 12(2021), 1–10. 10.3389/fpsyt.2021.764246
    1. Yan D. Q., Huang Y. X., Chen X., Wang M., Li J., Luo D. (2021). Application of the Chinese version of the Pittsburgh sleep quality Index in people living with HIV: preliminary reliability and validity. Frontiers in Psychiatry, 12(2021), 676022. 10.3389/fpsyt.2021.676022
    1. Zhang Q. Q., Li L., Zhong B. L. (2021). Prevalence of insomnia symptoms in older chinese adults during the COVID-19 pandemic: A meta-analysis. Front Med (Lausanne ), 8, 779914. 10.3389/fmed.2021.779914

Source: PubMed

Подписаться