Objective: Sleep disturbances have frequently been observed in HIV+ patients. Low sleep quality has also been associated with the use of Efavirenz (EFV). Anxiety and depression have also been associated with HIV infection while the weight of an association among EFV, sleep disturbances and depression is controversial. Aim of this study was to analyze the sleep quality, to describe the prevalence of anxiety and depression and to detect the presence of any association among these symptoms and sleep disturbances in a group of subjects treated with an EFV-based regimen.
Patients and Methods: A single-center cross-sectional study was performed on 60 patients anti-HIV+ on stable EFV-based antiretroviral treatment. Self-administered, standardized questionnaires including the Pittsburg Sleep Quality Index - PSQI, the Self Rating Anxiety State SAS 054 and Beck Depression Inventory - BDI SF were administered.
Results: 28 subjects (42.9%) reported any sleep disturbance, 13 (21.7%) nightmares, 28 (42.9%) an unrefreshed awakening. 77% of subjects referring nightmares reported to be unrefreshed at wake up (p=0.031) and a pathological score at PSQI (p=0.031) while 82.1% of them referring an unrefreshed awakening reported a pathological score at PSQI (p<0.001). Finally, reporting nightmares and unrefreshed awakening were not associated to total time of EFV exposition. 23 (38%) subjects reported anxiety, 18 (30%) depression; these symptoms don’t correlate with time of exposition to EFV. 69% of subjects referring nightmares also reported anxiety (p=0.023). 64.3% and 57.1% of subjects referring unrefreshed awakening reported anxiety (p<0.001) and depression (p<0.001), respectively. The global PSQI score shows a strong correlation with SAS 054 score and BDI SF score.
Conclusions: After a median time of five years of exposure to EFV, a high number of subjects maintain any sleep disturbances or nightmares. These symptoms could be considered an expression of persisting CNS side effects in patients treated for a long time with EFV.