Comparative Efficacy and Safety of Wakefulness-Promoting Agents for Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea: A Systematic Review and Network Meta-analysis: Annals of Internal Medicine: Vol 176, No 5
Background: Excessive daytime sleepiness (EDS) is common among patients with obstructive sleep apnea (OSA). The comparative effectiveness of pharmacologic agents is unknown. Purpose: To compare the effectiveness of drugs for EDS in OSA using network meta-analysis. Data Sources: MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov to 7 November 2022. Study Selection: Reviewers identified randomized trials that enrolled patients with EDS-associated OSA on or eligible for conventional therapy assigned to any pharmacologic intervention. Data Extraction: Paired reviewers independently extracted data addressing effects of drugs on the Epworth Sleepiness Scale (ESS), Maintenance of Wakefulness Test (MWT), and adverse events at the longest reported follow-up. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Data Synthesis: Fourteen trials (3085 patients) were eligible. At 4 weeks, compared with placebo, solriamfeto