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.

Keywords:

• excessive sleepiness
• wakefulness
• armodafinil
• obstructive sleep apnea
• narcolepsy
• shift-work disorder

Disclosures

Editorial support was provided by Jane Bryant of Anthemis Consulting Ltd, Aaron Henley, and support from Cephalon Inc., Frazer, PA who provided a medical accuracy review. The authors were not compensated and retained full editorial control over the content of the paper.

Dr Schwartz has served as a consultant and/or speaker for AstraZeneca, Boeringer Ingelheim, Cephalon, Inc., GlaxoSmithKline, Jazz, Pfizer, Schering-Plough, Sepracor, and Takeda.

Dr Roth has received grants from Aventis, Cephalon, Inc., GlaxoSmithKline, Neurocrine, Pfizer, Sanofi, Schering-Plough, Sepracor, Somaxon, Syrex, Takeda, TransOral, Wyeth, and Xenoport, and has acted as a consultant for Abbott, Acadia, Acoglix, Actelion, Alchemers, Alza, Ancile, Arena, AstraZeneca, Aventis, AVER, Bristol-Myers Squibb, BTG, Cephalon, Inc., Cypress, Dove, Elan, Eli Lilly, Evotec, Forest Labs, GlaxoSmith-Kline, Hypnion, Impax, Intec, IntraCellular, Jazz, Johnson and Johnson, King, Lundbeck, McNeil, MediciNova, Merck, Neurim, Neurocrine, Neurogen, Novartis, Orexo, Organon, Prestwick, Proctor and Gamble, Pfizer, Purdue Pharma, Resteva, Roche, Sanofi, Schering-Plough, Sepracor, Servier, Shire, Somaxon, Syrex, Takeda, TransOral, Vanda, Vivometrics, Wyeth, Yamanuchi, and Xenoport. Dr Roth has also been a speaker for Cephalon, Inc., Sanofi, and Takeda.

Dr Drake has received research support from Cephalon, Inc., Pfizer Inc., and Neurocrine, and has participated in speaking engagements supported by Sepracor and Sanofi-Aventis.