The wake-promoting agent
modafinil is approved for the treatment of excessive
sleepiness associated with
obstructive sleep apnea (OSA), shift work disorder (SWD), and
narcolepsy. In OSA,
modafinil is recommended for use as an adjunct to standard
therapies that treat the underlying
airway obstruction. This article reviews the literature on
modafinil (pharmacology, pharmacokinetics, efficacy, tolerability, and abuse potential), with emphasis on use of
modafinil in the treatment of excessive
sleepiness in patients with OSA, SWD, and
narcolepsy. In large-scale, double-blind, placebo-controlled studies,
modafinil improved objectively determined sleep latency, improved overall clinical condition related to severity of
sleepiness, and reduced patient-reported
sleepiness. Improvements in wakefulness were accompanied by improvements in behavioral alertness, functional status, and health-related quality of life. In patients with SWD, diary data showed
modafinil reduced the maximum level of
sleepiness during night shift work, level of
sleepiness during the commute home, and incidence of accidents or near-accidents during the commute home when compared with placebo.
Modafinil was well tolerated, without adversely affecting cardiovascular parameters or scheduled sleep. These findings and those of extension studies which reported improvements were maintained suggest
modafinil has a beneficial effect on daily life and well-being in patients with excessive
sleepiness associated with OSA, SWD, or
narcolepsy.