The Influence of Sleep and Activity Patterns on Fatigue in Women with HIV/AIDS

Abstract

The cause of HIV-related fatigue is most likely multifactorial. When presented as a chief complaint, clinicians often include an assessment of stress level, depression, anemia, infection, and amount of sleep and activity. The empirical bases for these evaluations vary in their validity and implementation in clinical practice, but the basis for evaluating adequate amounts of sleep and activity currently lacks empirical research. The purpose of this study was to describe HIV seropositive women's sleep and activity patterns related to their fatigue experience. Sleep and activity were assessed with wrist actigraphy to obtain objective measures of total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hour activity rhythm, and naps. This sample of 100 women with HIV/AIDS averaged only 6.5 hours of sleep at night, and 45% of the sample napped. CD4 cell counts were unrelated to sleep and fatigue measures. Compared to the low-fatigue group, the women with high fatigue had significantly more difficulty falling asleep, more awakenings from nighttime sleep, poorer daytime functioning, and a higher frequency of depressive symptoms. Findings from this study provide clinicians with empirically based support for detailed clinical evaluations of sleep and activity patterns, as well as anxiety and depression, in clients who complain of fatigue. Findings also provide data for potential interventions to improve sleep and activity in persons living with HIV/AIDS and to reduce fatigue and depressive symptoms.

Types of Sleep Problems in Adults Living with HIV/AIDS

“…1 Adults living with a chronic illness are at higher risk for sleep problems, and depending on the definition, sleep problems are experienced by 30% to 100% of HIVpositive adults. [2][3][4][5][6][7][8][9] It is unclear what type of sleep problem adults with HIV experience, or whether their sleep disturbance is related to the infection itself or to the medical treatment and side effects of medications. Sleep disturbance is not only prevalent, but also one of the more intense and distressful symptoms experienced in this population.…”

CD4 Count and Physical Symptoms Among Urban African American Mothers with HIV: An Examination of the Role of Optimism and Depressive Symptoms

“…Cruess et al (2000) reported a link between lower levels of T-suppressor/cytotoxic cells and higher severity of physical health symptoms. Lee et al (2001) found evidence for a link between CD4 count and certain physical health symptoms (e.g., increased daytime sleepiness) among a sample characterized by low income and high rates of unemployment that included a relatively large percentage of African American women (58%). These findings, though limited in breadth, support the notion that physical health symptoms may be moderated by a third variable, including those examined in the current study: optimism and depressive symptoms.…”

“…Although not the primary focus of the study, Ashton and colleagues reported that individuals with lower CD4 counts reported more physical health symptoms at baseline and greater change in physical health symptoms over time. Alternatively, Lee et al (2001) reported that CD4 count was a less consistent predictor of physical health symptoms in their sample of women with HIV/AIDS. Specifically, CD4 count was not significantly related to ratings of general fatigue, a symptom associated with progression of illness and mortality among individuals with HIV/AIDS.…”

“…Although CD4 count is a primary marker of disease progression among individuals with HIV/AIDS and individuals with the illness have proven to be relatively reliable reporters of their own immune functioning (Boarts, Sledjeski, Bogart, & Delahanty, 2006), CD4 counts are an inconsistent predictor of physical health complaints in individuals with HIV/AIDS (Ashton et al, 2005;Lee, Portillo, & Miramontes, 2001;Wu et al, 1997). For example, Ashton et al (2005) reported a significant correlation between CD4 count and physical health symptoms in their primarily low-income, ethnically diverse sample of men and women with HIV/AIDS.…”

Improving Sleep for Hospitalized Antepartum Patients: A Non-Randomized Controlled Pilot Study

“…GSDS total scores can range from 0 (no sleep disturbance) to 147 (severe sleep disturbance). Scores above 42 are indicative of disturbed sleep in populations of women who work shifts, 27 women infected with the human immunodeficiency virus, 28 and women in treatment for breast cancer. 29 The Cronbach alpha coefficient in this sample was 0.72.…”