Fatigue and sleep disturbance in HIV-positive women: a qualitative and biomedical approach

J Clin Nurs. 2013 May;22(9-10):1262-9. doi: 10.1111/jocn.12012. Epub 2012 Dec 28.


Aims and objectives: This study explores how sleep and energy levels were affected in Chinese women diagnosed with HIV in China employing the Actiwatch actigraphy system to collect data on the women's sleep characteristics.

Background: The worldwide AIDS pandemic, a major impetus behind the recent focus on global aspects of health, is one area in which the behavioural and biomedical expertise of nursing science is sorely needed. In particular, few studies of HIV+ women have examined the association of HIV-related stress with sleep disturbance and fatigue. Especially, fatigue and sleep disturbances are a common complaint among people with HIV.

Design: A qualitative study with actigraphy device used.

Methods: In-depth interviews were conducted with 19 HIV+ women in Shanghai, China, from December 2009-March 2010 and within this group, nine of the women agreed to wear an Actiwatch actigraphy device for 72 hours.

Results: Two major themes emerged from the in-depth interviews are as follows: sleep disturbance and fatigue. Participants presented varying amounts of sleeplessness, and fatigue resulting from nightmares, worrying about whether to disclose their diagnosis, and whether they might transmit the disease to their partners or children. Among the nine Actiwatch study participants, data shown that those who experienced fragmented sleep also slept more during the daytime.

Conclusions: In this study, Chinese HIV+ women described how stress had caused them to become sleepless. The objective data collected via Actiwatch showed that these women required longer nap times, which indicates they did not have refreshing nocturnal sleep. Designing a culturally acceptable stress management intervention for these women is urgently needed.

Relevance to clinical practice: Sleep and fatigue level should be evaluated in each visit with HIV care. Nurses need to be trained in evaluating the HIV+ patients' sleep and fatigue status and refer them to psychologist and/or relaxation technique accordingly. Self-management intervention for HIV+ individuals should also include the sleep hygiene into consideration.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actigraphy
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Fatigue / complications*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / physiopathology
  • Humans
  • Middle Aged
  • Qualitative Research
  • Sleep Wake Disorders / complications*


  • Anti-HIV Agents