Modafinil in Obstructive Sleep Apnea-Hypopnea Syndrome: A Pilot Study in 6 Patients

Arnulf, Isabelle; Homeyer, Pascale; Garma, L; Whitelaw, William A.; Derenne, Jean‐Philippe

doi:10.1159/000196661

Cited by 63 publications

(20 citation statements)

References 7 publications

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“…The abnormal insulin resistance and change in glucose metabolism during sleep linked to obesity [16], is an important problem when studying neuronal activity (or its resultant, the sleep EEG). In subjects with upper airway dysfunction, it has been shown that certain obese patients, despite appropriate treatment with nasal continuous positive airway pressure, may present with residual sleepiness and may require prescription of a stimulant [17,18]. Undoubtedly, some patients with UAR pattern can be obese [19], but the known physiological impact of android obesity on diaphragm position and changes in ventilation/perfusion during REM sleep muscle atonia are factors that led us to select a nonobese population.…”

Section: Discussionmentioning

confidence: 99%

Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome

Guilleminault¹,

Kim²,

Chowdhuri³

et al. 2001

Eur Respir J

111

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Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome. C. Guilleminault, Y. Do Kim, S. Chowdhuri, M. Horita, M. Ohayon, C. Kushida. #ERS Journals Ltd 2001. ABSTRACT: This study has investigated differences in the nocturnal sleep and daytime sleepiness among patients with obstructive sleep apnoea syndrome (OSAS), upper airway resistance (UARS), sleep hypopnoea syndrome, and normal control subjects, using sleep scoring and spectral activity analysis of the electroencephalogram (EEG).Twelve nonobese males with UARS aged 30 -60 yrs were recruited. These subjects were strictly matched for age and body mass index with twelve OSAS patients, 12 sleep hypopnoea syndrome patients, and 12 normal controls, all male. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the Multiple Sleep Latency Test (MSLT). The macrostructure of sleep was determined using international criteria and spectral analysis of the sleep EEG was obtained from a central lead.The sleep macrostructure of OSAS and UARS patients was significantly different from that of controls. These patients were also sleepier during the daytime than controls. Complaints of tiredness and daytime sleepiness, ESS and MSLT scores were similar in the different patient groups. Mild dysmorphia was present in all three patient groups. However, nocturnal sleep was significantly different among the different groups. OSAS patients had significantly more awake time during sleep than the UARS patients. The spectral activity of the total sleep time of the patient groups also differed significantly from that of controls. When the sleep spectral activity of UARS and OSAS patients were compared, OSAS patients had less slow wave sleep activity than UARS patients. UARS patients had a significantly higher absolute power in the 7 -9 Hz bandwidth than OSAS patients. The absolute delta power over the different sleep cycles was also different between controls and patients, and between UARS and OSAS patients.There are clear differences in the macrostructure and spectral activity of sleep between upper airway resistance and obstructive sleep apnoea syndrome patients, demonstrated by differences in the cortical activity recorded in the central lead during sleep. Despite these nocturnal sleep differences, the tests of subjective daytime sleepiness are not significantly different.

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Section: Discussionmentioning

confidence: 99%

Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome

Guilleminault¹,

Kim²,

Chowdhuri³

et al. 2001

Eur Respir J

111

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“…To date, modafinil has been shown to facilitate wakefulness in patients with narcolepsy (Boivin et al 1993;Billiard et al 1994;Besset et al 1996;Broughton et al 1997;US Modafinil in Narcolepsy Multicenter Study Group 1998Mitler et al 2000;Moldofsky et al 2000), and obstructive sleep apnea/hypopnea syndrome (Arnulf et al 1997;Cassel et al 1998;Pack et al 2001). In addition to improving wakefulness, modafinil has been shown significantly to improve overall clinical condition (US Modafinil in Narcolepsy Multicenter Study Group 1998 and health-related quality of life (Beusterien et al 1999).…”

Section: Introductionmentioning

confidence: 99%

Initiating treatment with modafinil for control of excessive daytime sleepiness in patients switching from methylphenidate: an open-label safety study assessing three strategies

Thorpy

Schwartz²,

Kovačević-Ristanović

et al. 2003

Psychopharmacology

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Switching from methylphenidate to modafinil was well tolerated with or without a washout period or when the methylphenidate dose is gradually tapered during initiation of modafinil therapy. Daytime wakefulness was maintained in patients who have switched from methylphenidate to modafinil. These data suggest that patients with narcolepsy may be switched from methylphenidate to modafinil with few complications and inconveniences.

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“…To date, modafinil has been studied in two small pilot trials in patients with OSA/HS (43,44), albeit with different doses and designs from those of the present study. Both studies showed that modafinil improved daytime wakefulness but had no significant effect on sleep-disordered breathing or resting blood pressure monitored during the day.…”

mentioning

confidence: 99%

Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea

Pack

Black²,

Schwartz³

et al. 2001

Am J Respir Crit Care Med

271

160

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Patients with obstructive sleep apnea/hypopnea syndrome can experience residual daytime sleepiness despite regular use of nasal continuous positive airway pressure therapy. This randomized, double-blind, placebo-controlled, parallel group study assessed the efficacy and safety of modafinil for the treatment of residual daytime sleepiness in such patients. Patients received modafinil (n = 77) (200 mg/d, Week 1; 400 mg/d, Weeks 2 to 4) or matching placebo (n = 80) once daily for 4 wk. Modafinil significantly improved daytime sleepiness, with significantly greater mean changes from baseline in Epworth Sleepiness Scale scores at Weeks 1 and 4 (p < 0.001) and in multiple sleep latency times (MSLT) at Week 4 (p < 0.05). The percentage of patients with normalized daytime sleepiness (Epworth score < 10) was significantly higher with modafinil (51%) than with placebo (27%) (p < 0.01), but not for MSLT (> 10 min; 29% versus 25%). Headache (modafinil, 23%; placebo, 11%; p = 0.044) and nervousness (modafinil, 12%; placebo, 3%; p = 0.024) were the most common adverse events. During modafinil or placebo treatment, the mean duration of nCPAP use was 6.2 h/night, with no significant change from baseline observed between groups. Modafinil may be a useful adjunct treatment for the management of residual daytime sleepiness in patients with obstructive sleep apnea/hypopnea syndrome who are regular users of nasal continuous positive airway pressure therapy.

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Modafinil in Obstructive Sleep Apnea-Hypopnea Syndrome: A Pilot Study in 6 Patients

Cited by 63 publications

References 7 publications

Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome

Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome

Initiating treatment with modafinil for control of excessive daytime sleepiness in patients switching from methylphenidate: an open-label safety study assessing three strategies

Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea

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