Top PDF Modafinil in the treatment of excessive sleepiness

Modafinil in the treatment of excessive sleepiness

Modafinil in the treatment of excessive sleepiness

OSA is a common cause of excessive sleepiness, and residual sleepiness occurs in some patients who are oth- erwise well treated for the underlying airway obstruction (Weaver et al 2007). While modafi nil reduces residual sleepiness in these patients, it does not treat the cause of OSA. It is therefore critical that patients adhere to inter- ventions that directly address OSA-related pathology, such as CPAP therapy (Hirshkowitz and Black 2007). Weaver and colleagues established a relationship between hours of CPAP use during the night and achieving normal levels of daytime sleepiness and functioning; for example, thresholds above which further improvements were less likely for ESS was 4 hours, MSLT was 6 hours, and FOSQ was 7.5 hours (Weaver et al 2007). Despite concerns to the contrary (Pollak 2003), modafi nil does not appear to adversely affect CPAP use. While a statistically signifi cant 12-minute reduction in nightly CPAP use was shown for patients receiving modafi nil compared with patients receiving placebo in a 7-week, placebo-controlled crossover study of 30 patients (Kingshott et al 2000), modafi nil did not signifi cantly alter CPAP use in the large-scale, 4-week and 12-week double- blind studies (Pack et al 2001; Black and Hirshkowitz 2005). In a 12-month follow-up to the 12-week study, mean nightly CPAP use declined by 34 minutes (p 0.0001 for the change from baseline) to a fi nal visit duration of 5.4 hours (Hirshkowitz and Black 2007). This duration is within the range of previously reported values for long-term CPAP use (4.3–6.5 hours) (Engleman et al 1994b; Reeves-Hoche et al 1994; Krieger et al 1996; Pieters et al 1996; Collard et al 1997). As a precaution, CPAP use should be encouraged and periodically assessed (Black and Hirshkowitz 2007;
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Armodafinil in the treatment of excessive sleepiness

Armodafinil in the treatment of excessive sleepiness

Abstract: Excessive sleepiness (ES) is a widespread condition, commonly the result of a sleep/ wake disorder such as obstructive sleep apnea (OSA), shift-work disorder (SWD), or narcolepsy. ES poses significant health and safety concerns in patients. Numerous interventions are available to treat the underlying causes of ES and ES itself, including behavioral measures, mechanical devices, and pharmacologic agents. This review explores the evidence supporting the use of armodafinil to treat ES associated with OSA, SWD, and narcolepsy. Armodafinil is an oral non-amphetamine wake-promoting agent, the R-isomer of racemic modafinil. Armodafinil and modafinil share many clinical and pharmacologic properties and are distinct from central nervous system stimulants; however, the mechanisms of action of modafinil and armodafinil are poorly characterized. Compared with modafinil, the wake-promoting effects of armodafinil persist later in the day. It is for this reason that armodafinil may be a particularly appropriate therapy for patients with persistent ES due to OSA, SWD, or narcolepsy.
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Ready for takeoff? A critical review of armodafinil and modafinil for the treatment of sleepiness associated with jet lag

Ready for takeoff? A critical review of armodafinil and modafinil for the treatment of sleepiness associated with jet lag

Abstract: Jet lag syndrome (JLS) is a clinical syndrome of disrupted nocturnal sleep and daytime neurocognitive impairment which occurs in the context of rapid transmeridian travel. Many strategies for treatment of JLS exist, and include hypnotics to enhance nocturnal sleep, chronotherapeutic approaches (eg, light therapy, melatonin, or gradual schedule shifting), and alerting agents to counter daytime sleepiness. Safety concerns have prompted renewed inter- est in managing JLS-associated excessive daytime sleepiness (JLSAEDS). Off-label use of the newer alerting agents modafinil and armodafinil is increasing for this indication, often at the specific request of patients. In order to better evaluate the potential risks and benefits of these medications for the management of JLSAEDS, clinicians must be aware of what is known – and still not known. In this article, the pharmacology and pharmacokinetics of modafinil and armodafinil are reviewed, along with evidence for their efficacy in treating sleepiness associated with narcolepsy, obstructive sleep apnea and shift work sleep disorder. Clinical trial data for use of alerting agents in the management of JLSAEDS are limited to one three-day trial involving armodafinil, dosed in the morning to treat JLSAEDS in the setting of eastbound transmeridian travel. This study showed improvement in objective measures of daytime sleepiness at doses of 50 and 150 mg per day. However, global impression of clinical severity of symptom scores only improved on day 1 for those patients receiving 150 mg, and were otherwise not superior to placebo. Consideration for the use of modafinil or armodafinil for the treatment of sleepiness associated with JLS involves careful integration of patient-reported goals, a review of medical contraindications, and an awareness of rare adverse events. More research is needed in order to identify those who are most likely to benefit from this intervention and better define the risk-benefit ratio for this indication.
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Excessive Sleepiness in Adolescents and Young Adults: Causes, Consequences, and Treatment Strategies

