Effects of Solriamfetol on Cognitive Function in Participants with Cognitive Impairment Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea: Results of the SHARP Study (P4-13.004) (2023)

<h3>Objective:</h3> The SHARP study evaluated whether solriamfetol improves cognitive function in patients with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) and extant impaired cognition. <h3>Background:</h3> OSA is a common disorder characterized by repeated intermittent hypoxic events resulting in disrupted sleep and EDS. Positive Airway Pressure (PAP) reduces hypoxic events and mitigates sleep disruption, but EDS often persists. Cognitive impairment is a burdensome symptom in many patients with EDS associated with OSA, which leads to occupational and social dysfunction and degrades quality of life. Solriamfetol (Sunosi®) is approved to improve wakefulness in adults with EDS associated with OSA. In nonclinical pharmacology studies, solriamfetol inhibited dopamine/norepinephrine reuptake and activated trace amine-associated receptor 1 (TAAR1), potentially benefiting cognition. <h3>Design/Methods:</h3> SHARP was a randomized, double-blind, placebo-controlled, crossover trial in 59 patients with EDS associated with OSA and demonstrated cognitive impairment. All patients received solriamfetol (75mg for 3 days followed by 150mg/day) for 2 weeks, and placebo for 2 weeks, with treatment periods separated by a 1-week washout. The primary endpoint was change from baseline on the Digit Symbol Substitution Test equivalent of the Repeatable Battery for the Assessment of Neuropsychological Status (DSST-RBANS). Secondary endpoints included change from baseline on the British Columbia Cognitive Complaints Inventory (BC-CCI) and the Epworth Sleepiness Scale (ESS). <h3>Results:</h3> The study completion rate was 96.7%. Solriamfetol treatment improved performance on the DSST-RBANS compared to placebo (6.49 vs. 4.75, p=0.009), with an effect size (Cohen’s <i>d</i>) of 0.36. Solriamfetol treatment also yielded improvements on the BC-CCI (−4.70 vs −3.11, p=0.002; <i>d</i> =0.43) and the ESS (−4.41 vs −2.31, p=0.004; <i>d =</i> 0.50). The most common adverse events with solriamfetol treatment (incidence ≥3%) were nausea (6.9%) and anxiety (3.4%). <h3>Conclusions:</h3> Solriamfetol (150mg/day) improved both objective and subjective measures of cognitive function in patients with EDS associated with OSA and impaired cognition. <b>Disclosure:</b> Prof. Van Dongen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Jazz Pharmaceuticals. Prof. Van Dongen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Prof. Van Dongen has received personal compensation in the range of $500-$4,999 for serving as a speaker at virtual meeting with American Academy of Sleep Medicine. Prof. Van Dongen has received personal compensation in the range of $0-$499 for serving as a reviewer with AAA Foundation. Dr. Leary has received personal compensation for serving as an employee of Jazz Pharmaceuticals. Dr. Leary has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Proper. Dr. Leary has stock in Jazz Pharmaceuticals. Dr. Drake has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Drake has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eisai. Dr. Drake has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Harmony Biosciences. The institution of Dr. Drake has received research support from Jazz. The institution of Dr. Drake has received research support from Suven. The institution of Dr. Drake has received research support from P&amp;G. The institution of Dr. Drake has received research support from Axsome. Dr. Drake has received publishing royalties from a publication relating to health care. Dr. Bogan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Harmony. Dr. Bogan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz. Dr. Bogan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Takeda. Dr. Bogan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avadel. Dr. Bogan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck. Dr. Bogan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Harmony. Dr. Bogan has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Jazz. The institution of Dr. Bogan has received research support from Jazz Pharmaceuticals. The institution of Dr. Bogan has received research support from Harmony . The institution of Dr. Bogan has received research support from Philips. The institution of Dr. Bogan has received research support from Eisai. The institution of Dr. Bogan has received research support from Fresca. The institution of Dr. Bogan has received research support from Avadel. The institution of Dr. Bogan has received research support from Takeda. The institution of Dr. Bogan has received research support from Suven. The institution of Dr. Bogan has received research support from Axsome. Dr. Bogan has received intellectual property interests from a discovery or technology relating to health care. Dr. Bogan has a non-compensated relationship as a Chair with National Sleep Foundation that is relevant to AAN interests or activities. Judith Jaeger has received personal compensation for serving as an employee of CognitionMetrics, LLC. Mr. Rosenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. The institution of Mr. Rosenberg has received research support from Neurotrials Research. Caroline Streicher has received personal compensation for serving as an employee of Axsome Therapeutics. Caroline Streicher has stock in Axsome Therapeutics. Miss Kwak has received personal compensation for serving as an employee of Axsome Therapeutics. Miss Kwak has stock in Axsome Therapeutics. Dr. Bates has received personal compensation for serving as an employee of Axsome Therapeutics. Dr. Bates has stock in Axsome Therapeutics. Dr. Tabuteau has received personal compensation for serving as an employee of Axsome Therapeutics. Dr. Tabuteau has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Axsome Therapeutics. Dr. Tabuteau has received stock or an ownership interest from Axsome Therapeutics. Dr. Tabuteau has received intellectual property interests from a discovery or technology relating to health care.