From the Guidelines
For a patient with residual excessive daytime sleepiness (EDS) from obstructive sleep apnea (OSA), the most recommended medication is Solriamfetol (Sunosi) at 75-150mg once daily, as it has been shown to be effective in promoting wakefulness without the typical stimulant effects. The choice of medication for EDS in OSA patients is crucial, and the most recent and highest quality studies support the use of wake-promoting agents like Solriamfetol.
- The medication should be used as an adjunct to primary OSA treatment, not as a replacement for CPAP or other primary therapies.
- Before initiating any medication, it's essential to ensure optimal CPAP compliance and pressure settings, rule out other sleep disorders like narcolepsy, and address potential contributors to sleepiness such as insufficient sleep, depression, or medication side effects.
- Traditional stimulants like methylphenidate or amphetamine derivatives can be used in refractory cases, but they are not the first-line choice due to their potential for abuse and side effects. The evidence from studies 1 and 1 suggests that wake-promoting agents like Solriamfetol are effective in reducing EDS in OSA patients, and they should be considered as a treatment option.
- However, it's essential to note that the evidence for other medications like Doxepine, Venlafaxine, and Low dose Naltrexone is limited, and they are not recommended as first-line treatments for EDS in OSA patients.
- The American College of Physicians guidelines 1 also support the use of wake-promoting agents like Solriamfetol for the treatment of EDS in OSA patients.
From the FDA Drug Label
SUNOSI is a prescription medicine used to improve wakefulness in adults with excessive daytime sleepiness that is associated with narcolepsy or obstructive sleep apnea (OSA). INDICATIONS AND USAGE SUNOSI is a dopamine and norepinephrine reuptake inhibitor (DNRI) indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA).
The medication that could be recommended for Steady Eddie's condition is Solriamfetol (Sunosi), as it is indicated to improve wakefulness in adults with excessive daytime sleepiness associated with obstructive sleep apnea (OSA) 2, 2, 2.
- Key points:
- Solriamfetol (Sunosi) is a dopamine and norepinephrine reuptake inhibitor (DNRI)
- It is used to improve wakefulness in adult patients with excessive daytime sleepiness associated with OSA
- The starting dose for patients with OSA is 37.5 mg once daily, and the dose may be increased at intervals of at least 3 days, with a maximum dose of 150 mg once daily.
From the Research
Medication Options for Residual Excessive Daytime Sleepiness
- The patient's condition, residual excessive daytime sleepiness (EDS) from obstructive sleep apnea (OSA), can be treated with medications that target the underlying causes of EDS.
- Among the options provided, one medication has been specifically approved and studied for the treatment of EDS in adults with OSA.
Recommended Medication
- Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor that has been approved for the treatment of EDS in adults with OSA 3, 4, 5, 6.
- Studies have shown that solriamfetol is effective in improving wakefulness and reducing EDS in patients with OSA, with a favorable safety profile 3, 4, 5, 6.
- The recommended dosage of solriamfetol for OSA is 37.5-150 mg/day, with most patients initiating treatment at 37.5 or 75 mg/day and titrating to 75 or 150 mg/day as needed 3.
Other Options
- Doxepin (low dose) and Venlafaxine (low dose) are not typically recommended for the treatment of EDS in OSA.
- Low-dose Naltrexone is not a commonly used treatment for EDS in OSA, and its efficacy and safety for this indication are not well established.
Clinical Evidence
- Multiple studies have demonstrated the efficacy and safety of solriamfetol for the treatment of EDS in OSA, including phase III clinical trials and real-world studies 3, 4, 5, 6.
- Solriamfetol has been shown to improve wakefulness, reduce EDS, and enhance quality of life in patients with OSA, with a favorable safety profile 3, 4, 5, 6.