Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Neurology
• Pharmacology

Background:

• Obstructive sleep apnea/hypopnea syndrome (OSAHS) frequently causes residual daytime sleepiness despite nCPAP therapy.
• This persistent symptom significantly impacts patient quality of life and treatment adherence.

Purpose of the Study:

• To evaluate the efficacy and safety of modafinil as an adjunctive treatment for residual daytime sleepiness in OSAHS patients using nCPAP.
• To assess modafinil's impact on objective and subjective measures of sleepiness.

Main Methods:

• A 4-week, randomized, double-blind, placebo-controlled, parallel-group study.
• Patients received escalating doses of modafinil (200-400 mg/d) or placebo.
• Efficacy was measured using the Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT).

Main Results:

• Modafinil significantly improved ESS scores at weeks 1 and 4 (p < 0.001) and MSLT at week 4 (p < 0.05) compared to placebo.
• A higher percentage of modafinil-treated patients achieved normalized daytime sleepiness (ESS < 10) (51% vs 27%, p < 0.01).
• Headache and nervousness were more common adverse events with modafinil. nCPAP use remained consistent in both groups.

Conclusions:

• Modafinil is an effective and safe adjunct treatment for residual daytime sleepiness in OSAHS patients using nCPAP.
• It offers significant subjective and objective improvements in sleepiness, enhancing patient management.
• Further research may explore long-term efficacy and optimal dosing strategies.