Summary

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• This summary is based on the review of three systematic review(s)/meta-analysis(es). ^[1-3]
• Solriamfetol showed greater efficacy in reducing excessive daytime sleepiness (EDS) compared to pitolisant and sodium oxybate, with superior outcomes on the Epworth Sleepiness Scale (ESS) (mean difference (MD) -2.88, 95% confidence interval (CI) -4.89 to -0.88 compared to pitolisant; MD -2.56, 95% CI -4.62 to -0.51 compared to sodium oxybate) and the Maintenance of Wakefulness Test (MWT) (standardized mean differences (SMD) 0.45, 95% CI 0.02 to 0.88 compared to pitolisant; SMD 0.42, 95% CI 0.05 to 0.79 compared to modafinil).
• Sodium oxybate significantly reduced narcolepsy-related symptoms, including cataplexy attacks (P = 0.001), subjective daytime sleepiness (P < 0.0001), sleep latency (P < 0.0001), inadvertent naps/sleep attacks (P < 0.00001), and improved sleep architecture with notable changes in stage 1 sleep (P = 0.04), slow wave sleep (P = 0.003), rapid eye movement (REM) sleep (P = 0.0006), nocturnal awakenings (P = 0.004), and overall quality of nocturnal sleep (P < 0.00001).
• Clinical gamma hydroxybutyrate (GHB) use is not associated with cognitive impairments, while recreational GHB use at moderate levels may result in short-term cognitive impairments, and regular high-dose use or GHB-induced comas are likely linked to long-term cognitive impairments and neurotoxicity.
• GHB demonstrated lower tolerability compared to placebo due to dose-dependent side effects (relative risk (RR) = 6.08; 95% CI = 2.18 to 16.97; P = 0.0006).
• There is no population types or subgroups information available in the reviewed studies.