What are the concerns with using modafinil to treat residual sleepiness in obstructive sleep apnea (OSA)?

Updated: Sep 15, 2020
  • Author: Himanshu Wickramasinghe, MD, MBBS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

One concern clinicians share with the use of modafinil (or other stimulants) in the management of OSA is whether improvement in alertness with the use of these agents may lead to noncompliance with CPAP therapy. This is an important concern, because stimulants do not control the SDB, resulting in worsening symptom control and potentially increasing the risk of cardiovascular morbidity.

Fortunately, this does not appear to be a major problem at present. The 2 largest trials did not show a decrease in CPAP usage with modafinil. [214, 79] However, decreased CPAP usage was noted in the smaller randomized study of modafinil [213] and in an open-label extension trial. [215] Therefore, if a patient is prescribed a stimulant, compliance with CPAP must be closely monitored.


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