Pharmacologic Therapies Effective for Excessive Daytime Sleepiness

HealthDay News — For patients with obstructive sleep apnea (OSA), solriamfetol, armodafinil-modafinil, and pitolisant reduce daytime sleepiness, with solriamfetol likely superior, according to a systematic review and meta-analysis published online May 9 in the Annals of Internal Medicine.

Tyler Pitre, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues compared the effectiveness of drugs for excessive daytime sleepiness (EDS) in OSA in a network meta-analysis of 14 trials with 3,085 patients assigned to any pharmacologic intervention.

Researchers found that solriamfetol improves Epworth Sleepiness Scale (ESS) scores compared with placebo at 4 weeks (mean difference, −3.85; high certainty), while armodafinil-modafinil and pitolisant-H3-autoreceptor blockers probably improve ESS scores (mean differences, −2.25 and −2.78, respectively; both moderate certainty). Solriamfetol and armodafinil-modafinil improve the Maintenance of Wakefulness Test compared with placebo at 4  weeks (standardized mean differences, 0.9 and 0.41, respectively; both high certainty), while pitolisant-H3-autoreceptor blockers probably do not (moderate certainty). Armodafinil-modafinil probably increases the risk for discontinuation due to adverse events at 4 weeks (relative risk, 2.01; moderate certainty), while the association for solriamfetol was not found to be significant.

“Solriamfetol, armodafinil-modafinil, and pitolisant are effective therapies available to patients with OSA-associated EDS already on conventional therapy,” the authors write. “Potential for long-term harm of all available pharmacotherapy remains unclear.”

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