CHEST Guidelines-Sleepy-Heads-No-More

Sleepy-Heads-No-More_chest

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The article discusses a study on the effectiveness of solriamfetol, a wakefulness-promoting drug, in improving daytime cognitive performance in patients with obstructive sleep apnea (OSA) who experience residual sleepiness despite continuous positive airway pressure (CPAP) therapy. Conducted by Van Dongen et al., the 2-week randomized, placebo-controlled, crossover trial found moderate improvement in cognitive performance and cognitive concerns among participants using solriamfetol compared to a placebo. The cognitive task performance (digit symbol substitution test) showed a modest improvement (mean difference of 1.75 points), as did the scores on the British Columbia Cognitive Complaints Inventory.<br /><br />The trial, however, faced limitations such as an early termination by the sponsor and a shift in the primary outcome measure, which raises concerns about the robustness of the results. Moreover, the study was unable to provide comprehensive insights into the long-term efficacy and safety profile of solriamfetol. The non-measurement of baseline OSA severity also presents challenges for clinical application, as different patient groups and treatment pathways may react variably. <br /><br />The article also highlights the potential emergence of orexin agonists as alternative treatments for daytime sleepiness in OSA patients, which might offer better efficacy than current medications like solriamfetol. Despite the modest results, drugs like solriamfetol remain useful adjuncts for alleviating OSA symptoms where available. Future research directions include examining these newer agents not just for reducing sleepiness, but also for enhancing cognitive function. <br /><br />Financial disclosures attach the study's financial backing from various pharmaceutical companies, with authors affiliated with the Woolcock Institute, which has conducted related clinical trials. This backdrop underscores the necessity for ongoing research into both orexin agonists and existing wakefulness-promoting agents.

Keywords

solriamfetol

obstructive sleep apnea

cognitive performance

CPAP therapy

placebo-controlled trial

orexin agonists

daytime sleepiness

cognitive concerns

pharmaceutical research

wakefulness-promoting agents