Modafinil effects during acute continuous positive airway pressure withdrawal: a randomized crossover double-blind placebo-controlled trial.
BACKGROUND
Continuous positive airway pressure (CPAP) use is associated with reduced motor vehicle accidents in patients with obstructive sleep apnea (OSA). However, interruption of CPAP therapy is common and is associated with a decline in daytime function.


OBJECTIVE
We hypothesized that the wakefulness promoter, modafinil, would ameliorate this decline.


METHODS
Patients were admitted to the laboratory for three consecutive nights. CPAP was used for the first night, followed by a baseline day, and was then withdrawn for the two subsequent nights (nasal airflow monitored). On each of the mornings after the two CPAP withdrawal nights, patients received 200 mg modafinil or placebo (n = 21) in a randomized, double-blind, crossover design. Treatment periods were separated by a 5-week washout. Driving simulator performance, neurocognitive performance, and subjective alertness were measured by the AusEd driving simulator, psychomotor vigilance task, and Karolinska Sleepiness Scale, respectively.


RESULTS
During CPAP withdrawal, severe sleep-disordered breathing was evident and administration of modafinil improved simulated driving performance (steering variability, P < 0.0001; mean reaction time, P <or= 0.0002; lapses, P <or= 0.01 on a concurrent task), psychomotor vigilance task (mean 1/reaction time and lapses, both P <or= 0.0002), and subjective sleepiness (P <or= 0.01).


CONCLUSIONS
Modafinil prevented the decline in simulated driving performance, neurocognitive performance, and subjective sleepiness in patients with OSA with acutely interrupted CPAP therapy. Clinical trial registered with the Australian New Zealand Clinical Trials Registry at www.anzctr.org.au (ACTRN12606000027516).
Williams
Shaun C
SC
Sleep and Circadian Research Group/NHMRC Centre for Sleep Medicine, Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia. swilliams@woolcock.org.au
Marshall
Nathaniel S
NS
Kennerson
Marina
M
Rogers
Naomi L
NL
Liu
Peter Y
PY
Grunstein
Ronald R
RR
D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data; D001334:Automobile Driving; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D011597:Psychomotor Performance / Q000187:drug effects; D011930:Reaction Time / Q000187:drug effects; D012891:Sleep Apnea Syndromes / Q000628:therapy; D015300:Ventilator Weaning / Q000379:methods*; D014851:Wakefulness / Q000187:drug effects
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil