The current study showed that the prevalence of sleep disturbance among adult PLWHA was found to be 36% (95% CI: 31–41%). The proportion was higher among females 118 (78.1%). The finding of this study is in line with a study conducted in) and the USA, 40.93% (7), and China, 32.1%(9). It was lower than the study conducted in Nigeria 45.8% (14), Cameroun 66.7% (21), China 43.1% (8), Iran 47.5% (22), German 63% (23), Paris 68% (16) and 63% (24). The discrepancy was in socio-cultural characteristics, sampling methods, study setting, design, type of tool, and data collection methods. On the contrary, the finding of this study was higher than the study conducted in South Africa 16% (25). The possible reason for this discrepancy may be due to the former study used longitudinal follow up which may lead to loss to follow.
The current study revealed that sex was the determinant factor of sleep disturbance. Being female was 3.45 times more likely to develop sleep disturbance compared to their counterparts (AOR = 3.45, 95% CI; 1.52 − 7.79). In females, during the premenopausal/menopausal period, there was a hormonal imbalance of estrogen and progesterone that decreased the level of estrogen as well progesterone level which results in a two-fold increase in the number of arousals after sleep occurs this decreased total sleep time (26).
Participants having viral loads greater or equal to 1000copies /ml were nearly 7 times more likely to develop sleep disturbance compared to those clients having viral loads less than 1000 copies/ml (AOR = 6.88, 95% CI; 2.79–16.9). This is supported by a study conducted in California (10). High viral loads in the peripheral circulation enhance the HIV to enter into the central nervous system which activates macrophages and astrocytes (27) and consequently impaired their function which decreased the release of sleep regulatory substances(TNF-alpha) (28). Viral load increments associated with the disease progression to the chronic stage which changes sleep as more arousal and waking during sleep periods (29).
The odds of experiencing sleep disturbance among adult PLWHA who were WHO stage II&III was 4.29 times compared to those WHO stage I (AOR = 4.29, 95% CI; 1.05–17.53). This is supported by a study conducted in UAS (30). Having advanced WHO clinical stage may lead to developing opportunistic infections that impair sleep quality.
Participants having a CD4 cells counts less than 200 cells/mm3 were nearly 7 times more likely to develop sleep disturbance compared to those having CD4 cells count greater than 350 cells/mm3 (AOR = 6.85, 95% CI; 2.42–19.39). This is supported by a study conducted in Nigeria (5) and the USA (31). Immune decrements associated with HIV infection is directly linked to the psyche by a complex network of nerves, hormones, and neuropeptides. This network has a direct impact on sleep (14). It has been well documented that CD4 + cell count decreases, whereas viral load increases with the progression of HIV, consequently the quality of sleep worsens along the course of the disease, this related to CD4 + cell count and viral load as well (32).
Participants who had depression were 4.44 times more likely to develop sleep disturbance compared to those have no depression (AOR = 4.44, 95%CI; 1.95–10.10). This is supported by a study conducted in German (23) and five cities in the USA (7). Depression had a directional association between sleep disturbances (8). The reason is that in depression, the sleep-dependent component of sleep regulation is deficient and does not rise to its usual level. Due to this, the sleep amount of slow-wave sleep is reduced and the sleep period also shortened (33).
In the current study, participants who had anxiety were 10 times more likely to develop sleep disturbance compared to those participants with no anxiety (AOR = 10, 95% CI; 4.21–23.9). This is supported by a study conducted in China (8) and the USA (34). The reason is that, according to the polysomnographic features that characterize patients with anxiety have longer sleep onset latency, a greater number of arousals, and greater wake time during the night, fewer transitions into non-REM sleep (35).
In the present study, participants who lived alone had 6 times more likely to developed sleep disturbance compared to those living with their family (AOR = 6, 95% CI; 2.81–13.12). This is supported by a study conducted in the USA (36). Physical and social aspects of sleeping arrangements have been negatively affected the sleep quality (32). Better family and social support were associated with better sleep quality. Living with a supportive family can have a positive effect on mood, preventing social isolation, and promoting healthy sleep habits. Moreover, social support may help maintain a more consistent and consolidated sleep-wake schedule and may affect sleep by attenuating the effects of psychological stress on sleep (6, 37).
In the is study, participants who did not live in the separate bedrooms were nearly 4 times more like to develop sleep disturbance compared to those who lived in the separate bedrooms (AOR = 3.94, 95%CI; 1.86–8.36). This is supported by a study conducted in the USA (36). Sleep can be disrupted by a variety of factors related to the location of the bedroom in the house. Lack of separate bedrooms for sleep was predisposed to extra sound and light, sense of lack of security, exposure for bright room colures, image or art, lack of privacy were negatively influence on sleep quality (38).