Treatment Improves Daytime Sleepiness in Patients With Idiopathic Hypersomnia

Modafinil improved several measures of daytime sleepiness and related symptoms in patients with idiopathic hypersomnia, according to a study published in the Cochrane Database of Systematic Reviews.

“Idiopathic hypersomnia is a disorder of excessive daytime sleepiness, often accompanied by long sleep times or pronounced difficulty in awakening, in the absence of a known cause,” explained lead and corresponding author Lynn M. Trotti, MD, MSc, of Emory University School of Medicine, Atlanta, and coauthors. “The optimal treatment strategy for idiopathic hypersomnia is currently unknown.”

To assess the effects of medications studied in patients with idiopathic hypersomnia, researchers conducted a systematic review and settled on three randomized trials involving 112 participants. In all three, the risk of bias was low.

An analysis of two trials comparing modafinil with placebo in 102 participants, the majority of whom had idiopathic hypersomnia without long sleep time, found the medication improved self-reported sleepiness, disease severity, and the ability to stay awake. Specifically, self-reported sleepiness improved a significant 5.08 points over placebo on the Epworth Sleepiness Scale, 4.74 minutes more than with placebo on the Maintenance of Wakefulness Test, 1.02 points on the Clinical Global Impression of Severity scale, and resulted in a greater proportion of “much improved” or “very much improved” ratings on the Clinical Global Impression of Change. Side effects appeared to be more common with modafinil, although not significantly so.

The third trial in the review compared clarithromycin to placebo in 20 participants, half of whom had idiopathic hypersomnia with or without long sleep time. Trial data for participants with idiopathic hypersomnia showed no significant gains with clarithromycin on the Epworth Sleepiness Scale, psychomotor vigilance testing, sleep inertia, other subjective ratings, or side effects. Researchers deemed the information insufficient to conclude whether clarithromycin offers benefit for patients with the disorder.

“There is a clear need for additional studies testing interventions for the treatment of idiopathic hypersomnia,” they advised.

Reference:
Trotti LM, Becker LA, Friederich Murray C, Hoque R. Medications for daytime sleepiness in individuals with idiopathic hypersomnia. Cochrane Database Syst Rev. 2021;5(5):CD012714. doi:10.1002/14651858.CD012714.pub2