A supervised exercise intervention fails to improve subjective and objective sleep measures among older adults with and without HIV

Figures & data

Table 1 Baseline participant characteristics

	People living with HIV (%), n = 28	Uninfected controls (%), n = 29	p value
Age in years (Mean, SD)	57.3 (5.7)	60.2 (6.8)	0.09
Male	25 (89)	28 (93)	0.67
Body mass index (Mean, SD)	27.2 (4.3)	29.4 (4.4)	0.06
Race/Ethnicity			0.38
White non-Hispanic	18 (64)	22 (76)	–
Black non-Hispanic	5 (18)	1 (3)	–
Hispanic/ Other	5 (18)	6 (21)	–
Employment			<0.01
Employed (Full time/ part time)	9 (32)	22 (76)	–
Retired, Disability, Unemployed	19 (68)	7 (24)	–
Education			<0.05
Bachelor’s degree or more	11 (39)	21 (72)	–
Some college/associates degree/ less	17 (61)	8 (28)	–
Substance use
Current smoker	4 (14)	3 (11)	0.71
Daily alcohol use	3 (11)	8 (28)	0.21
Daily marijuana use	7 (25)	0 (0)	<0.01
Illicit substances within the past 2 years	5 (18)	0 (0)	<0.05
Comorbidities			0.07
0 or 1	2 (7)	9 (31)	–
2 or 3	14 (43)	8 (28)	–
4 or more	14 (50)	12 (41)	–
CD4+ T-cell count cells/µL (mean, SD)	636.3 (291.8)	–	–
Efavirenz containing regimen	1	–	–
Sleep medication usage (weekly)	11 (39)	4 (14)	0.03
Years on antiretroviral therapy (mean, SD)	16.0 (7.7)	–	–
Years since HIV diagnosis (mean, SD)	23.7 (7.0)	–	–
PSQI (mean, SD)	8.4 (3.1)	6.9 (4.1)	0.12
PSQI (mean, SD)	7.1 (2.7)	5.9 (3.5)	0.17
Average total sleep time (mean, SD), minutes*	408.5 (95.8)	440.0 (56.0)	0.15
Average sleep efficiency (mean, SD), %*	88.7 (6.0)	91.8 (2.8)	0.02

SD, standard deviation; Comorbidities included high blood pressure, heart problems, stroke/transient ischemic attack, diabetes, thyroid problem, emphysema, sleep apnea, hepatitis; Pittsburgh Sleep Quality Index (PSQI); * available in 27 people with HIV and 26 controls at baseline.

Table 2 Differences in subjective and objective sleep measures at baseline and at completion of the 24-week exercise intervention

	People with HIV (estimate [95% CI])	Uninfected controls (estimate, [95% CI])	Difference (estimate, [95%CI])	p-value
PSQI Baseline Week 24	N = 28 7.1 (6.1, 8.1) 7.2 (6.0, 8.5) p = 0.80	N = 29 5.9 (4.6, 7.3) 5.3 (4.2, 6.4) p = 0.25	1.2 (–0.5, 2.8) 2.0 (0.3, 3.6)	0.16 0.02
Total sleep time (min) Baseline Week 24	N = 20 425.9 (389.1, 462.6)) 403.8 (372.5, 435.0) p = 0.07	N = 21 435.9 (410.1, 461.6) 429.5 (404.3, 454.8) p = 0.71	−10.0 (–53.6, 33.5) −25.8 (–64.7, 13.2)	0.64 0.19
Sleep efficiency (%) Baseline Week 24	N = 20 90.3 (88.0, 92.6) 89.0 (86.1, 91.8) p = 0.06	N = 21 91.9 (90.5, 93.3) 91.9 (90.8, 93.0) p = 0.81	−1.6 (–4.2, 1.0) −2.9 (–5.9, 0.1)	0.22 0.06

Pittsburgh Sleep Quality Index (PSQI); 95% Confidence Interval; 95% CI.

Figure 1 Munich Chronotype Questionnaire (MCTQ) showing the sleep type as defined by midsleep (sleep onset + sleep duration/2) for all participants (top), the people with HIV (lower-left) and uninfected controls (lower-right). The people with HIV had a larger proportion of abnormal sleep types compared to uninfected controls. Data not present for all participants due to missing data or the use of an alarm clock on all days.

Table 3 Change in subjective and objective sleep parameters from baseline to week 24 in unadjusted and adjusted models

	Model A	Model B	Model C
PSQI
Change with Intervention	–0.3 [–1.0,0.4] p =0.45	NA	NA
Uninfected controls	NA	–0.7 [–1.6, 0.3] p =0.18	–0.4 [–1.5, 0.7] p = 0.47
PWH	NA	0.1 [0.8, 1.1] p = 0.78	0.4 [–0.7, 1.6] p = 0.45
Difference in change	NA	0.8 [0.6, 2.2] p = 0.26	0.8 [–2.2,0.6] p = 0.23
Week 24 difference by HIV Serostatus (REF: Controls)	NA	2.2 [0.6, 3.8] p = 0.006	2.2 [0.6, 3.8] p =0.006
Exercise intensity (REF: Moderate)	NA	NA	–0.5 [ −1.6, 0.5] p = 0.31
Total sleep time (minutes)
Change with intervention	–12.7 [–27.8, 2.4] p = 0.10	NA	NA
Uninfected controls	NA	–3.8 [–24.9, 17.3] p = 0.72	5.2 [–18.0, 28.4] p = 0.65
PWH	NA	–22.1 [–43.7, −0.5] p = 0.045	–11.7 [–36.2, 12.8] p = 0.34
Difference in change	NA	–18.3 [–48.5, 11.9] p = 0.23	–16.9 [–46.5, 12.6] p = 0.26
Week 24 difference by HIV Serostatus (REF: Controls)	NA	–24.5 [–64.5, 15.4] p = 0.23	–23.5 [–64.2, 17.2] p = 0.25
Exercise intensity (REF: Moderate)	NA	NA	–18.9 [–41.4, 3.6] p = 0.1
Sleep efficiency (%)
Change with intervention	–0.7 [ −1.5, 0.12] p = 0.09	NA	NA
Uninfected controls	NA	–0.1 [–1.2, 1.0] p = 0.82	–0.1 [–1.4, 1.2] p = 0.92
PWH	NA	–1.3 [–2.5, −0.1] p = 0.03	–1.2 (–2.6, 0.1) p = 0.08
Difference in change	NA	–1.2 [–2.8, 0.5] p = 0.16	–1.2 [–2.83, 0.48] p = 0.16
Week 24 difference by HIV Serostatus (REF: Controls)	NA	–2.8 [–5.4, −0.2] p = 0.038	–2.8 (–5.4, −0.1) p = 0.039
Exercise intensity (REF: Moderate)	NA	NA	–0.13 [–1.40, 1.13] p = 0.83

NA, not applicable to the model; PSQI, Pittsburg Sleep Quality Index; PWH, people with HIV.

Model A) change in the sleep outcomes with the exercise intervention, Model B) the same model allowing the intervention effect to change with HIV serostatus (time/serostatus interaction), and Model C) model B adjusted for exercise intensity.