Exploring Medications to Combat Excessive Daytime Sleepiness in OSA Patients

Many individuals have experienced feelings of sluggishness and lethargy in the afternoons. However, for those diagnosed with obstructive sleep apnea (OSA), these symptoms can be more severe and disruptive to daily life. Excessive daytime sleepiness (EDS) is a common occurrence for people with OSA, causing overwhelming urges to sleep at inappropriate times and difficulty completing simple tasks. While positive airway pressure (PAP) masks are commonly used to support the lungs with compressed air during sleep, they do not always alleviate EDS. Researchers have been diligently working to identify potential medications that can help relieve this debilitating symptom.

In a study conducted by resident physician Tyler Pitre and his colleagues from McMaster University in Canada, the comparative effectiveness of three anti-fatigue medications was investigated. The study reviewed 14 previous clinical trials involving 3,085 OSA patients with EDS. The medications examined were solriamfetol, armodafinil-modafinil, and pitolisant. All three medications proved to be more effective than placebos in combating EDS, although to varying degrees.

When comparing the 14 trials, solriamfetol demonstrated the most significant statistical difference in terms of wakefulness compared to a placebo. Armodafinil-modafinil and pitolisant also showed some improvement in measures of wakefulness after one month of use but were not as conclusive. It is worth noting that both armodafinil-modafinil and solriamfetol exhibited potential side effects, although patients were more likely to discontinue the use of armodafinil-modafinil.

Solriamfetol appears to outperform the other medications due to its potential impact on increasing norepinephrine levels (which prepares the body for action) and dopamine levels (associated with pleasure and motivation) in the brain. However, more research is needed to thoroughly investigate the long-term effects of solriamfetol on patients.

The potential benefits of solriamfetol and other anti-fatigue medications extend beyond OSA and EDS. Researchers are curious about their effectiveness in treating related conditions like chronic fatigue syndrome and long COVID. However, the underlying causes of these conditions are complex and require further investigation for effective treatment. It is essential to understand that the medications studied are already prescribed for OSA and EDS, with pitolisant currently under review by the US FDA. The choice of medication depends on various factors, including the patient’s health profile.

It is crucial to approach the use of these medications with caution due to potential side effects. For example, solriamfetol has been associated with an increase in blood pressure. Considering that OSA affects a substantial portion of the global population, estimated to be around a billion individuals, there is an urgent need for improved and safer treatment options. Pitre emphasizes the importance of addressing this issue, particularly as many individuals with OSA remain undiagnosed.

The search for effective treatments to alleviate excessive daytime sleepiness in OSA patients continues. Through the comparative analysis of anti-fatigue medications, researchers have discovered the potential benefits of solriamfetol in enhancing wakefulness. However, the long-term effects and underlying causes of OSA, EDS, and related conditions require further investigation. As researchers strive to enhance the understanding and treatment of these conditions, it is crucial for individuals to work closely with healthcare professionals to find the most suitable and safest treatment options available.