Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy

IF 11.2 1区 医学 Q1 CLINICAL NEUROLOGY
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Abstract

There remains an unmet need for a targeted treatment to address residual excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) after primary treatment. This network meta-analysis evaluated the efficacy and safety of wake-promoting agents (WPAs), namely solriamfetol, pitolisant, modafinil, and armodafinil, for treating residual EDS in patients with OSA. We conducted a comprehensive search which ultimately included 18 studies in the final analysis. All 4 WPAs demonstrated significant therapeutic benefits for the Epworth sleepiness scale (ESS) and maintenance of wakefulness test (MWT). Based on the surface under the cumulative ranking curve (SUCRA) score, solriamfetol, pitolisant, modafinil and armodafinil were ranked from highest to lowest for the ESS. A similar ranking was observed for MWT, where pitolisant was not included in the analysis. The subgroup analysis also evaluated the efficacy of WPAs in the primary treatment adherent and nonadherent subgroups. Regarding adverse reactions, solriamfetol demonstrated the lowest risk of all-cause discontinuation, whereas pitolisant exhibited minimal risks of adverse events leading to treatment discontinuation and treatment-emergent adverse events. Our analysis comprehensively compared the effects and adverse reactions of different WPAs in treating residual EDS in treated patients with OSA. This has significant implications for the practical clinical use of WPAs and future research.

阻塞性睡眠呼吸暂停患者白天过度嗜睡:对坚持/不坚持主要 OSA 治疗的患者使用促醒剂进行间接治疗比较。
阻塞性睡眠呼吸暂停(OSA)患者在接受初级治疗后,仍需要有针对性的治疗方法来解决残留的白天过度嗜睡(EDS)问题。这项网络荟萃分析评估了促进唤醒药物(WPA),即索拉非托、匹托利桑、莫达非尼和阿莫达非尼治疗 OSA 患者残余 EDS 的有效性和安全性。我们进行了全面搜索,最终将 18 项研究纳入最终分析。所有 4 种 WPA 在埃普沃思嗜睡量表(ESS)和保持清醒测试(MWT)方面均显示出显著的治疗效果。根据累积排名曲线下表面(SUCRA)得分,索利安非托、匹托利桑、莫达非尼和奥莫达非尼在ESS方面的排名从高到低依次为:索利安非托、匹托利桑、莫达非尼和奥莫达非尼。在 MWT 中也观察到了类似的排名,其中 pitolisant 未被纳入分析。亚组分析还评估了WPAs在坚持主要治疗和不坚持主要治疗亚组中的疗效。在不良反应方面,索利安非妥的全因停药风险最低,而匹多莫德的导致停药的不良反应和治疗引发的不良反应风险最小。我们的分析全面比较了不同 WPA 治疗 OSA 患者残余 EDS 的效果和不良反应。这对 WPAs 的实际临床应用和未来研究具有重要意义。
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来源期刊
Sleep Medicine Reviews
Sleep Medicine Reviews 医学-临床神经学
CiteScore
20.10
自引率
3.80%
发文量
107
期刊介绍: Sleep Medicine Reviews offers global coverage of sleep disorders, exploring their origins, diagnosis, treatment, and implications for related conditions at both individual and public health levels. Articles comprehensively review clinical information from peer-reviewed journals across various disciplines in sleep medicine, encompassing pulmonology, psychiatry, psychology, physiology, otolaryngology, pediatrics, geriatrics, cardiology, dentistry, nursing, neurology, and general medicine. The journal features narrative reviews, systematic reviews, and editorials addressing areas of controversy, debate, and future research within the field.
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