Effects of Solriamfetol on Neuropsychological Outcomes in Patients With Obstructive Sleep Apnea in the Real-world SURWEY Study 
Yaroslav Winter1, Graham Eglit2, Samantha Floam2, Ulf Kallweit3
1Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg-University, 2Axsome Therapeutics, Inc., 3Center for Biomedical Education and Research, University Witten/Herdecke
Objective:
To evaluate the effect of solriamfetol treatment on neuropsychological outcomes in patients with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) in the real-world SURWEY study.
Background:
Patients with EDS associated with OSA often exhibit cognitive deficits. Solriamfetol (Sunosi®) is a dopamine-norepinephrine reuptake inhibitor and TAAR1/5HT1A agonist approved to treat EDS associated with narcolepsy or OSA. Solriamfetol demonstrated improvements in cognitive performance in participants with EDS and cognitive impairment associated with OSA in the Phase 4 randomized SHARP study.
Design/Methods:
SURWEY was a retrospective, observational study using data from physicians prescribing solriamfetol for EDS associated with narcolepsy and OSA. Neuropsychological assessments were performed in a subgroup of patients with OSA prior to and 3 months after solriamfetol initiation. Tests included: Test of Attentional Performance (TAP) subtest alertness, the Regensburger Word Fluency Test, the Wechsler Memory Scale subtest visual reproduction, Wechsler Adult Intelligence Scale (WAIS-IV) subtest coding, and British Columbia Cognitive Complaints Inventory (BC-CCI).
Results:
Before solriamfetol initiation, participants (N=46) showed impaired alertness on the TAP (mean±SD 268.2±21.8 ms with warning signal, 270.2±21.9 ms without), impaired cognitive function on the BC-CCI (8.6±2.2), and reduced psychomotor and visual processing speed on the WAIS-IV coding subtest (7.1±1.5); no impairments in word fluency or memory were observed. Following solriamfetol treatment, TAP scores improved by a mean of 11.4% (237.7±21.4 ms with warning; 239.5±21.3 ms without, p<0.01 for both). BC-CCI scores improved by a mean of 40.8% (5.1±3.1, p<0.01). WAIS-IV coding scores improved by 30.6% (9.3±1.8, p<0.01). Epworth Sleepiness Scale scores improved by 4.7±2.7 (p<0.01); change in EDS was not associated with cognitive improvement (|r|=0.16, p=0.3).
Conclusions:
In this observational study, solriamfetol reduced OSA-associated cognitive impairment, independently of improvements in EDS.
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