Distúrbios do sono e qualidade de vida em pessoas com HIV

Abstract

People living with HIV (PLHIV) are particularly vulnerable to poor sleep quality, due to multiple factors, such as the disease itself, stigma and adverse events of antiretroviral therapy (ART). The general objective of the study was to determine the prevalence of sleep disorders in PLHIV and its impact on quality of life. This is a cross-sectional study, carried out at the infectious disease outpatient clinic of São José Hospital (SJH) in Fortaleza, Ceará. A sample of 385 PLHIV was calculated, selected by the non-probabilistic convenience strategy, being invited to participate in the study on the day of the routine consultation. Inclusion criteria were: male or female PLHIV, aged 18 years or older, on ART for at least three months. Exclusion criteria: pregnant women, incapacitating mental illness, homeless people and deprived of their freedom. Data collection occurred in the period of one year, through an interview in a private office, with an average duration of 20 minutes, using the instruments: 1. Sociodemographic, Epidemiological and Clinical Form for PLHIV; 2. Pittsburgh Sleep Quality Index (PSQI-BR); and 3. Quality of Life in PLHIV Assessment Instrument (WHOQOL-HIV-Bref). For data analysis, descriptive statistics, univariate and multivariate logistic regression analysis were performed, to determine the adjusted odds ratio (OR), precision (95% confidence interval - 95%CI) and significance of the estimate (Wald test). Two-tailed tests were used, with the level of significance established at 0.05 (5%), with P<0.05 being considered statistically significant. IBM SPSS Statistics software version 23.0 and R software version 4.0.3 were used for statistical procedures. The project was approved by the Research Ethics Committees of the Federal University of Ceará and SJH, respecting Resolution No. 466/2012 of the National Health Council. The results showed that the prevalence of sleep disorders in the sample was 43.38% (95% confidence interval: 38.43%- 48.33%). In the multivariate analysis, only the fact of having children (P=0.0054; OR=1.91; 95%CI=1.21-3.01), having eight years or less of study (P=0.0013; OR=2.11; 95%CI=1.34-3.34) and not practicing regular physical exercise (P=0.0001; OR=2.61; 95%CI=1.61-4.23), constituted independent factors associated with the occurrence of sleep disorders in PLHIV. When assessed the general perception of people with HIV about quality of life using the WHOQOL-HIV-Bref instrument (question 1), categorizing it as satisfactory (answers: 4-good, 5-very good) and unsatisfactory (answers: 1-very bad, 2- bad, 3-neither bad nor good), there was a prevalence of 34.80% of unsatisfactory quality of life. In multivariate logistic regression analysis, monthly income less than or equal to one minimum wage (P<0.0001; OR=3.19; 95%CI=1.87-5.45), not practicing regular physical exercise (P=0.0032; OR=2.27; 95%CI=1.32-3.92), having sleep disorders (P=0.0039; OR=2.04; 95%CI=1.26-3.31) and being unemployed, were independent factors associated with unsatisfactory quality of life. As for the median scores of the WHOQOL-HIV-Bref instrument, the perception of quality of life in domains II (Psychological), III (Level of Independence) and V (Environment) was considered intermediate, and higher in domains I (Physical), Domain IV (Social Relations) and Domain VI (Spirituality/Religion/Beliefs). It was concluded that 43.38% of PLHIV in the sample had sleep disorders, especially those with children, eight years or less of study and who did not practice regular physical exercise. In the analysis of quality of life, 34.80% of PLHIV had an unsatisfactory perception, especially those with monthly income less than or equal to a minimum wage, unemployed, without regular practice of physical exercise and with sleep disorders. The domains of the WHOQOL-HIV-Bref instrument most affected were II, III and V, in which the perception of quality of life was considered to be intermediate.