Considering the main objective of the study which was to analyze the quality of sleep and to identify whether socioeconomic and clinical aspects are associated with the domains of sleep quality in people living with HIV/AIDS, there was a predominance of sleep quality rating as "poor". Moreover, some associations were found among the domains with gender, age, schooling, marital status and the use of antiretroviral therapy.
In this manner, the high prevalence of sleep quality classified as "poor" in PLHA is related to the confrontation of the disease condition, since the diagnosis of being HIV positive is associated with the need for chronic use of antiretroviral therapy, which promotes several changes that are directly related to psychological, physical and social aspects .
The knowledge of the influence of socioeconomic factors on sleep parameters is fundamental and complementary, since it is relevant to consider socioeconomic factors that may also interfere with sleep parameters, for example, the education level of the individuals with HIV may differentiate them in regards to the access of information and has great importance in health conditions; gender is another factor because women often have increased or impaired mental health variables (anxiety and depression); Marital status, because living with HIV means facing discrimination, breaking up relationships and sexual problems. Under such circumstances, living and coping with the disease becomes increasingly challenging and, as a consequence, the quality of sleep can suffer .
Sleep quality impairment and the presence of disorders in PLHA are common since the onset of infection, and that is because the central nervous system (CNS) may be an important target of infection [13-15], in which other factors may also be related such as: cognitive impairment, peripheral painful neuropathy, chronic fatigue, difficulty concentrating, depression, symptoms of inability to be productive during the day and unwillingness to perform healthy habits [15,17].
Detailing the results on the domains of sleep quality analyzed, we found relations between the subjective quality of sleep with gender. In view of this result, there is a greater impairment of the subjective quality of sleep in women that were included in this study; this relation has been pointed out in the literature, affirming that females show sleep interruption, being related to different psychological, cultural, social and environmental influences factors [10,18]. One of the possible explanations for this finding is based on the fact that the higher prevalence of changes such as the Metabolic Syndrome is observed in women and not in men, which is generally associated with greater accumulation of fat in the central region of the body, and this abdominal obesity leads to higher indices of body image dissatisfaction, contributing to a greater risk of developing psychological disorders, such as depression; and sleep disorders [19-20].
As for the domain Sleep latency, we can observe an association with the marital status, this factor can be explained by the fact that the group classified as "single" presents less time to fall asleep (latency), which is a positive characteristic when compared to those who are married.
It is known that sleep latency corresponds to difficulty in initiating or continuing to sleep, and these conditions may be related to the situations in which individuals face due to the state of tension and anxiety in their daily life, therefore, being on condition of chronic disease may increase this behavior . Thus, for these reasons, the literature also points out that PLHA present these disorders significantly, indicating "insufficient sleep" or "sleeping less than they would like to" [10,22]. However, there are unknown reports that point to the relation of poor sleep latency with being single, thus requiring that further studies be performed to clarify this association.
On the other hand, the usual efficiency component was associated with marital status, where the bachelors presented greater sleep efficiency or felt that the sleep period reached was enough; and with the use of HAART, indicating in this group greater sleep efficiency. There are contradictory reports on this aspect in the literature, since it is indicated that sleep problems are common in patients who are using HAART because they promote high prevalence of insomnia, complaints of daytime sleepiness. Furthermore, increased neck circumference and central obesity are potential risk factors for obstructive sleep apnea in patients with HIV undergoing HAART [23-25]. Another factor is the stress associated with HIV infection that can lead to the onset of insomnia. In addition, depression is common in the seropositive population, in which it is directly related to insomnia [13,26].
In particular, it has been elucidated that the use of Efavirenz, present in conventional combinations and in the widely prescribed 3-in-1 version, causes a number of physical and psychological manifestations that are related to sleep impairment of PLHA. As well as symptoms, such as fatigue, pain, nausea, depression associated with the stressful circumstances surrounding the diagnosis can also be adverse effects of HAART [27,28].
Another association found in the present study was between the sleep disorder domain and schooling, thus this association needs to be investigated later, since there is insufficient information in the literature that justifies if the low level of schooling in PLHA makes this population more predisposed to sleep disorders. However, the indicative of the present study for such result is that low educational level or low clarification on their health (disease) causes PLHA not to present characteristics that aid in the hygiene of sleep. Thus, the literature indicates that sleep hygiene refers to a set of measures and attitudes that point to a certain level of clarification, for example, it is necessary to know the different biological mechanisms regulating sleep; stimulate the regularity of sleeping and waking hours; know about the adverse effects of alcohol and stimulants like coffee and cigarette. It is necessary to take some care in regards to the place of sleep, such as adequate temperature and light, comfortable bed and nightwear, avoid watching television, reading or studying in bed. In addition to being extremely necessary the modification of lifestyle with the inclusion of healthy eating habits and practice of physical activity as a co-adjuvant in sleep stimulation, that is, clarification is needed to promote attitudes that favor good sleep quality .
Finally, the use of hypnotics or medications indicated to assist the individual in maintaining sleep was related to age, indicating that older individuals with HIV/AIDS included in this study used medications as a way to decrease sleep disorder and consequently symptoms of insomnia. In this sense, studies have elucidated that during adulthood there are reports of nights of disturbed sleep, linking this factor with modifications such as: age, stress and health problems. Therefore, pharmacotherapy, through prescription and over-the-counter (OTC) drugs, has been a common way of managing insomnia symptoms and this use is particularly high among older adults .
Poor quality of life related to sleep is associated with the risk of cardiovascular disease , β-amyloid accumulation in the brain suggests an increased risk of developing Alzheimer's  and makes the behavior more prone to developing obesity . Therefore, it is necessary to understand and address the mechanisms that promote the reduction of sleep quality.
When analyzing the existing limitations in this study we can point out the lack of information about specific types of drugs and antiretroviral therapy that PLHA used, since treatment with antiretroviral therapy is divided into four classes of inhibitors. The evaluation of the use of medication for psychiatric disorders for reasons other than depression and anxiety factor common in the population studied needs to be investigated so that there is a control of all medications used. Non-use of objective instruments to assess sleep quality such as polysomnography, which is a non-invasive test that measures the breathing, muscular and cerebral activity of the individuals during sleep, and the apparatus actimetro that records levels of activity and rest. Another limitation was the sample size and the regional character of the study, which limits extrapolating the results to other populations. In addition, there is a need for longitudinal studies that assess the quality of sleep of people living with HIV/AIDS.
In the present study most of the population had poor sleep quality. However, women living with HIV, single and with a low level of education, had the highest scores in the assessed sleep quality domains. In view of these findings, it is important to mention that the observation of sleep quality and all its components is a useful tool in the comprehensive evaluation of patients living with HIV, since sleep is such an important element for the general health of these subjects.