Cognitive Performance Following Modafinil versus Placebo in Sleep‐deprived Emergency Physicians: A Double‐blind Randomized Crossover Study

Abstract

Objectives: Modafinil has recently been approved for the treatment of shift work sleep disorder, making it potentially available for shift-working emergency physicians. The authors' objectives were to determine whether modafinil improved cognitive performance of emergency physicians following overnight shifts and to record symptoms and subjective evaluations of the effect of modafinil on the participants.Methods: This was a randomized, double-blind, placebo-controlled crossover study that followed CON-SORT guidelines. Participants were assigned to one of two study groups, with study sessions occurring at least seven weeks apart, and received either modafinil or placebo depending on their random allocation. Testing after night shifts included a coding task and an AX version of the Continuous Performance Task, both of which test cognitive function. Participants also completed visual analog scales for three subjective outcomes, and symptoms were elicited.Results: Modafinil facilitated performance on long interstimulus-interval AX trials (F [1, 23] = 6.65, p = 0.1) and marginally reduced errors on AY trials in the Continuous Performance Task (F [1, 23] = 3.59, p = 0.07), suggesting facilitation of sustained attention, cognitive control, and working memory. Additionally, modafinil, compared with placebo, facilitated performance on the coding task at the first session. Subjective data from visual analog scales confirmed that modafinil increased perceived alertness during the simulated patient care sessions but worsened sleep onset when opportunities for sleep arose. Conclusions:Modafinil increased certain aspects of cognitive function and subjectively improved participants' ability to attend post-night-shift didactic sessions but made it more difficult for participants to fall asleep when opportunities for sleep arose.ACADEMIC EMERGENCY MEDICINE 2006; 13:158-165 ª

Non-pharmacological cognitive enhancement

“…For modafinil adverse reactions were primarily headache, dizziness, gastrointestinal complains (e.g. nausea, abdominal pain, dry mouth), increased diuresis, palpitations, nervousness, restlessness, and sleep disturbances and especially in studies with non-sleep deprived individuals, insomnia (Baranski and Pigeau, 1997;Caldwell et al, 1999Caldwell et al, , 2000Caldwell et al, , 2004Dinges et al, 2006;Eddy et al, 2005;Gill et al, 2006;Hart et al, 2006;Lagarde et al, 1995;Pigeau et al, 1995;Wesensten et al, 2002;Whitmore et al, 2006). For methylphenidate a frequently reported side effect (reported in 13 out of 14 trials reporting side effects) was increased heart rate, while increase in blood pressure was not consistently found (Bray et al, 2004;Brumaghim and Klorman, 1998;Clark et al, 1986;Fitzpatrick et al, 1988;Hink et al, 1978;Mehta et al, 2000;Peloquin and Klorman, 1986;Rogers et al, 1999;Strauss et al, 1984;Volkow et al, 1999aVolkow et al, , 1999bWetzel et al, 1981).…”

Differential effects of modafinil and methylphenidate on stop-signal reaction time task performance in the rat, and interactions with the dopamine receptor antagonist cis-flupenthixol

“…While these cognitive enhancements are often related to the more extensively-documented wakepromoting effects of modafinil (e.g. Dagan and Doljansky 2006;Gill et al 2006), it is becoming clear that modafinil may also improve cognitive ability in non-sleep-deprived subjects. For example, modafinil significantly improved the performance of healthy adults in tests of visual pattern recognition memory, delayed matching-to-sample, digit span and spatial planning (Turner et al 2003).…”

The Neurocognitive Enhancement of Surgeons: An Ethical Perspective

“…The prospect of fatigued surgeons taking a prescription drug, such as modafinil, to allow them to operate for longer, and possibly to a higher standard, is perhaps not as farfetched as some may suggest. This drug has already been trialed in emergency physicians, when performing non-medical-related tasks at the end of a nightshift [35]. The study had self-reported failings and thus did little to clarify modafinil's potential role, but nevertheless it was the first to consider the prospect that clinicians could use medication to enhance their performance.…”