Isfahan University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Evaluating Pharmacological Treatments for Excessive Daytime Sleepiness in Obstructive Sleep Apnea: A Comprehensive Network Meta-Analysis and Systematic Review Publisher Pubmed



Neshat SS1, 2 ; Heidari A3 ; Henriquezbeltran M4 ; Patel K2 ; Colaco B2 ; Arunthari V2 ; Lee Mateus AY2 ; Cheung J2 ; Labarca G5, 6
Authors
Show Affiliations
Authors Affiliations
  1. 1. Department of Epidemiology and Statistics, University of California, San Francisco, CA, United States
  2. 2. Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic Jacksonville, FL, United States
  3. 3. School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Nucleo de Investigacion en Ciencias de la Salud, Universidad Adventista de Chile, Chillan, Chile
  5. 5. Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
  6. 6. Department of Respiratory Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile

Source: Sleep Medicine Reviews Published:2024


Abstract

Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS). Pharmacotherapy offers a potential treatment approach for EDS in OSA patients. This systematic review and meta-analysis aimed to assess the efficacy and safety of pharmacological interventions for alleviating EDS in patients with OSA. Following PRISMA guidelines, we included randomized controlled trials investigating pharmacological treatments for EDS in adult OSA until August 2023. We conducted meta-analysis, subgroup, and meta-regression analyses using a random effects model. Finally, a network meta-analysis synthesized direct and indirect evidence, followed by a comprehensive safety analysis. We included 32 articles in the meta-analysis (n = 3357). Pharmacotherapy showed a significant improvement in the Epworth Sleepiness Scale (ESS) score (Mean Difference (MD) −2.73, (95 % Confidence Interval (CI) [−3.25, −2.20], p < 0.01) and Maintenance of Wakefulness Test (MWT) score (MD 6.00 (95 % CI [2.66, 9.33] p < 0.01). Solriamfetol, followed by Pitolisant and modafinil, exhibited the greatest ESS reduction, while Danavorexton, followed by Solriamfetol and MK-7288, had the strongest impact on MWT. MK-7288 had the most total adverse events (AEs), followed by Danavorexton and armodafinil. Pharmacological Interventions significantly alleviate EDS in OSA patients but with heterogeneity across medications. Treatment decisions should involve a personalized assessment of patient factors and desired outcomes. © 2024 Elsevier Ltd
Related Docs
View other Related Docs
1. Comparison of Berlin Questionnaire, Stop-Bang, and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients, International Journal of Preventive Medicine (2018)
2. Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review, Oman Medical Journal (2018)
3. Evaluation of Blood Levels of Omentin-1 and Orexin-A in Adults With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis, Life (2023)
4. Effect of Continuous Positive Airway Pressure Therapy on Blood Levels of Il-6, Il-10, Il-18, Il-1Β, Il-4, and Il-17 in Obstructive Sleep Apnoea Adults: A Systematic Review, Meta-Analysis and Trial Sequential Analysis, International Orthodontics (2024)
5. Gender Difrances on Polysomographic Findings and Clinical Symptome in Iranian Subjects With Obstructive Sleep Apnea Syndrome, Journal of Isfahan Medical School (2011)
6. Comparison of the Effectiveness of Modafinil and Methylphenidate in Treatment of Excessive Daytime Sleepiness in Patients With Parkinson’S Disease, Current Journal of Neurology (2024)
7. Frequency of Positional Obstructive Sleep Apnea (Posa) in Patients With Obstructive Sleep Apnea and Differences in Demographic and Clinical Characteristics, Journal of Isfahan Medical School (2018)
8. Screening Tools for Obstructive Sleep Apnea in Pregnant Women: An Extended and Updated Systematic Review and Meta‑Analysis, International Journal of Preventive Medicine (2024)
Experts (# of related papers)
View all Related Experts
Babak Amra (25)
Forogh Soltaninejad (11)
Other Related Docs
9. The Role of Magnesium in Sleep Health: A Systematic Review of Available Literature, Biological Trace Element Research (2023)
10. Evaluation of Sleep Training Effectiveness on the Quality of Sleep in Cancer Patients During Chemotherapy, Advanced Biomedical Research (2021)
11. Clinical and Polysomnographic Characteristics of Patients With Extreme Obstructive Sleep Apnea, Ahi > 100: A Case-Control Study, Shiraz E Medical Journal (2021)
12. Saffron and Sleep Quality: A Systematic Review of Randomized Controlled Trials, Nutrition and Metabolic Insights (2023)
13. Smartphone Addiction and Obstructive Sleep Apnea Syndrome: An Evaluation of the Possible Association, Journal of Health Sciences and Surveillance System (2022)
14. Comparison of Prevalence Rates of Restless Legs Syndrome, Self-Assessed Risks of Obstructive Sleep Apnea, and Daytime Sleepiness Among Patients With Multiple Sclerosis (Ms), Clinically Isolated Syndrome (Cis) and Neuromyelitis Optica Spectrum Disorder (Nmosd), Sleep Medicine (2020)
15. Comparative Analysis of Treatment Options for Chronic Heart Failure and Depression: A Systematic Review and Bayesian Network Meta-Analysis, Heart Failure Reviews (2024)
