Pharmacotherapy for excessive daytime sleepiness.
Excessive daytime sleepiness (EDS) has recognized detrimental consequences such as road traffic accidents, impaired psychological functioning and reduced work performance. EDS can result from multiple causes such as sleep deprivation, sleep fragmentation, neurological, psychiatric and circadian rhythm disorders. Treating the underlying cause of EDS remains the mainstay of therapy but in those who continue to be excessively sleepy, further treatment may be warranted. Traditionally, the amphetamine derivatives, methylphenidate and pemoline (collectively sympathomimetic) psychostimulants were the commonest form of therapy for EDS, particularly in conditions such as narcolepsy. More recently, the advent of modafinil has broadened the range of therapeutic options. Modafinil has a safer side-effect profile and as a result, interest in this drug for the management of EDS in other disorders, as well as narcolepsy, has increased considerably. There is a growing school of thought that modafinil may have a role to play in other indications such as obstructive sleep apnea/hypopnea syndrome already treated by nasal continuous positive airway pressure but persisting EDS, shift work sleep disorders, neurological causes of sleepiness, and healthy adults performing sustained operations, particularly those in the military. However, until adequately powered randomised-controlled trials confirm long-term efficacy and safety, the recommendation of wakefulness promoters in healthy adults cannot be justified.
Banerjee
Dev
D
Sleep and Ventilation Unit, Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
Vitiello
Michael V
MV
Grunstein
Ronald R
RR
D000662:Amphetamines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001682:Biological Availability; D002385:Cataplexy / Q000097:blood / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy*; D006801:Humans; D008134:Long-Term Care; D000077408:Modafinil; D009290:Narcolepsy / Q000097:blood / Q000188:drug therapy*; D013566:Sympathomimetics / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
D000662:Amphetamines; D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D013566:Sympathomimetics; D000077408:Modafinil