The Role of Sleep in Cardiovascular Health Among Men Living with HIV

Project Summary Cardiovascular disease (CVD) is a major health concern facing the U.S. population, with the impact of risk factors accumulating over the lifespan and beginning well before older age. Increasingly, the study of cardiovascular health for people living with HIV is vital given the growing number of middle- and older-aged adults living with HIV as a chronic condition and its complex effects on cardiovascular health directly, and indirectly through HIV's impact on inflammation. In the general population, poor or inadequate sleep has been linked with increased risk for CVD, in part through its impact on inflammation and other physiological mechanisms. In our own work, among sexual minority men living with HIV, poor sleep has also been linked with lower rates of adherence to antiretroviral (ART) medications. Therefore, the study of cardiovascular health among people living with HIV requires special consideration of the pathways from poor sleep through worsened HIV health to increased CVD risk both directly, and indirectly through inflammation (principally, IL-6, TNF-alpha, and CRP). Further, we hypothesize that, contributing to this larger picture of physiological pathways from sleep to CVD risk, is a day-level psychosocial-behavioral dynamic whereby experiences of minority stress affect subsequent ART adherence through the impact of minority stress on sleep. Accordingly, in the proposed observational, longitudinal study of 240 racially-diverse sexual minority men living with HIV, aged 45-64, we aim to use longitudinal data to test the hypotheses that poor sleep longitudinally predicts greater CVD risk among SMM-LWH aged 45-64, in part through the impact of poor sleep on HIV health, and in part through the impact of poor sleep on inflammation. Additionally, we aim to test the day-level hypothesis that the impact of multiple, intersecting sources of minority stress (sexual minority stress, racial/ethnic minority stress, and/or HIV-related stress) on next-day ART adherence in SMM-LWH operates, in part, through the day-level impact of minority stress on poor sleep. This proposed study aligns with the growing recognition of the importance of sleep in numerous mental, behavioral, and physical health outcomes, and also contributes to our understanding of how minority stress “gets under the skin” (here, through its impact on sleep) to affect physical health outcomes in individuals with marginalized identities.