title: Sleep disturbance mediates the association between psychological distress and immune status among HIV-positive men and women on combination antiretroviral therapy.
abstract: OBJECTIVE
  This study examined the relationship between psychological distress, subjective sleep disturbance and immune status among HIV-positive men and women.
  
  
  METHODS
  Fifty-seven participants (41 men, 16 women) without AIDS-related illness and currently on combination antiretroviral therapy were recruited through community advertisement and physician referral. Participants completed the Impact of Events Scale (IES) to assess symptoms of psychological distress and the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep over the past month. T-lymphocyte subpopulations were also assessed from early morning blood samples.
  
  
  RESULTS
  Participants reporting greater psychological distress also reported more pronounced sleep disruption. Higher levels of distress and greater sleep disturbance were also significantly related to lower T-cytotoxic/suppressor (CD3+CD8+) cell counts. Path analysis revealed that the association between distress level and CD3+CD8+ cell counts was mediated by poorer subjective sleep quality.
  
  
  CONCLUSIONS
  These findings suggest that psychological distress may impact upon the immune system through its effects on sleep quality.
authors.affiliation: Department of Psychology, University of Pennsylvania, 3815 Walnut Street, Philadelphia 19104-6196, USA. dcruess@psych.upenn.edu
authors.forename: Dean G
authors.initials: DG
authors.lastname: Cruess
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Ron
authors.initials: R
authors.lastname: Duran
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D017252:CD3 Complex; D016827:CD8 Antigens; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000150:complications* / Q000523:psychology*; D013315:Stress, Psychological
chemical_list: D000998:Antiviral Agents; D017252:CD3 Complex; D016827:CD8 Antigens