Solriamfetol offers hope for excessive daytime sleepiness in OSA

The dopamine-norepinephrine reuptake inhibitor solriamfetol helps reduce excessive daytime sleepiness in patients with obstructive sleep apnoea (OSA), without compromising primary OSA treatment, as shown in a study.

The study randomized patients to receive 12 weeks of placebo or solriamfetol at 37.5, 75, 150, or 300 mg/day. Efficacy analysis was stratified by primary OSA therapy adherence. Coprimary endpoints were week-12 change from baseline in Maintenance of Wakefulness Test (40-minute MWT) and Epworth Sleepiness Scale (ESS).

A total of 324 (70.6 percent) participants were treatment adherent (continuous positive airway pressure use ≥4 hours/night on ≥70 percent nights, surgical intervention, or oral appliance use on ≥70 percent nights), and 135 (29.4 percent) were nonadherent.

Compared with placebo, solriamfetol reduced excessive daytime sleepiness. Mean differences in MWT sleep latency with the 37.5-, 75-, 150-, and 300-mg groups were 4.8, 8.4, 10.2, and 12.5 minutes among adherent participants, and 3.7, 9.9, 11.9, and 13.5 minutes among nonadherent participants, respectively.

Mean differences in ESS in the 37.5-, 75-, 150-, and 300-mg groups versus the placebo group were –2.4, –1.3, –4.2, and –4.7 among adherent participants, and –0.7, –2.6, –5.0, and –4.6 among nonadherent participants, respectively.

Commonly reported adverse events included headache, nausea, anxiety, decreased appetite, nasopharyngitis, and diarrhoea. Solriamfetol exerted no clinically meaningful changes in primary OSA therapy use.