Excessive Sleepiness in Adolescents and Young Adults: Causes, Consequences, and Treatment Strategies

ABSTRACT. Adolescents and young adults are often excessively sleepy. This excessive sleepiness can have a profound negative effect on school performance, cogni- tive function, and mood and has been associated with other serious consequences such as increased incidence of automobile crashes. In this article we review available scientific knowledge about normal sleep changes in ad- olescents (13–22 years of age), the factors associated with chronic insufficient sleep, the effect of insufficient sleep on a variety of systems and functions, and the primary sleep disorders or organic dysfunctions that, if untreated, can cause excessive daytime sleepiness in this population. Pediatrics 2005;115:1774–1786; sleep, sleepi- ness, adolescents, pediatric sleep problems, daytime sleep- iness, young adults, circadian rhythm, melatonin, motor vehicle accidents, depression, attention-deficit/hyperac- tivity disorder, school start times, school performance, obstructive sleep apnea, narcolepsy, idiopathic hypersom- nia, delayed phase syndrome, insufficient sleep.
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Daytime sleepiness in elderly Parkinson’s disease patients and treatment with the psychostimulant modafinil: A preliminary study

Daytime sleepiness in elderly Parkinson’s disease patients and treatment with the psychostimulant modafinil: A preliminary study

Background: Patients with Parkinson’s disease (PD) or Parkinsonian syndromes often report excessive daytime sleepiness (EDS). The aim of this study was to evaluate the effects of the psy- chostimulant modafinil on elderly, institutionalized, severely impaired PD patients with EDS. Method: A three-week open study on ten institutionalized PD patients scoring 10 points on the Epworth Sleepiness Scale (ESS) with modafinil eventually on 100 mg twice a day. Patients were assessed at the start, week 1, and week 3 with ESS, Clinical Global Impression (CGI) scale severity of PD and appetite.
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Prader Willi syndrome, excessive daytime sleepiness, and narcoleptic symptoms: a case report

Prader Willi syndrome, excessive daytime sleepiness, and narcoleptic symptoms: a case report

Sleep abnormalities in patients with PWS lead to detri- mental effects on daily functioning and learning. Our report provides a unique longitudinal perspective on the disordered sleep of a PWS patient, and the effect- iveness of long-term modafinil use for the treatment of EDS in a young girl with PWS over the course of three years. EDS is a common symptom of PWS, affecting between 70 and 85 percent of PWS individuals [4]. Caregivers often report increased sleepiness in both children and adults with PWS; individuals with PWS also self-report higher levels of EDS compared to other intellectually disabled groups [6]. EDS is also object- ively demonstrated through abnormal MSLT results in PWS patients. A collection of studies reviewed by Maas et al. reported severe sleepiness (MSLT score less than 5 minutes) in 40 to 50 percent of adults with PWS and moderate to severe sleepiness (MSLT score less than 10 minutes) in 70 to 100 percent [2,7]. A combin- ation of obesity, craniofacial abnormalities, sleep apnea and abnormalities of sleep structure are proposed con- tributing factors related to their daytime hypersomnia [4]. Sleep difficulties can functionally impair attention and behavior and overall cognitive status and school functioning [1]. Our patient was initially noted to nap for two to three hours each day and sleep for 12 hours during the night. These sleep periods are relatively long compared to age-matched peers; the average sleep dur- ation for eight-year-olds is 10.6 ± 0.6h per 24h period
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Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

Although our result pointed out that insufficient sleep is one of the most important factors affect EDS in OSAS patients, the management of EDS in the OSAS patients under CPAP treatment is a multifaceted problem includ- ing treatment, social and healthcare related factors, and these need to be discuss comprehensively. Knowledge about facilitators and barriers for adherence to CPAP treat- ment can be used in interventional strategies [21]. This can be increased by intensive patient education. The use of a wake-promoting medication, modafinil, is also ap- proved for OSAS patients who are adherent to CPAP therapy but exhibit a residual EDS [22]. However, the common side effects of modafinil include headache (28%), anxiety (16%), and nervousness (14%). In addition, the possibility that addiction to modafinil may be probable [23]. Before the prescription of stimulants, it is necessary to establish an educational program for OSAS patients under CPAP treatment to enlighten what patients can do for themselves about sleep hygiene.
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<p>Management Of Excessive Sleepiness In Patients With Narcolepsy And OSA: Current Challenges And Future Prospects</p>

