Many of us will be familiar with feeling sluggish and lethargic in the afternoon, but for those who have obstructive sleep apnea (OSA), the problem is more severe.
Fortunately, researchers have now identified a drug that offers a good chance of helping. And no, it doesn’t come in espresso form.
Excessive daytime sleepiness (EDS) for people with OSA can seriously affect daily life. This means an overwhelming urge to fall asleep at inappropriate times – while driving or eating, for example – and often struggling to complete simple tasks.
Although a positive airway pressure (PAP) mask is a common issue for those with OSA, and can help support the lungs with compressed air at night, it does not always eliminate EDS. As a result, experts are working hard to identify drugs that might help.
“The most important thing for people with OSA to do is use their PAP machine, but if they are still sleepy there are options in the form of medications that can reduce their fatigue,” said resident physician in internal medicine, Tyler Pitre, from McMaster University in Canada.
Pitre and his colleagues reviewed 14 previous clinical trials involving 3,085 people with OSA and EDS, looking at the comparative effectiveness of three anti-fatigue drugs: solriamfetol, armodafinil-modafiniland pitolisant. All three are more effective than placebos in fighting EDS, to varying degrees.
Pooling data for 14 trials, the team found that solriamfetol offered the greatest statistical difference over a placebo in terms of wakefulness. The evidence is less concrete for armodafinil-modafinil and pitolisant, which “likely improve” some, but not all, measures of wakefulness after one month of use. Statistics also show that side effects can be an issue with armodafinil-modafinil and solriamfetol, although patients are more likely to stop using the former.
Although it is difficult to summarize the findings across multiple trials, the comparison shows solriamfetol’s frontal effects, possibly as a result of increases in levels of norepinephrine (prepare the body for action) and dopamine (linked to pleasure and motivation) in the brain.
The researchers say that the pros and cons of solriamfetol deserve further investigation, especially in terms of long-term effects on people who take it because there is little evidence on long-term use. And it’s not just those with OSA and EDS who can benefit from solriamfetol and these other medications.
“It will be interesting to see how effective these anti-fatigue drugs are for treating related diseases such as chronic fatigue syndrome and prolonged COVID, now that we know they work for a similar condition,” said assistant anesthesia professor Dena Zeraatkar, from McMaster University.
But we still don’t know much about chronic COVID or chronic fatigue, and any treatment for them must ideally get to the underlying causes, of which there are many.
Two of the drugs studied are already prescribed for OSA and EDS, with pitolisant still under review by the US FDA. Which drug the doctor prescribes depends on a range of factors including the patient’s personal health profile. However, this is the first time that these treatments have been compared against each other in this way.
With side effects potentially being an issue – solriamfetol has been linked to increased blood pressure for example – care must be taken. That said, with as many as one billion people worldwide affected by OSA, it is clear that there is an urgent need for better treatments to be found.
“Fifteen to 30 percent of people in North America have a diagnosis of OSA and the prevalence may be higher because many others are undiagnosed,” said Fool.
“Many people have symptoms because the condition is strongly associated with obesity, which affects a large and increasing number of people in Canada, the United States and other high-income countries.”
The research was published in Annals of Internal Medicine.