715 Efavirenz Increases Slow-wave Sleep R. Landovitz*, J. Winkelman, S. Yawetz, C. Koziol, P. Sax Brigham and Women's Hosp, Boston, MA
Background: Efavirenz treatment is associated with central nervous system side effects including sleep disturbances. We sought to prospectively measure the effects of efavirenz on sleep using standardized instruments and overnight polysomnography.
Methods: The Pittsburgh Sleep Quality Index was administered prospectively to 33 patients (pts) beginning a new anti-retroviral regimen containing efavirenz. The questionnaire was administered at baseline and within 4 wks of beginning efavirenz. A subgroup of 8 pts was also evaluated prospectively with standard overnight polysomnography, POMS (Profile of Mood States), the MOS-HIV quality of life survey, and a Sleep/Dream inventory.
Results: Of the 33 pts enrolled, 6 pts (18.2%) discontinued therapy for adverse effects prior to completing a post-efavirenz survey: 2 for CNS toxicity, 4 for other adverse effects. Six (6) pts withdrew from the study for other reasons. The remaining 22 pts were followed prospectively. Of the 16 pts with PSQI-defined poor baseline sleep, 14 remained poor sleepers throughout the duration of the monitoring period. All 6 reporting good baseline sleep, remained good. Five (5) pts have complete data from overnight polysomnography. There was a mean 11.2% increase in sleep efficiency immediately after beginning efavirenz, but on average there was no net change by 4 wks on therapy. The proportion of time spent in slow-wave sleep increased by a mean 5% immediately on therapy and increased an additional 4.8% by 4 wks.
Conclusions: Pts reporting good or poor sleep at baseline using standardized sleep instruments continued to report good or poor sleep on efavirenz, respectively. Polysomnography revealed initial objective increases in the proportion of time spent in slow-wave sleep and increases in sleep-efficiency, although the latter reverted after 4 wks on treatment. These measurements are consistent with a sedating effect of the drug and deeper sleep, although it remains unclear what functional significance this may have on restfulness of sleep. Few other medications have such an effect.