16. Validation of the Persian Version of Berlin Sleep Questionnaire for Diagnosing Obstructive Sleep Apnea, International Journal of Preventive Medicine (2013)
17. The Prediction of Obstructive Sleep Apnea Severity Based on Anthropometric and Mallampati Indices, Journal of Research in Medical Sciences (2019)
18. Effect of Melatonin Supplementation on Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Journal of Neurology (2022)
19. Comparative Evaluation of Therapeutic Approaches to Central Sleep Apnea, Advanced Biomedical Research (2019)
20. Circadian Rhythm Sleep Disorders in Patients With Multiple Sclerosis and Its Association With Fatigue: A Case-Control Study, Journal of Research in Medical Sciences (2013)
21. A Comparative Study on the Effects of Surgery Alone and Along With Radiofrequency in Improvement of Patients With Nocturnal Snoring in Isfahan, Iran, Journal of Research in Medical Sciences (2012)
22. Evaluation of Plasma/Serum Adiponectin (An Anti-Inflammatory Factor) Levels in Adult Patients With Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis, Life (2022)
23. Potential Role of Exogenous Melatonin Supplement in Delirium Prevention in Critically Ill Patients: A Double-Blind Randomized Pilot Study, Iranian Journal of Pharmaceutical Research (2018)
24. Obstructive Sleep Apnea, Diagnosed by the Berlin Questionnaire and Association With Coronary Artery Disease Severity, ARYA Atherosclerosis (2015)
25. Mild Traumatic Brain Injury: Insomnia or Sleepiness, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management (2023)
26. Are There Clinical Differences Between 3D-Printed and Milled Complete Dentures? a Systematic Review and Meta-Analysis, International Dental Journal (2024)
27. Positive Pressure Ventilation Treatment Based on Daytime and Night-Time Titration in Patients With Obesity Hypoventilation Syndrome: A Randomized Controlled Trial, Sleep Science (2023)
28. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies, International Journal of Preventive Medicine (2014)
29. The Efficacy of Low and Moderate Dosage of Diazepam on Sleep Bruxism in Children: A Randomized Placebo-Controlled Clinical Trial, Journal of Research in Medical Sciences (2019)
30. The Association Between Sleep Quality, Health Status and Disability Due to Breathlessness in Chronic Obstructive Pulmonary Disease Patients, Clinical Respiratory Journal (2021)
31. Effect of a Nursing Care Program Based on Roy's Adaptation Model on Sleep Quality in Patients Undergoing Methadone Maintenance Treatment: A Randomized Clinical Trial, HAYAT (2024)
32. Non Invasive Ventilation's Effectiveness (Niv) in Patients With Interstitial Lung Disease and Hypercapnic Respiratory Failure, Tanaffos (2022)
33. Correlation Between Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome in a General Population in Iran, Journal of Research in Medical Sciences (2011)
34. Association Between Periodontal Disease and Non-Apnea Sleep Disorder: A Systematic Review, Clinical Oral Investigations (2020)
35. Effect of Cpap Therapy on Serum Lipids and Blood Pressure in Patients With Obstructive Sleep Apnea Syndrome, Tanaffos (2019)
36. Prevalence of Sleep Apnea-Related Symptoms in a Persian Population, Sleep and Breathing (2011)
37. Post-Coronary Artery Bypass Graft Surgery Insomnia: Quetiapine Vs Alprazolam, Iranian Heart Journal (2021)
38. Evaluation of the Relationship Between Sleep Quality and Duration With Obesity in a Population of Iranian Adults, Journal of Health System Research (2020)
39. Does Cosmetic Rhinoplasty Affect Sleep Quality And/Or Contribute to the Development of Obstructive Sleep Apnea?, Cranio - Journal of Craniomandibular and Sleep Practice (2024)
40. The Effect of Dracocephalum Extract on Sleep Quality in Post-Menopausal Women: A Randomized Placebo-Controlled Trial, Iranian Journal of Psychiatry (2022)
41. Effect of Coenzyme Q10 Supplementation on Work-Related Fatigue in Nurses: A Double-Blind, Randomized Placebo-Controlled Study, Fatigue: Biomedicine, Health and Behavior (2020)
42. The Effect of Opium on Polysomnographic Findings in Patients With Sleep Apnea, Tanaffos (2010)
43. Sleep Apnea Syndrome and Complex Partial Seizure; Is There Any Association?, Journal of Isfahan Medical School (2013)
44. Sleep Duration and Sarcopenia Risk: A Systematic Review and Dose-Response Meta-Analysis, Sleep and Breathing (2020)
45. Ultra-Processed Food Intake and Risk of Insomnia: A Systematic Review and Meta-Analysis, Nutrients (2024)
46. Association of Dietary Quality Indices With Sleep Quality in Chronic Obstructive Pulmonary Disease Patients, Nutrition and Food Science (2020)
47. Sleep Apnea Symptoms in Diabetics and Their First Degree Relatives, International Journal of Preventive Medicine (2012)
48. Comparison of Therapeutic Approaches to Addicted Patients With Central Sleep Apnea, Tanaffos (2018)
49. Effects of Laparoscopic Sleeve Gastrectomy and Roux-En-Y Gastric Bypass on the Improvement of Sleep Quality, Daytime Sleepiness, and Obstructive Sleep Apnea in a Six-Month Follow-Up, Tanaffos (2020)
50. Evaluating Changes in Pulse Transit Time Drop Index in Patients With Obstructive Sleep Apnea Before and During Cpap Therapy, Clinical Respiratory Journal (2022)