The drug solriamfetol was found to be the most effective treatment for excessive daytime sleepiness (EDS) for people with obstructive sleep apnea (OSA), according to a study comparing the efficacy and safety of wakefulness-promoting agents published in the Annals of Internal Medicine

The standard treatment for OSA is a positive airway pressure (PAP) mask that uses compressed air to support lung airways during sleep. However, some people with OSA still experience EDS and may benefit from anti-fatigue medication.

“The most important thing that people with OSA should do is use their PAP machine, but if they are still sleepy there are options in the form of medications that can reduce their tiredness,” says first author Tyler Pitre, MD, a resident physician in internal medicine at McMaster University and incoming respirology fellow at the University of Toronto, in a release. 

Pitre adds that OSA affects nearly 1 billion people globally, leaving many of them at risk of EDS.

Researchers made their findings by conducting a systematic review of 14 clinical trials of anti-fatigue medications 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.

The review found that while solriamfetol is likely the best medication for EDS, the drugs armodafinil–modafinil and pitolisant also are effective in combatting fatigue.

The study concluded that “adverse events probably increase the risk for discontinuation of armodafinil–modafinil and may increase the risk for discontinuation with solriamfetol.” Researchers note that solriamfetol can also raise blood pressure, especially risky for people with OSA, as many of them also have cardiovascular issues. 

“It would be interesting to see how effective these anti-fatigue medications will be for treating related illnesses, such as chronic fatigue syndrome and long COVID, now that we know they work for a similar condition,” says senior author Dena Zeraatkar, PhD, an assistant professor of the department of anesthesia, in a release.

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