CHEST Guidelines-Results-of-the-Solriamfetol's-Effect-on-Cognitive-

Results-of-the-Solriamfetol's-Effect-on-Cognitive-

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The SHARP study examined the impact of solriamfetol on cognitive function in patients with obstructive sleep apnea (OSA) experiencing excessive daytime sleepiness (EDS) and cognitive impairment. Conducted as a phase IV randomized, double-blind, placebo-controlled crossover trial, 59 participants were administered solriamfetol and placebo over alternating two-week periods, with a one-week washout interval. The study primarily measured changes in cognitive function using the Digit Symbol Substitution Test (DSST) from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), along with other assessments including British Columbia Cognitive Complaints Inventory (BC-CCI) and Epworth Sleepiness Scale (ESS).<br /><br />The findings demonstrated that solriamfetol significantly improved DSST scores compared to placebo, indicating enhancement in cognitive function (P = .009; effect size [Cohen’s d], 0.37). Improvements were consistent at 2, 6, and 8 hours post-dose. Additionally, significant enhancements were seen in BC-CCI scores (P = .002) and ESS scores (P = .004), suggesting better cognitive complaint resolution and reduced daytime sleepiness, respectively. Common side effects included nausea (7%) and anxiety (3%).<br /><br />Solriamfetol's efficacy was highlighted in promoting wakefulness and improving both subjective and objective cognitive functions in patients with OSA and EDS. The absence of serious adverse events supports its safety profile. Solriamfetol’s dopamine and norepinephrine reuptake inhibition, possibly mediated through TAAR1 and serotonin 1A receptors, might explain its pro-cognitive benefits. Despite the study's strengths, such as its design and focus on cognitive end points, its findings are limited by the sample size and scope, suggesting more research is needed for wider applicability and comparison with other wake-promoting agents. These results advocate for solriamfetol's potential in addressing cognitive deficits in OSA-related EDS.

Keywords

solriamfetol

cognitive function

obstructive sleep apnea

excessive daytime sleepiness

phase IV trial

Digit Symbol Substitution Test

neuropsychological assessment

wakefulness

dopamine reuptake inhibition

cognitive impairment