<p>Management Of Excessive Sleepiness In Patients With Narcolepsy And OSA: Current Challenges And Future Prospects</p>

Abstract: Excessive daytime sleepiness (EDS) can be caused by insuf fi cient sleep but is also a manifestation of medical or sleep disorders and a side effect of medications. It impacts quality of life and creates safety concerns in the home, at work, and on the roads. Screening questionnaires can be used to estimate EDS, but further evaluation is necessary. EDS is a common symptom of both narcolepsy and obstructive sleep apnea (OSA). Polysomnography and multiple sleep latency testing are used to diagnose these disorders. However, isolating the primary etiology of EDS can be challenging and may be multifactorial. Untreated OSA can show polysomnographic fi ndings that are similar to narcolepsy. The effects of sleep deprivation and certain medications can also affect the polysomnographic results. These challenges can lead to misdiagnosis. In addition, narcolepsy and OSA can occur as comorbid disorders. If EDS persists despite adequate treatment for either disorder, a comorbid diag- nosis should be sought. Thus, despite advances in clinical practice, appropriate management of these patients can be challenging. This review is focused on EDS due to OSA and narcolepsy and addresses some of the challenges with managing this patient population. Keywords: EDS, excessive daytime sleepiness, narcolepsy, OSA, obstructive sleep apnea
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Armodafinil in the treatment of sleep/wake disorders

Armodafinil in the treatment of sleep/wake disorders

Abstract: Excessive sleepiness (ES) is a major but underestimated public health concern associated with significant impairments in alertness/wakefulness and significant morbidity. The term ES has been used in the sleep medicine literature for years, but due to its nonspecific symptoms (ie tiredness or fatigue), it frequently goes unrecognized or is misdiagnosed in primary care. In some cases ES arises due to poor sleep habits or self-imposed sleep deprivation; however, ES is also a key component of a number of sleep/wake disorders and multiple medical and psychiatric disorders. Identification and treatment of ES is critical to improve the quality of life and well-being of patients and for the safety of the wider community. The inability of patients to recognize the nature, extent, and symptomatic profile of sleep/wake disorders requires vigilance on the part of healthcare professionals. Interventions to address ES and its associated impairments, treatment of the underlying sleep/wake disorder, and follow-up are a priority given the potential for serious consequences if left untreated. Wakefulness-promoting agents are available that treat ES associated with sleep/wake disorders. This review examines current approaches for managing this debilitating and potentially life-threatening condition, focusing on the place of armodafinil as a wakefulness-promoting agent.
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TREATMENT OPTIONS FOR NARCOLEPSY: A REVIEW

TREATMENT OPTIONS FOR NARCOLEPSY: A REVIEW

Narcolepsy is a chronic neurological disorder specifying the abnormal sleep manifestations which mainly impact the quality of life of narcolepsy patients. The exact cause is unclear but found significant evidences that orexin/hypocretin deficiency causes narcolepsy which regulates sleep. Treatment focuses on symptomatic relief throughout medication, education, and behavioral therapy. Stimulants are the first line treatment for the excessive daytime sleepiness. Modafinil, sodium oxybate, amphetamine, methylphenidate, and selegiline are effectual treatments for somnolence associated with narcolepsy. Tricyclic antidepressants and SSRIs are one of the best treatments for cataplexy, sleep paralysis, and hypnagogic hallucinations. Benzodiazepines are the best regimen for disturbed nocturnal sleep.
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Risk of obstructive sleep apnea and excessive daytime sleepiness in hospitalized psychiatric patients

Risk of obstructive sleep apnea and excessive daytime sleepiness in hospitalized psychiatric patients

The investigators recruited 152 participants from the patients hospitalized at the AUB-MC psychiatric unit. Our psychi- atric unit admits ~ 250 patients per year. The sample used in this study was collected over 2 years. Some of the patients admitted to the unit did not agree to participate, and some did not meet criteria for inclusion. We estimate a response rate of ~ 30%. The participants were 56.6% female and the average age range was 26 to 45. The demographic and descriptive characteristics of the group are shown in Table 1. As expected, a lower risk of sleep apnea, per the Berlin ques- tionnaire scores, was detected in females when compared to males (Table 1). Most of the participants were overweight, and this group had the highest risk of sleep apnea. The primary psychiatric diagnoses of the participants upon admission to the psychiatric unit are listed in Table 1. Depression was the most common admitting diagnosis at 44.0% (Table 1). When the participants were asked if they ever received a diagnosis of sleep apnea, or ever used continuous positive airway pressure or bi-level positive airway pressure devices for treatment of OSA, only 5% responded affirmatively. Per the Berlin questionnaire, 39.5% of the participants were
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Obesity and Excessive Daytime Sleepiness in Prepubertal Children With Obstructive Sleep Apnea

