A study in Nanning, China, found that mood symptoms accounted for much of the association between sleep quality and well-being among people living with HIV.
Researchers surveyed 426 adults living with HIV who attended outpatient clinics at two hospitals in Nanning between January and September 2024. Participants reported their sleep quality, depressive symptoms, anxiety symptoms and health-related quality of life using established questionnaires.
After accounting for demographic and clinical factors, higher sleep-quality scores were associated with better quality of life. In mediation analyses, depression accounted for an estimated 80.57% of the overall association and anxiety for 32.96%. The association was stronger among participants with rural household registration, but that subgroup finding was exploratory.
How sleep and mood were linked
Each one-point increase in the sleep-quality score was associated with a 1.59-point increase in the health-related quality-of-life score after adjustment for sociodemographic and clinical factors, with a 95% confidence interval of 1.03 to 2.14. The relationship was approximately linear: better reported sleep was linked to better quality of life.
The researchers' mediation analysis estimated that depressive symptoms accounted for 80.57% of the total association between sleep quality and quality of life, while anxiety symptoms accounted for 32.96%. These percentages describe statistical pathways in the study; they do not establish that sleep problems cause depression or anxiety. The sleep-quality and quality-of-life association appeared stronger among people with rural household registration.
Evidence and caveats
This was a cross-sectional study, meaning sleep, mood and quality of life were measured at one point rather than followed over time. It can identify associations and statistical pathways, but it cannot determine whether poor sleep leads to depression or anxiety, whether the direction is reversed, or whether another factor contributes to all three.
The study included 426 people attending outpatient clinics at two hospitals in Nanning, and relied on self-reported questionnaires, which may introduce recall or reporting bias. The results may not apply to people living with HIV elsewhere in China or to those not engaged in care. The researchers also noted that factors such as antiretroviral-treatment adherence, time since diagnosis and levels of social support were not measured, and that the rural-registration subgroup analysis was exploratory, did not adjust for multiple comparisons and needs replication in larger, multi-site studies.
// Source
Scientific Reports · 2026 · DOI: 10.1038/s41598-026-70354-3
Authors: Xin Xiao, Lu Pan, Wei Wei, Jun Zou, Jinping Huang, Huachun Zou
Institutions: Monash University, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Medical University, The Fourth People's Hospital, The Second Nanning People's Hospital, Riverside Hospital of Guangxi Zhuang Autonomous Region, Guilin Medical University, Ministry of Education, Melbourne Sexual Health Centre, Shanghai Public Health Clinical Center, Southwest Medical University
