{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T09:23:11Z","timestamp":1789809791908,"version":"4.0.1"},"reference-count":28,"publisher":"European Respiratory Society (ERS)","issue":"5","funder":[{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"publisher","award":["Bridging grant"],"award-info":[{"award-number":["Bridging grant"]}],"id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1004528"],"award-info":[{"award-number":["1004528"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1038709"],"award-info":[{"award-number":["1038709"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2015,11,27]]},"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:p>Modafinil is used internationally to treat residual sleepiness despite continuous positive airway pressure in obstructive sleep apnoea (res-OSA). In 2011, the European Medicines Agency removed the indication based on an unfavourable risk\u2013benefit profile in two trials for efficacy and all accumulated safety data. We performed a meta-analysis of all randomised controlled trials of modafinil (or armodafinil) in res-OSA to quantify efficacy and safety.<\/jats:p><jats:p>We systematically searched and assessed studies from major databases, conferences and trials registries to find randomised, placebo-controlled trials of modafinil\/armodafinil for \u22652\u2005weeks in adult res-OSA treating sleepiness.<\/jats:p><jats:p>We analysed 10 of the 232 articles identified that met inclusion criteria (1466 patients). Modafinil\/armodafinil improved the Epworth Sleepiness Scale score (2.2 points, 95% CI 1.5\u20132.9) and the Maintenance of Wakefulness Test over placebo (3\u2005min, 95% CI 2.1\u20133.8\u2005min). Modafinil\/armodafinil tripled adverse events and doubled adverse events leading to withdrawal but did not increase serious adverse events (hospitalisations or death).<\/jats:p><jats:p>Modafinil and armodafinil improve subjective and objective daytime sleepiness in res-OSA. We believe our analysis is a fairer analysis of the risk\u2013benefit profile of this indication. Clinicians may want to use this data to balance the risks and benefits on a case-by-case basis with their patients.<\/jats:p>","DOI":"10.1183\/13993003.01509-2015","type":"journal-article","created":{"date-parts":[[2016,2,5]],"date-time":"2016-02-05T03:23:58Z","timestamp":1454642638000},"page":"1420-1428","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":79,"title":["Modafinil\/armodafinil in obstructive sleep apnoea: a systematic review and meta-analysis"],"prefix":"10.1183","volume":"47","author":[{"given":"Julia L.","family":"Chapman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Vakulin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hedner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendon J.","family":"Yee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel S.","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2016,2,4]]},"reference":[{"key":"2024102023525589000_47.5.1420.1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/0022-510X(92)90004-5","article-title":"Daytime sleepiness after long-term continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome","volume":"1\u20132","author":"Sforza","year":"1992","journal-title":"J Neurol Sci"},{"key":"2024102023525589000_47.5.1420.2","unstructured":"European Medicines Agency. 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