Association between sleep quality and perceived stress among people living with HIV in China: a moderated mediation model.

Poor sleep quality and perceived stress are common among people living with HIV (PLWH), but the underlying mechanisms linking the two remain unclear. This study examined whether resilience mediates the relationship between sleep quality and perceived stress, and whether this mediation is moderated by age. We analyzed baseline data from 800 PLWH enrolled in a longitudinal cohort study in Guangxi, China. Validated scales assessed sleep quality, resilience, and perceived stress. Path analysis tested a moderated mediation model, controlling for covariates. Poor sleep quality was significantly associated with higher perceived stress (β = 1.367, P < 0.001). Resilience partially mediated this relationship, with an indirect effect coefficient accounting for 32.3% of the total effect. Furthermore, age moderated the indirect effect of sleep quality on stress through resilience. The mediation effect was stronger in participants aged 50 and above (0.359, 95% CI: 0.159-0.613) than in those under 50 (0.255, 95% CI: 0.109-0.450). These findings suggest that resilience plays a key role in buffering the negative impact of poor sleep on perceived stress, particularly among older adults. Interventions aimed at improving sleep and enhancing resilience may help reduce stress among PLWH, especially in aging populations.