PT - JOURNAL ARTICLE AU - Julia L. Chapman AU - Andrew Vakulin AU - Jan Hedner AU - Brendon J. Yee AU - Nathaniel S. Marshall TI - Modafinil/armodafinil in obstructive sleep apnoea: a systematic review and meta-analysis AID - 10.1183/13993003.01509-2015 DP - 2016 May 01 TA - European Respiratory Journal PG - 1420--1428 VI - 47 IP - 5 4099 - http://erj.ersjournals.com/content/47/5/1420.short 4100 - http://erj.ersjournals.com/content/47/5/1420.full SO - Eur Respir J2016 May 01; 47 AB - Modafinil is used internationally to treat residual sleepiness despite continuous positive airway pressure in obstructive sleep apnoea (res-OSA). In 2011, the European Medicines Agency removed the indication based on an unfavourable risk–benefit profile in two trials for efficacy and all accumulated safety data. We performed a meta-analysis of all randomised controlled trials of modafinil (or armodafinil) in res-OSA to quantify efficacy and safety.We systematically searched and assessed studies from major databases, conferences and trials registries to find randomised, placebo-controlled trials of modafinil/armodafinil for ≥2 weeks in adult res-OSA treating sleepiness.We analysed 10 of the 232 articles identified that met inclusion criteria (1466 patients). Modafinil/armodafinil improved the Epworth Sleepiness Scale score (2.2 points, 95% CI 1.5–2.9) and the Maintenance of Wakefulness Test over placebo (3 min, 95% CI 2.1–3.8 min). Modafinil/armodafinil tripled adverse events and doubled adverse events leading to withdrawal but did not increase serious adverse events (hospitalisations or death).Modafinil and armodafinil improve subjective and objective daytime sleepiness in res-OSA. We believe our analysis is a fairer analysis of the risk–benefit profile of this indication. Clinicians may want to use this data to balance the risks and benefits on a case-by-case basis with their patients.An EMA risk–benefit analysis of modafinil in OSA was negative. Does analysing extra trials change the conclusion? http://ow.ly/VYvO8