Non-pharmacological interventions to improve sleep quality among people living with HIV: a systematic review and meta-analysis

Abstract

Abstract Background Sleep disturbances are highly prevalent among people living with HIV (PLWH) and are associated with poor quality of life, suboptimal treatment adherence, and adverse clinical outcomes. Non-pharmacological interventions are increasingly recommended as scalable, low-risk strategies, but their effectiveness in PLWH has not previously been quantitatively synthesized. This review aimed to systematically synthesize this evidence and, where studies were sufficiently comparable, to quantify the pooled effect. Methods This systematic review and meta-analysis followed PRISMA 2020 guidelines. Ten electronic databases were searched from inception to October 2025 for randomized and non-randomized studies assessing sleep outcomes (PSQI, ISI, actigraphy, or polysomnography) in PLWH. Two reviewers independently screened studies and extracted data; risk of bias was assessed by design (RoB 2.0 for randomized trials; JBI tools otherwise), judged by domain rather than a single score. Because the eleven eligible studies differed substantially in comparator structure and outcome instrument, quantitative synthesis was restricted a priori to studies with comparable controlled post-intervention PSQI data; remaining evidence was synthesized narratively. Results Eleven studies met eligibility criteria. Three randomized trials (Molavi 2020, Qi 2024, Wen 2025; N = 187) had comparable PSQI data and were pooled using a random-effects model. The pooled Hedges g was − 1.38 (95% CI − 1.78 to − 0.99; I² = 27.5%); a Hartung-Knapp sensitivity check, which is more appropriate for a small number of studies, gave a wider but still significant interval (− 2.31 to − 0.48). Leave-one-out analysis retained the direction and significance of the effect after omitting any single study. A study with a mixed pharmacological comparator and studies reporting non-PSQI outcomes were synthesized narratively rather than pooled. With only three pooled studies, publication bias could not be reliably assessed. Conclusions Among studies with comparable PSQI data, non-pharmacological interventions were associated with a statistically significant improvement in subjective sleep quality. This pooled evidence base is small (k = 3) and heterogeneous in intervention type; no single category can be established as superior. Findings should be regarded as preliminary pending larger, standardized trials. Trial registration This review is registered with PROSPERO (CRD420251176879).

The authors' abstract, as published at the source. BMC Public Health, 2026 · DOI ↗