Social Connectedness and Sleep Disturbance Among Hypertensive Adults with and without HIV in Botswana

Background. Sleep disturbance is common among adults with chronic conditions such as HIV and hypertension, yet whether subjective and structural dimensions of social connectedness relate to sleep similarly across HIV status and age remains unclear. We examined associations of loneliness and structural social integration with sleep disturbance among adults with and without HIV in Botswana, and whether HIV status and age jointly modify these associations. Methods. Cross-sectional survey data on sleep disturbance (PROMIS Sleep Disturbance scale), loneliness (UCLA Brief Loneliness Scale), and social integration (Berkman-Syme Social Network Index) were collected from 700 hypertensive adults in Botswana (400 with HIV; 300 HIV-negative); mean age = 53.2 years ( SD  = 13.6), 76% women. Multivariable linear and logistic regressions adjusted for age, sex, HIV-status, and non-HIV comorbidity burden; effect modification by HIV-status and age was examined. Results. Greater loneliness was associated with higher sleep disturbance ( B  = 5.32, 95% CI [4.40, 6.25]) and greater odds of moderate-to-severe sleep disturbance ( OR  = 3.40, [2.41, 4.81]). Greater social integration was associated with lower odds of moderate-to-severe sleep disturbance ( OR  = 0.80, [0.65, 0.99]). In exploratory analyses, social integration’s protective effect on clinically significant sleep disturbance appeared stronger among older HIV-negative adults than among older PWH. Conclusions. Loneliness is a robust correlate of sleep disturbance regardless of HIV status. Exploratory analyses showed sleep-related benefits of structural social integration may be attenuated among older PWH. This preliminary finding raises the possibility that expanding network size alone may be insufficient to protect sleep in aging PWH.