Obesity and Excessive Daytime Sleepiness in Prepubertal Children With Obstructive Sleep Apnea

these preliminary assumptions and indicates that BMI plays a major role in defining the phenotype of OSA in children. At equivalent levels of OSA severity, the like- lihood of MSL of ⱕ 12.0 minutes was more than sixfold greater for obese children, and a strong association emerged between BMI and sleep propensity (Fig 1). These and other differences in the clinical syndrome of OSA among nonobese and obese children prompted us to propose the existence of 2 types of clinical OSA, which may have implications not only regarding the type and extent of end-organ dysfunction induced by the recur- rent upper airway obstruction during sleep but also re- garding treatment outcomes. 31–34 Of note, there were no
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An association between liraglutide treatment and reduction in excessive daytime sleepiness in obese subjects with type 2 diabetes

An association between liraglutide treatment and reduction in excessive daytime sleepiness in obese subjects with type 2 diabetes

Methods: This single-centre retrospective study included 158 obese (body mass index [BMI] ≥ 30 kg/m 2 ) adult subjects with type-2 diabetes who were initiated with liraglutide treatment at least 3 months before study inclusion. Data of the Epworth Sleepiness Scale (ESS), anthropometric parameters, glucose-control and metabolic parameters were collected at liraglutide initiation (baseline) and at months 1 and 3 after liraglutide initiation. Results: Significant reductions in ESS score were achieved at months 1 ( − 1.3 ± 2.8, p < 0.001) and 3 ( − 1.5 ± 3.0, p < 0.001) after liraglutide introduction. After 3 months of treatment with liraglutide, significant changes in body weight ( p < 0.001), BMI ( p < 0.001), waist ( p < 0.001) and neck circumferences ( p < 0.005), HbA1c ( p < 0.001), mean blood glucose ( p < 0.001), fasting plasma glucose ( p < 0.001), triglycerides ( p < 0.01) and total cholesterol ( p < 0.001) were achieved.
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Prevalence and Assessment of Excessive Daytime Sleepiness in Diabetic and Obese Patients.

Prevalence and Assessment of Excessive Daytime Sleepiness in Diabetic and Obese Patients.

Thus sleep quality is seen poor in diabetic patients. To improve sleep quality, a clinical pharmacist can help patients to follow good sleep habits. The pharmacist encourages patients to engage in good sleep hygiene to reduce daytime sleepiness and instruct patients that adequate high-quality sleep is important to improve daytime function. Good sleep hygiene includes ensuring adequate sleep duration, developing sleep promoting bedtime rituals, avoiding staying in bed if unable to sleep, and avoiding caffeine if it disturbs the patient’s ability to fall asleep. There are many effective treatments for sleep disorders, and the deleterious health effects of insufficient sleep or a coexisting sleep disorder warrant greater attention. Pharmacist can be instrumental in encouraging adherence to treatment for sleep disorders. Although persons with diabetes are instructed to restrict calories and to increase physical activity, the presence of less than optimal sleep may undermine these important treatment goals. Thus, educating patients with type 2 diabetes about the importance of sleep and regular screening for sleep disorders has the potential for a positive clinical outcome .
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Factors Associated with Smoking Behaviors among Military Cadets of King Khalid Military Academy (KKMA), Riyadh, Saudi Arabia (2015-2016)

Factors Associated with Smoking Behaviors among Military Cadets of King Khalid Military Academy (KKMA), Riyadh, Saudi Arabia (2015-2016)

The present study showed that the excessive daytime sleepiness was prevalent among the medical students, The University of Tabuk, no significant statistical differences was found between the students with the excessive daytime sleepiness and others without this serious sleep disorder regarding age, sex, hours spent in Technology/day, coffee intake, use of sleep medications, and chronic diseases. The current data showed that the use of Technology was higher among those with excessive daytime sleepiness. It is a well-established fact that attentiveness during class time is a significant determinant of academic achievement; excessive daytime sleepiness could lead to fatigue and substantially impair attention. 6 The situation of excessive daytime
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Waking up to sleepiness: Modafinil, the media and the pharmaceuticalisation of everyday/night life

