Sleep Quality by Reproductive Stage Among Women Living With HIV in the United States Enrolled in the Health Outcomes Around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) Study

BACKGROUND: Sleep quality significantly affects health. Despite evidence that women living with HIV experience higher rates of poor sleep quality than women who are HIV seronegative, few studies have explored sleep quality among women with HIV by reproductive stage. SETTING: HOPE is an observational study of women living with HIV (WLHIV) ages 18-45 years, enrolled at 14 sites across the United States and Puerto Rico. METHODS: At entry, participants reported reproductive stage as nulliparous, pregnant, within 1-year postpartum, or >1-year postpartum (parous). Participants completed the Brief Pittsburgh Sleep Quality Index (B-PSQI), with poor sleep quality defined as a score >5. Log-binomial models were fit to estimate poor sleep quality adjusted prevalence ratios (aPRs) by reproductive stage and predictors of poor sleep quality overall and within each reproductive stage. RESULTS: Of 689 participants completing the entry visit between August 2022 and February 2025, 500 (73%) had evaluable sleep quality data. Prevalence of poor sleep quality was highest among postpartum and parous women (54% and 53%, respectively), compared with nulliparous and pregnant women (48% and 44%, respectively). There was no difference in poor sleep quality prevalence by reproductive stage after adjusting for potential confounders. Screening positive for moderate/severe depression, moderate/severe anxiety, and/or post-traumatic stress disorder, as well as experiencing high perceived stress or homelessness, were associated with higher prevalence of poor sleep quality for all groups. CONCLUSIONS: Poor sleep quality was common in this cohort of WLHIV, regardless of reproductive stage. This work can inform interventions to improve sleep quality among WLHIV.