Clinical question
How effective and safe are medications given for the treatment of daytime sleepiness in patients with idiopathic hypersomnia?
Bottom line
Modafinil is effective for the treatment of several aspects of idiopathic hypersomnia symptomatology. Two randomised controlled trials showed reductions in Epworth Sleepiness Scale scores, the primary measure of daytime sleepiness used in this review. Objective sleepiness, as measured by the Maintenance of Wakefulness Test mean sleep latency, also significantly improved with modafinil in these 2 studies. The available data were insufficient to determine whether clarithromycin is superior to placebo for the treatment of idiopathic hypersomnia. Further studies of this intervention would better clarify its effects.
Caveat
The increase in adverse events in the modafinil group did not reach statistical significance. The certainty of the evidence for the outcomes of interest ranged from high to low for modafinil, and was low for clarithromycin. This was mostly due to limited numbers of study participants leading to very low precision in the results. Dropout due to adverse events was not significantly different between modafinil and placebo groups.
Context
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. The optimal treatment strategy for idiopathic hypersomnia is currently unknown.
Cochrane Systematic Review
Trotti LM, et al. Medications for daytime sleepiness in individuals with idiopathic hypersomnia. Cochrane Database Syst Rev 2021;5(5):CD012714. This review contains 3 trials with a total of 114 participants.
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