Researchers discover best treatment for excessive daytime sleepiness

Tired man

A new study shows that solriamfetol is the most effective treatment for daytime sleepiness in patients with sleep apnea, along with the standard treatment of positive airway pressure mask. The study results are based on a comprehensive review of 14 clinical trials.

Researchers Dena Zeraatkar and Tyler Pitre from McMaster University have discovered that solriamfetol is the most effective treatment for excessive daytime sleepiness (EDS) in people suffering from obstructive sleep apnea (OSA).

The standard treatment for OSA is a positive airway pressure (PAP) mask, which uses compressed air to assist the lung airways during sleep. But with this treatment, there are those who continue to endure EDS. These individuals may find relief from their symptoms through the use of anti-fatigue medications.

Zeraatkar and Pitre recently published their findings in the journal Annals of Internal Medicine.

Dena Zeraatkar

Dena Zeraatkar. Credit: McMaster University

“The most important thing people with OSA should do is use their PAP machine, but if they’re still sleepy, there are medication options that can reduce their fatigue,” said first author Tyler Pitre, an internal medicine resident. medicine. at McMaster University and incoming respirology fellow at the University of Toronto.

Tyler Pitre

Tyler Pitre. Credit: McMaster University

“Fifteen to 30 percent of people in North America have a diagnosis of OSA, and the prevalence may be much higher, as many others are undiagnosed. Many people have symptoms, as the condition is highly associated with obesity, which affects a large and increasing number people in Canada, the United States and other high-income countries,” he said.

“Among these patients, many will have EDS, which affects their quality of life, making them less productive and also putting them at risk for other psychological problems. Improving this situation is of critical importance to physicians.”

Pitre said OSA affects nearly a billion people globally, leaving many of them at risk for EDS.

Zeraatkar and Pitre made their findings by conducting a systematic review of 14 clinical trials of anti-fatigue drugs involving 3,085 people, as well as analyzing data from MEDLINE, CENTRAL, EMBASE and in a specific network meta-analysis. They conducted their research from October 2022 to January 2023.

Senior author Zeraatkar said that while solriamfetol is probably the best drug for EDS, the drugs armodafinil-modafinil and pitolisant are also effective in fighting fatigue.

Solriamfetol can also raise blood pressure, especially risky for people with OSA, as many of them also have cardiovascular problems.

“It would be interesting to see how effective these anti-fatigue drugs will be in treating related diseases such as chronic fatigue syndrome and long-term COVID, now that we know they work for a similar condition,” said Zeraatkar, an assistant professor at the institute . of anesthesia.

Reference: “Comparative efficacy and safety of wakefulness-promoting agents for excessive daytime sleepiness in patients with obstructive sleep apnea – a systematic review and network meta-analysis” by Tyler Pitre, MD, MA, Jasmine Mah, MD, MSc, Sarah Roberts, BHSc, Kairavi Desai, BMSc, Yusing Gu, MD, Clodagh Ryan, MD, Ph.D., Jason W. Busse, DC, Ph.D. and Dena Zeraatkar, Ph.D., May 2023, Annals of Internal Medicine.
DOI: 10.7326/M22-3473

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