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Household energy poverty and sleep disorders among people living with HIV: Does the level of physical activity have any moderating effect?

This study of 1,132 people living with HIV in Kenya reveals that household energy poverty significantly increases insomnia, while physical activity reduces insomnia symptoms, though it does not statistically moderate the negative impact of energy poverty.

Original authors: Boateng, G. O., Ahmed, H., Odei Boateng, M., Agbe, E., Owuor, P., Adjei Adams, E.

Published 2026-07-31

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CC BY 4.0

Original authors: Boateng, G. O., Ahmed, H., Odei Boateng, M., Agbe, E., Owuor, P., Adjei Adams, E.

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ⚕️ This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer

Imagine your body is a high-tech spaceship that needs to dock safely every night to recharge its batteries. That docking process is sleep. Scientists have long known that if the docking bay is too cold, too noisy, or if the air is filled with smoke, the ship can't land properly. This is the world of sleep science, where researchers study how our environment and our daily habits act as either a smooth runway or a bumpy obstacle course for getting rest. One specific obstacle that has been getting a lot of attention lately is "energy poverty." Think of this not just as having a low battery, but as a household that struggles to afford the fuel needed to keep the lights on, the heat working, or the air clean. When a home is energy-poor, it's like trying to sleep in a tent during a storm while worrying about the cost of the raincoat.

Now, add a second layer to this story: the people living with HIV. These are individuals whose immune systems are already fighting a tough battle, making good sleep even more critical for their health. But here's the million-dollar question: if a person is stuck in a cold, dark, or smoky home because they can't afford energy, is there a way to fix their sleep just by moving their body? Maybe if they run, jump, or walk enough, their internal "sleep engine" will rev up strong enough to ignore the bad conditions outside? This is the puzzle a team of researchers set out to solve. They wanted to know if household energy poverty makes sleep worse for people living with HIV, and if exercising vigorously, moderately, or just a little bit could act like a shield, buffering them from the bad effects of a cold or dark home.

The researchers, led by Dr. Godfred Odei Boateng and his team, went to Kenya to investigate this. They gathered data from 1,132 people living with HIV in the Kisumu West and Seme sub-counties. They asked these participants about their sleep, their energy situation, and how much they moved their bodies. They used a special scale to measure "household energy poverty," which included questions like, "Do you worry your energy will run out before you have money to refill?" and "Do you have to cut back on food or medicine to pay for energy?" They also measured sleep problems (specifically insomnia) and tracked three levels of physical activity: vigorous (like heavy lifting or fast biking), moderate (like carrying light loads or regular biking), and minimal (like walking).

Here is what they found, and it's a mix of bad news, good news, and a "maybe" that needs more digging. First, the bad news: the study confirmed that household energy poverty is a major sleep killer. The data showed a clear link: as energy poverty scores went up, insomnia scores went up too. In fact, about 74% of the participants had energy poverty scores above the average, and over a third reported significant insomnia. It's like a heavy blanket of stress and discomfort that makes it nearly impossible to drift off.

The good news is that moving your body helps, no matter how hard you push. The study found that engaging in any level of physical activity—whether it was a full-blown workout, a moderate jog, or just a simple walk—was associated with lower insomnia scores. It's as if exercise acts like a natural sleep aid, helping to calm the mind and regulate the body's temperature, making it easier to fall asleep even when things are tough at home.

However, the "maybe" part is where the story gets tricky. The researchers had a big hope: they thought that maybe exercise could act as a "shield" or a "buffer." They wondered if exercising vigorously would cancel out the bad effects of living in an energy-poor home. Did a hard workout make the cold or the noise less important? The answer, according to the data, is that while exercise is great on its own, it didn't statistically prove to be a shield against energy poverty. The interaction between energy poverty and physical activity wasn't strong enough to say, "Yes, exercise completely fixes the sleep problems caused by energy poverty." The study suggests a buffering effect might exist, but the numbers didn't shout it out loud enough to be certain.

So, what does this all mean? The paper concludes that household energy poverty definitely increases insomnia among people living with HIV in Kenya. It also confirms that getting active, whether you are a marathon runner or just a walker, helps reduce insomnia. But the idea that exercise can fully neutralize the sleep-disrupting power of energy poverty remains a suggestion rather than a proven fact. The authors suggest that to truly fix sleep problems in vulnerable populations, we need a two-pronged approach: we need to fix the structural issues (like making clean energy affordable and accessible) and encourage lifestyle changes like physical activity. You can't just tell someone to "go for a run" if their house is freezing cold and they are worried about their next meal; you have to help them warm the house and get them moving. The study didn't find a magic bullet where exercise alone solves the energy crisis, but it did show that keeping active is a powerful tool in the fight for better sleep, even when the odds are stacked against you.

