New Drug Shows Promise in Combating Daytime Sleepiness in Those with Sleep Apnea
For individuals with obstructive sleep apnea (OSA), the persistent problem of daytime sleepiness can have a significant impact on their daily lives. The intense urge to sleep at inappropriate times, such as while driving or eating, can make completing simple tasks a challenge. While positive airway pressure (PAP) masks are commonly used to support the lungs and alleviate OSA symptoms, they do not always effectively eliminate excessive daytime sleepiness (EDS). However, a recent study has identified a drug that may offer new hope for those struggling with this issue.
Researchers from McMaster University in Canada conducted a study involving 3,085 people with OSA and EDS. They reviewed 14 previous clinical trials to assess the comparative effectiveness of three anti-fatigue medications: solriamfetol, armodafinil-modafinil, and pitolisant. The results demonstrated that all three drugs were more effective than placebos in combating EDS to varying degrees.
Upon analyzing the data from the trials, the researchers found that solriamfetol displayed the greatest statistical difference in terms of wakefulness compared to a placebo. Although the evidence was not as definitive for armodafinil-modafinil and pitolisant, the researchers noted that these medications “probably improve” certain aspects of wakefulness after a month of use. It is important to note that both armodafinil-modafinil and solriamfetol were associated with potential side effects, with patients being more likely to discontinue the use of armodafinil-modafinil due to side effects.
Solriamfetol, in particular, has shown promising effects on wakefulness, possibly due to its impact on increasing levels of norepinephrine and dopamine in the brain. However, more research is needed to fully understand the long-term effects and potential risks associated with the use of solriamfetol.
Assistant anesthesia professor Dena Zeraatkar, also from McMaster University, highlighted the potential broader application of these anti-fatigue medications. Zeraatkar expressed interest in exploring their efficacy in treating related conditions such as chronic fatigue syndrome and long COVID, as they have shown effectiveness in addressing similar symptoms.
While two of the drugs studied are already prescribed for OSA and EDS, the approval of pitolisant by the US Food and Drug Administration (FDA) is still pending. Determining the most appropriate drug for a patient depends on various factors, including their personal health profile. However, this study marks the first comparison of these treatments against each other in this context.
The researchers emphasize the need for caution due to potential side effects associated with these medications, such as an increase in blood pressure with solriamfetol. Nevertheless, considering that OSA affects up to a billion people worldwide, the urgent need for more effective treatments is evident.
“Fifteen to 30 percent of people in North America have a diagnosis of OSA, and the prevalence could be much higher as many others are undiagnosed,” said Tyler Pitre, a resident physician in internal medicine at McMaster University. “Many people have symptoms as the condition is highly associated with obesity, which affects a large and increasing number of people in Canada, the United States, and other high-income countries.”
While further research is necessary to fully understand the potential benefits and risks of these medications, this study offers hope for individuals with OSA and EDS. The findings encourage further investigation into treatment options not only for sleep apnea-related conditions but also for chronic fatigue and long COVID. The study was published in the Annals of Internal Medicine.