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Background:
Insomnia is frequently found in patients on EFV. Little is known on the
sleep-pattern underlying this toxicity and its potential
relationship with
plasma drug levels.
Patients and methods:
A
total of 18 HIV+
subjects receiving EFV for >3 months and a control group of 13
volunteers were recruited. Insomnia was assessed through sleep diaries and
the PSQ index. Ambulatory EEG recorded sleep architecture in
HIV+ patients and controls. EFV plasma levels were
measured in HIV+
patients.
Results:
Neuropsychological assessment
identified insomnia
in 13 subjects receiving EFV, while normal results were obtained in
the remaining five patients and in all 13 controls. Among patients on
EFV, those with insomnia showed lower sleep efficiency
(81 ±15 vs 96 ±7%,
P<0.01),
longer time awake (20 ±15 vs 4 ±0.2%,
P<0.01)
and shorter REM-sleep (14 ±6 vs 22 ±3%,P<0.01)
in
the EEG-monitoring.
Conversely, HIV+ patients on EFV, irrespectively of suffering
insomnia, showed longer sleep latencies than
controls (32 ±28 vs
11 ±3 min,
P<0.01),
and shorter deep-sleep (NREM stage 3–4)
(10 ±6 vs 22 ±3%,
P<0.01).
Mean EFV plasma
levels were higher
in subjects with insomnia (4.3 ±2.9 vs 2.7 ±0.7 ng/l), and those
with sleep efficiency <90% had more frequently EFV
concentrations >4
ng/l (62.5 vs 37.5%,
P<0.01).
In three subjects
with high drug
levels (6.2 ±2.1 ng/l), EFV dose reduction to 500 mg
The 2nd IAS
Conference on HIV Pathogenesis and Treatment S225
qd provided
improvement in sleep complaints, while EFV concentrations
remained within
therapeutic range (2.6 ±1.2 ng/l).
Conclusion:
HIV+ patients with
EFV-related insomnia show significant sleep architecture
abnormalities. Both insomnia and reduced sleep efficiency correlate with EFV
plasma levels. EFV sleep complaints may ameliorate after
drug dose adjustment.
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