Modafinil for excessive sleepiness associated with shift-work sleep disorder.
BACKGROUND
Patients with shift-work sleep disorder chronically have excessive sleepiness during night work and insomnia when attempting to sleep during the day. We evaluated the use of modafinil for treating sleepiness in patients with this disorder.


METHODS
In a three-month, double-blind trial, we randomly assigned 209 patients with shift-work sleep disorder to receive either 200 mg of modafinil or placebo before the start of each shift. Assessments were performed with the use of the nighttime Multiple Sleep Latency Test, the Clinical Global Impression of Change, the Psychomotor Vigilance Test, diaries of patients, and daytime polysomnography. After randomization, we conducted monthly assessments.


RESULTS
Treatment with modafinil, as compared with placebo, resulted in a modest improvement from baseline in mean (+/-SEM) nighttime sleep latency (the interval between the time a person attempts to fall asleep and the onset of sleep) (1.7+/-0.4 vs. 0.3+/-0.3 minutes, respectively; P=0.002), and more patients had improvement in their clinical symptoms (74 percent vs. 36 percent, respectively; P<0.001). Patients who were receiving modafinil also had a reduction in the frequency and duration of lapses of attention during nighttime testing of their performance on the Psychomotor Vigilance Test (change from baseline, a reduction in lapse frequency of 2.6 vs. an increase of 3.8, respectively; P<0.001), and proportionally fewer patients reported having had accidents or near accidents while commuting home (29 percent vs. 54 percent, respectively; P<0.001). Despite these benefits, patients treated with modafinil continued to have excessive sleepiness and impaired performance at night. Modafinil did not adversely affect daytime sleep as compared with placebo. Headache was the most common adverse event.


CONCLUSIONS
Treatment with 200 mg of modafinil reduced the extreme sleepiness that we observed in patients with shift-work sleep disorder and resulted in a small but significant improvement in performance as compared with placebo. However, the residual sleepiness that was observed in the treated patients underscores the need for the development of interventions that are even more effective.
Czeisler
Charles A
CA
Division of Sleep Medicine, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA 02115, USA. caczeisler@hms.harvard.edu
Walsh
James K
JK
Roth
Thomas
T
Hughes
Rod J
RJ
Wright
Kenneth P
KP
Kingsbury
Lilliam
L
Arora
Sanjay
S
Schwartz
Jonathan R L
JR
Niebler
Gwendolyn E
GE
Dinges
David F
DF
D000328:Adult; D001288:Attention / Q000187:drug effects; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D011597:Psychomotor Performance / Q000187:drug effects; D020178:Sleep Disorders, Circadian Rhythm / Q000188:drug therapy*; D014940:Work Schedule Tolerance
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil