Solriamfetol Treatment Yields Cognitive Gains in Obstructive Sleep Apnea: Daily Dose

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On June 16, 2025, we reported on a study presented at SLEEP 2025 that examined neuropsychological outcomes in adults who received solriamfetol for excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) through routine clinical practice.

The study

Researchers conducted the retrospective observational SURWEY study of 46 adults with EDS associated with OSA. They conducted comprehensive cognitive assessments before treatment initiation and after 3 months of therapy.

The tests included in the analysis were:

• Test of Attentional Performance (TAP) subtest alertness

• Regensburger Word Fluency Test

• Wechsler Memory Scale subtest visual reproduction

• Wechsler Adult Intelligence Scale (WAIS-IV) subtest coding

• British Columbia Cognitive Complaints Inventory (BC-CCI)

At baseline, participants demonstrated clear cognitive impairments across several domains. 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. BC-CCI scores averaged 8.6±2.2, reflecting significant cognitive burden. Investigators also reported reduced coding subtest scores on the WAIS. The mean score of 7.1±1.5 indicates impaired psychomotor and visual processing speed.

The findings

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.

Authors' comments

"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."

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