Modafinil in the treatment of selected sleep disorders

Until 2010, modafinil, which is a wakefulness promoting agent, was approved in Europe for a wider spectrum of indications, such as narcolepsy, idiopathic hypersomnia, obstructive sleep apnoea and shift work sleep disorder. Currently, it is registered by the European Medicines Agency only for the treatment of narcolepsy, and is used as an off-label therapy in other sleep disorders. This paper presents the efficacy of modafinil in selected sleep disorders. Modafinil remains first-choice treatment for narcolepsy. It reduces the frequency of bouts of inadvertent sleep and nap episodes, the duration and intensity of daytime hypersomnolence, and also significantly improves the quality of life of patients. However, it is associated with only a slight improvement in cataplexy and other symptoms. In idiopathic hypersomnia, modafinil reduces the frequency of naps and unintentional sleep episodes, as well as subjective sleepiness measured with the Epworth Sleepiness Scale. Furthermore, the drug is used to treat hypersomnia from obstructive sleep apnoea in the case of lack of improvement despite optimal positive airway pressure therapy. Modafinil is also approved by the U.S. Food and Drug Administration for the treatment of shift work sleep disorder. The drug has been shown to reduce the level of somnolence, but it has not been found to reduce unintentional sleep episodes, reported mistakes or accidents at work. Given the strong negative impact of hypersomnolence on performance at work and school, the risk of accidents and the quality of life, the risk-benefit assessment of modafinil often justifies its use in the treatment of hypersomnolence also outside the approved indications.

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Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215110001635 ◽

2010 ◽

Vol 125 (2) ◽

pp. 193-198 ◽

Cited By ~ 10

Author(s):

S M Powell ◽

M Tremlett ◽

D A Bosman

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnoea ◽

Sleep Disordered Breathing ◽

Sleep Apnoea ◽

Life Assessment ◽

Effect Sizes ◽

Obstructive Sleep ◽

Disordered Breathing

AbstractObjective:To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.Design:Prospective, longitudinal study.Setting:The otolaryngology department of a university teaching hospital in Northern England.Participants:Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.Main outcome measure:The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.Methods:The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.Results:Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).Conclusion:In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

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P161 Obstructive sleep apnoea and quality of life in Fabry disease: a parallel cohort study

CHEST Journal ◽

10.1016/j.chest.2017.04.063 ◽

2017 ◽

Vol 151 (5) ◽

pp. A59

Author(s):

T. Gaisl ◽

N. Gerard ◽

N. Sievi ◽

C.F. Clarenbach ◽

P.A. Krayenbühl ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Fabry Disease ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Obstructive Sleep

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The prevalence of common sleep disorders in young adults: a descriptive population-based study

SLEEP ◽

10.1093/sleep/zsaa072 ◽

2020 ◽

Vol 43 (10) ◽

Cited By ~ 2

Author(s):

Nigel McArdle ◽

Sarah V Ward ◽

Romola S Bucks ◽

Kathleen Maddison ◽

Anne Smith ◽

...

Keyword(s):

Quality Of Life ◽

Young Adults ◽

Sleep Disorders ◽

Sleep Disorder ◽

Restless Legs Syndrome ◽

Survey Methods ◽

Apnea Hypopnea Index ◽

Restless Legs ◽

Obstructive Sleep

Abstract Sleep disorders in adults are associated with adverse health effects including reduced quality of life and increased mortality. However, there is little information on sleep disorders in young adults. A cross-sectional observational study was undertaken in 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012–2014) to describe the prevalence of common sleep disorders. In-laboratory polysomnography (PSG) and validated survey methods were used, including the Epworth Sleepiness Scale, Pittsburgh Sleep Symptom Questionnaire-Insomnia, and International Restless Legs Syndrome Study Group criteria. A total of 1,146 participants completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analyzable PSG data. Participants had a mean age of 22.2 years and female to male ratio of 1.1 to 1. The respective sleep disorder prevalences in females and males were: obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI]: ≥5 events/hour) 14.9% (95% CI: 11.8–18.5) and 26.9% (95% CI: 22.9–31.2); chronic insomnia, 19.3% (95% CI: 16.7–23.9) and 10.6% (95% CI: 8.3–13.9); restless legs syndrome, 3.8% (95% CI: 2.4–5.6) and 1.9% (95% CI: 0.9–3.4); and abnormal periodic leg movements during sleep (>5 movements/hour), 8.6% (95% CI: 6.3–11.5) and 9.6% (95% CI: 7.1–12.7). There were statistically significant differences in prevalence between sexes for OSA and insomnia, which persisted after adjustment for body mass index and education. In those with complete data on all sleep-related assessments (n = 836), at least one sleep disorder was present in 41.0% of females and 42.3% of males. Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.

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Idiopathic hypersomnia, Kleine–Levin syndrome, and symptomatic hypersomnias

10.1093/med/9780199682003.003.0015 ◽

2017 ◽

Cited By ~ 1

Author(s):

Michel Billiard ◽

Yves Dauvilliers

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Disorders ◽

Sleep Apnea Syndrome ◽

Medical Disorder ◽

Obstructive Sleep ◽

Idiopathic Hypersomnia ◽

Apnea Syndrome

Besides obstructive sleep apnea syndrome and narcolepsy, there are a number of other causes of excessive daytime sleepiness, listed in the International Classification of Sleep Disorders, third edition, as central disorders of hypersomnolence. They include primary sleep disorders such as idiopathic hypersomnia, Kleine-Levin syndrome and a number of hypersomnias due to a medical disorder, a medication, or a substance, associated with a psychiatric disorder, or due to insufficient sleep. Idiopathic hypersomnia and Kleine–Levin syndrome have attracted much interest in recent years, and an overview of recent progresses is presented in this chapter. The symptomatic hypersomnias are less well known to sleep physicians and often neglected by specialists, either internists or psychiatrists, although they may seriously impact the quality of life of patients

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