Technical Summary: Household Energy Poverty, Physical Activity, and Sleep Disorders among People Living with HIV in Kenya

Problem Statement
Household energy poverty—the inability to access sufficient and affordable energy to meet basic needs—is a growing public health threat, particularly in sub-Saharan Africa, where millions lack access to clean cooking fuels and electricity. While energy poverty is known to be associated with deleterious health outcomes, including poor sleep, no prior study has examined this relationship specifically among people living with HIV (PLHIV). Furthermore, the potential of physical activity to moderate (buffer) the negative impact of energy poverty on sleep disorders remains unexplored in this population. Given that HIV itself disrupts sleep through direct and indirect pathways, and that energy poverty forces households into risky coping strategies (e.g., using unsafe heating sources, enduring extreme temperatures) that further degrade sleep quality, understanding these interrelationships is critical for vulnerable populations.

Methodology
This study utilized a cross-sectional survey design drawing data from the "Resource Insecurity and Well-being Study on PLHIV in Kenya."

Sample: The analytical sample consisted of 1,132 PLHIV participants recruited from the Seme and Kisumu West sub-counties of Kisumu County, Kenya, via a stratified two-stage cluster sampling method.
Data Collection: Conducted between July 10 and August 3, 2023, using Computer-Assisted Personal Interviews (CAPI).
Variables:
- Outcome: Sleep disorder, specifically measured as Insomnia using a 5-item scale (Cronbach's $\alpha$ = 0.75) derived from a sleep disorder questionnaire, with scores ranging from 5 to 17.
- Explanatory Variable: Household Energy Poverty, measured using a validated 10-item scale (Cronbach's $\alpha$ = 0.93) ranging from 0 to 30, where higher scores indicate greater poverty.
- Moderators: Three levels of Physical Activity (Vigorous, Moderate, and Minimal), assessed using the International Physical Activity Questionnaire (IPAQ) Short-Form.
- Covariates: Biosocial factors (age, gender, number of children under 5) and socio-cultural factors (marital status, neighborhood, education, subjective socioeconomic status, monthly income, and self-rated health).
Analysis: The researchers employed univariate and bivariate analyses followed by multivariate linear regressions. To test the moderating effect, interaction models were constructed for each level of physical activity against household energy poverty, adjusting for all covariates. STATA version 19 was used for all statistical analyses.

Key Results

Prevalence: In the sample, 74.2% of participants had household energy poverty scores above the mean (18.15), and 36.6% reported insomnia scores of 7.03 or higher.
Energy Poverty and Insomnia: Multivariate regression confirmed a significant positive association between household energy poverty and insomnia. As energy poverty increased, insomnia scores increased ( $\beta$ = 0.09 to 0.10, $p < 0.001$ ), even after controlling for covariates.
Physical Activity and Insomnia: All three levels of physical activity (vigorous, moderate, and minimal) were significantly associated with lower insomnia scores. Vigorous activity showed the strongest negative association ( $\beta$ = -0.00041), followed by moderate ( $\beta$ = -0.00040) and minimal ( $\beta$ = -0.00025).
Moderation Effects: The interaction models tested whether physical activity buffered the effect of energy poverty on insomnia. The results indicated that while the main effect of energy poverty remained robust, the interaction terms between energy poverty and physical activity (at all three levels) were not statistically significant. However, the authors note that the model directionally suggested a potential buffering effect, even if it did not reach statistical significance.
Other Factors: Higher subjective socioeconomic status, higher monthly income, and better self-rated health were associated with lower insomnia scores. Conversely, being separated/divorced/widowed or married/cohabiting (compared to single) and older age were associated with higher insomnia scores. Education level did not show a significant association in the multivariate model.

Significance and Claims
The paper claims to be the first study to examine the specific relationship between household energy poverty and sleep disorders among PLHIV. Its primary contribution is establishing that household energy poverty is a significant predictor of increased insomnia in this population.

Regarding the role of physical activity, the authors modestly claim that while engaging in any level of physical activity reduces insomnia, the statistical evidence for physical activity moderating (buffering) the specific impact of energy poverty on insomnia was not significant in this cross-sectional analysis. Nevertheless, the findings suggest that physical activity has the potential to buffer these effects, warranting further investigation.

The study concludes that public health interventions for PLHIV in sub-Saharan Africa should be holistic, addressing both structural factors (expanding access to clean energy, reducing socioeconomic disparities) and lifestyle factors (promoting physical activity) to improve sleep outcomes. The authors emphasize that while physical activity is a low-cost behavioral strategy, addressing the root causes of energy poverty may be more effective for improving sleep health in energy-deprived households.

Limitations Acknowledged by the Authors
The authors explicitly note several limitations:

Cross-sectional Design: The single time-point data collection prevents causal inferences.
Measurement Bias: Potential social desirability bias and recall errors in self-reported questionnaires.
Measurement Error: Potential errors in predictor variables that could impact moderation models.
The authors suggest that future research should utilize longitudinal data and latent variable modeling to better establish causal pathways and reduce measurement error.

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