Access Type

Open Access Dissertation

Date of Award

January 2013

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Hossein N. Yarandi

Abstract

SLEEP HOMEODYNAMICS AND WELLBEING IN ASYMPTOMATIC HIV–SEROPOSITIVE AFRICAN AMERICAN WOMEN

by

TABETHA LYNN GAYTON

December 2013

Advisor: Hossein N. Yarandi, PhD

Major: Nursing (Urban Health)

Degree: Doctor of Philosophy

BACKGROUND: HIV–related sleep disruption is a common complaint of persons with HIV infection. With the demographical shifts, African American women have now emerged as one of the fastest growing HIV populations today, yet they remain a vulnerable and underrepresented population in the sleep literature.

OBJECTIVE: The purpose of this pilot study was to explore the dynamics of HIV–related sleep disruption and wellbeing in asymptomatic HIV–seropositive AA women of childbearing age within the context of a holistic, theoretical substruction from Myra Levine’s Conservation Model (1967). The rationale for the proposed study was to provide a foundation of both the objective and subjective experience of HIV–related sleep disruption, which as a stressor can affect wellbeing.

METHODS: A descriptive correlational design was used to examine the immunological integrity, sleep/wake rhythm, sleep quality, daytime sleepiness, IL–6 rhythm, and quality of life in 20 asymptomatic HIV–seropositive African American women receiving care at Wayne State University Physicians Group Infectious Diseases Clinic in Detroit, MI. In this 4–day protocol, measures included CD4+ cell count, HIV RNA viral load, wrist actigraphy, Pittsburgh Sleep Quality Index, Subjective Sleep Quality Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, plasma IL–6, Quality of Life Index, and Quality of Life Visual Analogue Scale.

RESULTS: Both the objective and subjective experience of sleep demonstrated severe sleep disruption and disorganized sleep patterns. Nearly half (45%) of the sample slept < 6 hours per night, usually not falling asleep until sometime after 12 midnight. Objective daytime functioning was also disrupted with frequent dozing (> 9 sleep episodes) noted throughout the day. Self–reported daytime sleepiness was inconsistent with the objective assessment and was within normal limits. The sample's mean IL–6 level was 2.03 pg/mL, which is much lower than that reported in other asymptomatic samples or normal controls. Quality of life measures indicated a positive sense of wellbeing, but the daily pattern of quality of life was not associated with the daily pattern of sleep efficiency, subjective sleep quality, daytime sleepiness, or IL–6 levels when controlling for CD4+ cell count and HIV RNA viral load. And lastly, the 1–item quality of life scale showed agreement with the 66–item quality of life index using Bland–Altman agreement analysis, which may help in decreasing participant burden in clinical trials enrolling this population.

CONCLUSION: This sample suffered from severe HIV–related sleep disruption, as evidenced by an average sleep time of 6.4 hours per night and frequent dozing throughout the day. Despite this disruption, the sample perceived a positive sense of quality of life. These results provide further evidence that future studies exploring efforts to improve sleep and daytime functioning in asymptomatic HIV–seropositive African American women are essential in order to maintain quality of life and wellbeing in this population.

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