Abstract
Emerging evidence links poor sleep health with a range of adverse health behaviors, including condomless anal intercourse (CAI) among men who have sex with men (MSM). We tested associations between a range of sleep health indicators and sex outcomes in an online sample of 559 MSM in Paris France, recruited from a geosocial-networking phone application. Participants reported on sleep quality, sleep duration, problems falling asleep, and problems staying awake during wake-time activities, and four sex outcomes: numbers of receptive, insertive, and total CAI partners in the past three months, and use of substances before or during sex. In bivariate analyses, all four sleep variables were associated with the three CAI outcomes, whereas poor sleep quality and problems falling asleep were positively associated with using substances before or during sex. Most of these associations remained significant when adjusting for various socio-demographic and behavioral covariates. These findings highlight the importance of addressing sleep health to prevent HIV risk among MSM.
Resumen
La evidencia emergente relaciona la mala salud del sueño con una variedad de comportamientos de salud adversos, incluyendo el sexo anal sin condón entre hombres que tienen sexo con hombres (HSH). Examinamos asociaciones entre una variedad de indicadores de salud del sueño y resultados sexuales en un grupo de 559 HSH en París, Francia, reclutados en una aplicación telefónica de redes geosociales. Los participantes reportaron la calidad del sueño, la duración del sueño, los problemas para conciliar el sueño y los problemas para mantenerse despiertos durante las actividades del despertar, y cuatro resultados sexuales: número de parejas receptivas (pasivas), activas, y totales de sexo anal sin condón, y uso de sustancias antes o durante el sexo. En los análisis bivariados, las cuatro variables del sueño se asociaron positivamente con los tres resultados de sexo anal sin condón, mientras que la mala calidad del sueño y los problemas de conciliar el sueño se asociaron positivamente con el uso de sustancias antes o durante el sexo. La mayoría de estas asociaciones siguieron siendo significativas cuando ajustamos para diversas covariables sociodemográficas y conductuales. Estos resultados destacan la importancia de abordar la salud del sueño para prevenir el riesgo de VIH entre HSH.
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References
Fillo J, Alfano CA, Paulus DJ, et al. Emotion dysregulation explains relations between sleep disturbance and smoking quit-related cognition and behaviour. Addict Behav. 2016;57:6–12.
Hogenkamp PS, Nilsson E, Nilsson VC, et al. Acute sleep deprivation increases portion size and affects food choice in young men. Psychoneuroendocrinol. 2013;38(9):1668–74.
Forman EM, Schumacher LM, Crosby R, et al. Ecological momentary assessment of dietary lapses across behavioral weight loss treatment: Characteristics, predictors, and relationships with weight change. Ann Behav Med. 2017;51:1–13.
Hasler BP, Kirisci L, Clark DB. Restless sleep and variable sleep timing during late childhood accelerate the onset of alcohol and other drug involvement. J Stud Alcohol Drugs. 2016;77(4):649–55.
Downing MJ, Houang ST, Scheinmann R, et al. Engagement in care, psychological distress, and resilience are associated with sleep quality among HIV-positive gay, bisexual, and other men who have sex with men. Sleep Health. 2016;2(4):322–9.
Duncan DT, Goedel WC, Mayer KH, et al. Poor sleep health and its association with mental health, substance use, and condomless anal intercourse among gay, bisexual, and other men who have sex with men. Sleep Health. 2016;2(4):316–21.
Fucito LM, Bold KW, Van Reen E, et al. Reciprocal variations in sleep and drinking over time among heavy-drinking young adults. J Abnormal Psychol. 2017;127:92.
Chuah YL, Venkatraman V, Dinges DF, Chee MW. The neural basis of interindividual variability in inhibitory efficiency after sleep deprivation. J Neurosci. 2006;26(27):7156–62.
Womack SD, Hook JN, Reyna SH, Ramos M. Sleep loss and risk-taking behavior: a review of the literature. Behavioral Sleep Med. 2013;11(5):343–59.
Barber LK. Conceptualizations of sleep in stress theory: exciting new directions. Stress Health. 2014;30(5):431–2.
Hagger MS. Where does sleep fit in models of self-control and health behaviour. Stress Health. 2014;30:425–30.
