Solriamfetol for residual sleepiness and its impact on continuous positive airway pressure adherence: A French...

Solriamfetol may improve obstructive sleep apnoea syndrome (OSA) while potentially influencing CPAP adherence.

To investigate the impact of solriamfetol initiation for residual sleepiness on CPAP adherence and termination rates in adults with OSA.

Data from the French Système National des Données de Santé (SNDS) database, which contains data on health spending reimbursements for > 99% of all individuals living in France, were analyzed. All OSA patients who received at least one administration of solriamfetol for between 09/01/2021 and 06/30/2023 and who received at least one CPAP reimbursement in the 12 months before the index date of solriamfetol administration were included. A CPAP adherence score was calculated based on the reimbursement levels for this treatment over 4-week periods: score = 3 (more than 4 hours per night on average), score = 2 (between 2 and 4 hours per night on average), score = 1 (less than 2 hours per night on average), patient no longer using CPAP: score=0. For each patient, we calculated the average score over 6 sequences of 4 weeks preceding and following the index date of solriamfetol initiation. A control group from the SNDS CPAP-treated OSA was matched by propensity score to subjects treated with CPAP and solriamfetol.

930 OSA patients initiated on solriamfetol were included and matched to 8,920 controls. The characteristics of the cases and controls were similar (age = 56.4 and 57.1 years, 64.5% and 64.6% male, and same burden of comorbidities). During the 6 months before and after the start of solriamfetol treatment, the mean CPAP adherence score was slightly but significantly higher in the solriamfetol group than in the control group (before: 2.8 vs. 2.6, p < 0.0001, after: 2.8 vs. 2.5, p < 0.0001).

We found no evidence that solriamfetol initiation was associated with reduced CPAP adherence.