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Efavirenz increases sleep latency and decreases sleep duration
  By Will Boggs, MD
NEW YORK (Reuters Health) - Efavirenz induces a variety of sleep abnormalities, especially at higher plasma concentrations, according to a report in the February 1st issue of Clinical Infectious Diseases.
Efavirenz therapy has been associated with vivid dreams, difficulty falling asleep, and night awakenings, the authors report, but less is known about whether efavirenz induces abnormalities in sleep architecture.
Dr. Vincent Soriano from Instituto de Salud Carlos III, Madrid, Spain and colleagues performed ambulatory electroencephalogram monitoring to assess the sleep of 18 HIV-infected subjects treated with efavirenz (13 with insomnia, 5 without) and of 13 healthy controls.
Patients with efavirenz-associated insomnia had low sleep efficiency values, increased total time awake and compensatory napping, and a greater number of night arousals, the authors report.
Efavirenz-treated patients, whether or not they reported insomnia, had increased sleep latency, the report indicates, as well as significantly reduced proportions of nonrapid eye movement stages 3 and 4 (deep sleep).
HIV-infected patients with insomnia showed higher concentrations of efavirenz, though not statistically significant, the researchers note, and sleep efficiencies below 90% were nearly twice as common among patients with plasma efavirenz concentrations above 4 mg/mL than among patients whose concentrations were lower.
"Some toxicities in patients on efavirenz, as insomnia, seem to be dose-related," Dr. Soriano told Reuters Health. "Therefore, determining efavirenz plasma levels may allow [the physician] to adjust doses."
Dr. Soriano said that the mechanism behind efavirenz-associated insomnia is "unclear so far. Direct inhibition of some serotonergic pathways in the hypothalamus by efavirenz seems to be the most likely mechanism."
Clin Infect Dis 2004;38:430-432.

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