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EFFECTS OF SOLRIAMFETOL ON NEUROPSYCHOLOGICAL OUTCOMES IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA IN THE REAL-WORLD SURWEY STUDY

Yaroslav Winter — Graham M.L. Eglit2, Samantha Floam2, Ulf Kallweit3 1University of Saarland, Philipps University Marburg, 2Axsome Therapeutics, Inc., 4Center for Biomedical Education and Research, University Witten/Herdecke

2026 ASCP Annual Meeting

Patients with excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA) show deficits in cognitive domains including alertness, attention, executive function and decision-making. Solriamfetol (Sunosi®) is a dopamine-norepinephrine reuptake inhibitor with agonistic properties at the trace amine-associated receptor 1 and serotonin 1A receptor approved for treatment of EDS associated with narcolepsy or OSA. Solriamfetol demonstrated improvements in cognitive performance in patients with EDS in OSA in a phase 4 randomized study. Here, we report a post-hoc analysis of neuropsychological outcomes in patients with EDS in OSA treated with solriamfetol in a real-world setting.

Methods

SURWEY was a retrospective, observational study using data from physicians who prescribed solriamfetol for EDS in OSA. Neuropsychological assessments were performed in a subgroup of patients prior to and 3 months after solriamfetol initiation. Tests included: Test of Attentional Performance (TAP) subtest alertness, the Regensburger Word Fluency Test, the Wechsler Memory Scale subtest visual reproduction, Wechsler Adult Intelligence Scale (WAIS-IV) subtest coding and British Columbia Cognitive Complaints Inventory (BC-CCI). Data were analyzed with repeated measures ANOVA. The relationship between changes in EDS and cognition were assessed via regression.

Results

Before solriamfetol initiation, participants (N=46) showed impaired alertness on the TAP (mean±SD 268.2±21.8 ms with warning signal, 270.2±21.9 ms without), impaired cognitive function on the BC-CCI (8.6±2.2), and reduced psychomotor and visual processing speed on the WAIS-IV coding subtest (7.1±1.5). After 3 months of treatment with solriamfetol, TAP scores improved by a mean of 11.4% (237.7±21.4 ms with warning signal; 239.5±21.3 ms without, p < 0.01 for both). BC-CCI scores improved by a mean of 40.8% (5.1±3.1, p < 0.01). WAIS-IV coding scores improved by 30.6% (9.3±1.8, p LESS THAN 0.01). Word fluency and memory were not impaired at baseline, or after solriamfetol initiation. Epworth Sleepiness Scale scores improved with solriamfetol treatment by 4.7±2.7 (p < 0.01). There was no association between the improvements in cognitive function and change in EDS (|r|=0.16, p=0.3).

Conclusion

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.