Waking up to sleepiness: Modafinil, the media and the pharmaceuticalisation of everyday/night life

broader coverage of the problems of sleep deprivation for the military and the various efforts, both actual and on the horizon, to combat it. The Guardian (29 th July 2004), for example, in an article entitled ‘Wired awake: Soldiers in the field go for days without rest’, notes how dealing with sleep deprivation is a ‘perennial problem for the military’, before drawing upon various military experts in the field to comment on this problem. ‘While drugs to combat sleepiness have their risks’, Greg Belensky (from the Walter Reed Army Institute of Research in Silver Spring, Maryland) states, ‘so too does deploying troops who aren’t sufficiently rested’. Belensky’s team, the reader is told, has ‘studied the effects of caffeine, speed and Provigil…on troops kept awake for up to 85 hours’. Readers are also informed of other cutting edge developments, such as research conducted by Ruth Benca at the University of
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Excessive Daytime Sleepiness and Hypertension in Cameroonian Adult Population

Excessive Daytime Sleepiness and Hypertension in Cameroonian Adult Population

In this large population-based study in a sub-Saharan African country, we found no independent association between excessive daytime sleepiness and hypertension. In hypertensive subjects, Sudanese ethnicity, residence in Bandjoun or Douala and obesity are factors independently associated with EDS. Thus, EDS should be systematically evaluated for in hypertensive and obese subjects in order to identify the cause as this will permit optimal management of these patients. In addition, other studies should examine the reasons for a higher prevalence of EDS in Sudanese hypertensive patients and also in those living in West and Littoral region of Cameroon. The reduction of body mass index should also allow a reduction of burden of EDS in hypertensive subjects.
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The Psychosocial Problems of Children With Narcolepsy and Those With Excessive Daytime Sleepiness of Uncertain Origin

The Psychosocial Problems of Children With Narcolepsy and Those With Excessive Daytime Sleepiness of Uncertain Origin

ported cataplexy (the EDS group) might well have in- cluded some who had not yet developed cataplexy (which would have confirmed the diagnosis of narco- lepsy) or exhibited it in such a subtle form that it was not reported on enquiry. In clinical practice it is important to repeat assessments in such children to see whether more definitive diagnostic features emerge with time. At the time of the study, there was no convincing evidence that the children in the EDS group had another sleep disorder to account for their abnormal sleepiness. Their psycho- social problem profile was found to be closely similar to that of the narcolepsy group. This might suggest that the main disadvantage for children with narcolepsy is the excessive sleepiness that they share with the EDS group rather than something more specific to narcolepsy, such as exposure to the distressing experiences described ear- lier as part of the narcolepsy syndrome. In view of the low rate of comorbid conditions and current medication use in the clinical groups (and that both groups showed similar patterns), it seems unlikely that these biased the comparisons regarding the children’s psychosocial disad- vantages.
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Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study

Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study

Our study has some limitations. One concerns the difference in the number of days of CPAP titration be- tween home and laboratory groups. However, our main outcome was the immediate effect of CPAP and we chose to compare a 3 to 5-night period of home titration with a 1-night laboratory titration to guarantee the com- fort for patients who were living far away from the sleep laboratory and to compare the effects of two CPAP titra- tion pathways, as performed routinely, in order to appre- ciate differences, if any, between common methods of patients management. Furthermore, subjects were allowed to choose to receive CPAP titration at home or in the laboratory, therefore, there may be an unmeasured self- selection bias whereby subjects who chose to have home titrations may have been more likely to have perceived improvement in HRQoL. Another limitation was related to the different size of males and females subgroups. Further studies are needed to assess gender differences. Fur- thermore, we used the SF-12, whereas using SF-36 could have potentially provided better discrimination. However, PGWBI and SF-12 were administered to- gether to guarantee a further extension of HRQoL measures, avoiding an excessive and confusing num- ber of items during administration.
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Sleep quality, beliefs and attitudes about sleep : a comparison of Caucasian Australian, Zimbabwean and Ghanaian black immigrants resident in Australia

Sleep quality, beliefs and attitudes about sleep : a comparison of Caucasian Australian, Zimbabwean and Ghanaian black immigrants resident in Australia

Overall, there has been recognition that psychological and behavioural factors have a significant role in the treatment of insomnia to the extent that there has been increased interest in therapies targeting these factors (Morin, et al., 2006). A systematic review of 37 treatment studies (N = 2246) published between 1998 and 2004 inclusive, revealed that psychological and behaviour therapies produced changes in several parameters (e.g., beliefs about sleep, sleep quality, sleep efficiency, sleep onset latency) of individuals with either primary insomnia or insomnia associated with medical or psychiatric disorders (see Morin, et al., 2006 for detailed analysis of treatment studies). According to Morin et al (2006), five treatments in particular met American Psychological Association (APA) criteria for empirically supported psychological treatments for insomnia: stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavioural therapy.
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