Modafinil for excessive sleepiness associated with shift-work sleep disorder

Area of Science:

• Sleep Medicine
• Pharmacology

Background:

• Shift-work sleep disorder (SWSD) causes chronic excessive sleepiness during night shifts and insomnia during daytime sleep.
• Evaluating modafinil's efficacy in managing SWSD-related sleepiness is crucial for affected individuals.

Purpose of the Study:

• To assess the effectiveness of modafinil in treating excessive sleepiness in patients diagnosed with shift-work sleep disorder.

Main Methods:

• A three-month, double-blind, placebo-controlled trial involving 209 SWSD patients.
• Participants received either 200 mg of modafinil or placebo before each shift.
• Assessments included the Multiple Sleep Latency Test, Clinical Global Impression of Change, Psychomotor Vigilance Test, patient diaries, and polysomnography.

Main Results:

• Modafinil showed a modest improvement in nighttime sleep latency (1.7 vs. 0.3 minutes, P=0.002) and clinical symptoms (74% vs. 36%, P<0.001) compared to placebo.
• Modafinil reduced attention lapses (P<0.001) and decreased reported accidents/near accidents during commutes (29% vs. 54%, P<0.001).
• Despite benefits, residual sleepiness and impaired performance persisted; headache was the most common side effect.

Conclusions:

• Modafinil (200 mg) effectively reduced extreme sleepiness and slightly improved performance in SWSD patients versus placebo.
• The observed residual sleepiness indicates a need for developing more potent therapeutic interventions for SWSD.