Antidepressant, Stimulant/Wake Promoting Agent, and Sedative/Hypnotic Use in Patients with Obstructive Sleep Apnea in the United States

OBJECTIVE: To assess the use of antidepressants, stimulants (amphetamine/methylphenidate), wake promoting agents (WPAs; modafinil/armodafinil), and sedative/hypnotics in patients with obstructive sleep apnea (OSA).

METHODS: A retrospective analysis of US healthcare claims (Symphony Healthcare Analytics) was conducted (7/2010 through 3/2015). Patients with ≥2 claims with an ICD-9 diagnostic code for OSA were included. 

RESULTS:  During the study period, 8.7 million patients had ≥2 OSA diagnosis claims. Among these patients, 34% received an antidepressant, 16% received a sedative/hypnotic, 4% received amphetamine/methylphenidate, and 2% received modafinil/armodafinil. Antidepressants included citalopram (9%), sertraline (8%), duloxetine (7%), fluoxetine (6%), escitalopram (6%), venlafaxine (5%) and amitriptyline (4%). Sedative/hypnotic drugs included zolpidem (13%), temazepam (3%), eszopiclone (2%) and zaleplon (1%). Comorbid major depressive disorder was diagnosed in 20% of OSA patients while comorbid insomnia was diagnosed in 11% of OSA patients.

CONCLUSIONS: Although prior research has shown that many patients with OSA experience persistent excessive sleepiness despite adequate airway treatment, stimulants and WPAs were prescribed to only a very small percentage of patients with OSA. Sedative/hypnotics and antidepressants were prescribed more frequently than stimulants/WPAs. Limitations of this research include lack of confirmed indication for use in prescription claims data, and potential bias related to sampling error. More research is needed to understand why more patients with OSA received prescriptions for sedative-hypnotics and antidepressants than for stimulants/WPAs.