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Solriamfetol Improves OSA-Related Cognitive Deficits Independent of Sleepiness Reduction
Solriamfetol's significant cognitive benefits may be the result of mechanisms operating independently of its wake-promoting effects, study authors suggest.
A real-world study of 46 adults with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) found that solriamfetol (Sunosi; Axsome Therapeutics) treatment significantly improved multiple cognitive domains beyond its established effects on sleepiness.1
According to findings presented at SLEEP 2025, June 8-11, in Seattle, WA, solriamfetol treatment was linked to improvements in alertness, cognitive complaints, and psychomotor speed that appeared independent of sleepiness reduction.1
Courtesy of Mainz Comprehensive Epilepsy and Sleep Medicine Center
Solriamfetol, a dual dopamine and norepinephrine reuptake inhibitor with agonistic properties at the trace amine-associated receptor 1 and serotonin 1A receptor, was approved by the FDA in March 2019 for the treatment of EDS associated with narcolepsy as well as for EDS in OSA as an adjunct to primary airway therapies.2
The retrospective observational SURWEY study analyzed neuropsychological outcomes in adult participants who received solriamfetol for EDS associated with OSA through routine clinical practice. Researchers, led by Yaroslav Winter, MD, MSc, head of Mainz Comprehensive Epilepsy and Sleep Medicine Center, Johannes Gutenberg University, conducted comprehensive cognitive assessments before treatment initiation and after 3 months of therapy.1
At baseline, participants demonstrated clear cognitive impairments across several domains. Test of Attentional Performance (TAP) alertness scores were elevated at 268.2±21.8 ms with warning signal and 270.2±21.9 ms without warning signal, outcomes indicative of impaired alertness. British Columbia Cognitive Complaints Inventory (BC-CCI) scores averaged 8.6±2.2, reflecting significant cognitive burden. Winter and colleagues also reported reduced coding subtest scores on the Wechsler Adult Intelligence Scale (WAIS). The mean score of 7.1±1.5 indicates impaired psychomotor and visual processing speed.1
Participants showed substantial improvement on all measures at 3 months of treatment.
- TAP alertness scores improved by 11.4% to 237.7±21.4 ms with warning signal and 239.5±21.3 ms without warning signal (P <.01 for both conditions).
- Cognitive complaints decreased markedly, with BC-CCI scores improving 40.8% to 5.1±3.1 (P <.01).
- Processing speed showed notable enhancement, with WAIS-IV coding scores increasing 30.6% to 9.3±1.8 (P <.01).
The researchers detected no baseline impairments among study participants in word fluency and memory functions, measured by the Regensburger Word Fluency Test and Wechsler Memory Scale visual reproduction subtest, respectively, and the measures remained stable throughout treatment. Epworth Sleepiness Scale scores decreased by 4.7±2.7 points (P <.01), confirming the expected improvement in daytime sleepiness, they wrote.
Notably, regression analysis revealed no association between cognitive improvements and reduction in sleepiness (r =0.16, P =.3), suggesting that solriamfetol's cognitive benefits may operate through mechanisms independent of its wake-promoting effects.
The findings support previous phase 4 randomized trial data demonstrating cognitive benefits of solriamfetol in this population.
The once-daily medication has a half-life approximately 7 hours, is considered a schedule IV controlled substance, and comes with a caution for patients with cardiovascular disease or hypertension.
"These real-world results show that solriamfetol not only reduces EDS in patients with OSA, but also has the potential to partially reduce OSA-associated cognitive impairment. This effect was not associated with changes in EDS," Winter et al concluded.