Terre L. Clinical implications of impaired sleep. Am J Lifestyle Med. 2014;8(6):352–70.
Edwards S, Reeves GM, Fishbein D. Integrative model of the relationship between sleep problems and risk for youth substance use. Curr Addict Rep. 2015;2(2):130–40.
Zarcone V, De La Pena A, Dement WC. Heightened sexual interest and sleep disturbance. Percept Mot Skills. 1974;39(3):1135–41.
Budweiser S, Enderlein S, Jörres RA, et al. Men’s sexual health: sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009;6(11):3147–57.
Costa RM, Oliveira TF. Poorer subjective sleep quality is related to higher fantasy-induced sexual arousal in women of reproductive age. J Sex Marital Ther. 2016;42(8):740–8.
Centers for Disease Control and Prevention. HIV surveillance report, 2015. 2016; 27. http://www.cdc.gov/hiv/library/reports/surveillance/html. Accessed 15 Dec 2017.
Millar BM, Starks TJ, Rendina HJ, Parsons JT. Three reasons to consider the role of tiredness in sexual risk-taking among gay and bisexual men. Arch Sex Behav. 2018;52:1–13.
Chen JH, Shiu CS. Sexual orientation and sleep in the US: a national profile. Am J Prev Med. 2017;52(4):433–42.
Galinsky AM, Ward BW, Joestl SS, et al. Sleep duration, sleep quality, and sexual orientation: findings from the 2013–2015 National Health Interview Survey. Sleep Health. 2018;4(1):56–62.
Patterson CJ, Tate DP, Sumontha J, Xu R. Sleep difficulties among sexual minority adults: associations with family relationship problems. Psychol Sex Orientat Gend Divers. 2018;5(1):109–16.
Centers for Disease Control and Prevention. HIV transmission risk. 2012. http://www.cdc.gov/hiv/law/pdf/Hivtranmsmision.pdf. Accessed 15 Dec 2017.
Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiat Res. 1989;28(2):193–213.
Duncan DT, Park SH, Goedel WC, et al. Perceived neighborhood safety is associated with poor sleep health among gay, bisexual, and other men who have sex with men in Paris, France. J Urban Health. 2017;94(3):399–407.
Park SH, Al-Ajlouni Y, Palamar JJ, Goedel WC, Estreet A, Elbel B, Sherman SE, Duncan DT. Financial hardship and drug use among men who have sex with men. Substance abuse treatment, prevention, and policy. Subst Abuse Treat Prev Policy. 2018;13(1):19–25.
Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics. 2009;50(6):613–21.
Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1):86–95.
Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiat. 2005;66(10):1254–69.
Cedernaes J, Brandell J, Ros O, et al. Increased impulsivity in response to food cues after sleep loss in healthy young men. Obesity. 2014;22(8):1786–91.
Friedrich A, Schlarb AA. Let’s talk about sleep: a systematic review of psychological interventions to improve sleep in college students. J Sleep Res. 2017;27:1–19.
Wu J, Wu H, Lu C, et al. Self-reported sleep disturbances in HIV-infected people: a meta-analysis of prevalence and moderators. Sleep Med. 2015;16(8):901–7.
Centers for Disease Control and Prevention: Insufficient sleep is a public health epidemic. 2015. https://www.cdc.gov/features/dssleep/index.html. Accessed 15 Dec 2017.
Millar BM, Rendina HJ, Starks TJ, Grov, C, Parsons JT. The role of chronotype, circadian misalignment, and tiredness in the substance use behaviors of gay and bisexual men. Psychol Sex Orientat Gend Divers. 2018.
Acknowledgements
We thank the translators and participants of this study who contributed to the project. We thank William Goedel, Noah Kreski, and Jace Morganstein for assisting in the development, translation, and management of the survey used in the current study.
Funding
This study was supported by Dr. Dustin Duncan’s New York University School of Medicine Start-Up Research Fund.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Millar, B.M., Parsons, J.T., Redline, S. et al. What’s Sleep Got to Do with It?: Sleep Health and Sexual Risk-Taking Among Men Who have Sex with Men. AIDS Behav 23, 572–579 (2019). https://doi.org/10.1007/s10461-018-2288-x
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DOI: https://doi.org/10.1007/s10461-018-2288-x