Armodafinil (Nuvigil), Postoperative Recovery of OSA (Obstructive Sleep Apnea) and Obese Patients
Armodafinil (Nuvigil), Postoperative Recovery of OSA (Obstructive Sleep Apnea) and Obese Patients
Obstructive sleep apnea (OSA) and obesity is associated with increased perioperative
 morbidity and mortality. This group of patients is at risk of perioperative desaturations
 which can be worsened by perioperative sedatives and narcotics needed for surgery. OSA
 patients might also need to spend the night in intensive care for more frequent monitoring
 for any desaturations episodes especially if the patient will be requiring multiple
 intravenous narcotic boluses for pain control. Several studies have looked into the most
 appropriate way to manage these patients and some recommendations have been made to avoid
 outpatient surgery with close monitoring for first 24 hours after surgery specifically if
 patient will require intravenous postoperative narcotics.

 Nuvigil (Armodafinil) is a wake promoting agent (Cephalon inc., West Chester, PA) that's FDA
 approved for excessive daytime sleepiness in narcolepsy, shift work sleep disorder, and
 obstructive sleep apnea. The precise mechanism(s) through which armodafinil (R-enantiomer) or
 modafinil (mixture of R- and S-enantiomers) promote wakefulness is unknown.

 Nuvigil is longer acting product which is similar in action to Modafinil however is much
 cheaper. Nuvigil has not been previously studied for postoperative recovery. The
 investigators intend to study the effects of Nuvigil on postoperative recovery time and
 wakefulness in obstructive sleep apnea and obese patients.
Modafinil has been shown to improve recovery after general anesthesia in a small pilot study
 which involved 30 patients. In these study, patients were given one dose of Modafinil 200mg
 po versus placebo after surgery when patient tolerating po with a sip of water and were
 discharged home. They were asked to assess their fatigue, alertness and energy level during
 the following 24 hrs. Modafinil was found to significantly reduce fatigue and improves
 feelings of alertness and energy in postoperative patients. It was concluded that patients
 recovering from general anesthesia can significantly benefit from Modafinil.

 A more recent study looked at the perioperative use of Modafinil in 67 patients presenting
 for lithotripsy requiring sedation. Goal was to asses improvement in recovery compared to
 placebo. Patients were randomized to 4 groups 1 and 2 received midazolam/ fentanyl sedation
 plus Modafinil 200mg po given 1 hr before sedation versus placebo, the other two received
 remifentanil / propofol infusion plus Modafinil 20 mg po versus placebo. Groups were compared
 using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of
 sedation and analgesia (OAA/S) and Aldrete score and they found no statistical significant
 difference between groups. However they measured the Verbal rating scale (VRS) scores for
 secondary outcome variables e.g. energy, tiredness and dizziness were also recorded before
 and after treatment. They concluded that Modafinil reduces patient-reported tiredness after
 sedation/analgesia however does not improve recovery in terms of objective measures of
 patient psychomotor skills.

 Nuvigil is longer acting product which is similar in action to Modafinil and has not been
 previously studied for postoperative recovery. We intend to study the effects of Nuvigil on
 postoperative recovery time and wakefulness in obstructive sleep apnea patients and obese
 patients.
Inclusion Criteria:

 -  Patient presented for surgery under general anesthesia

 -  Documented OSA

 -  Patients with BMI above 35

 Exclusion Criteria:

 -  Coronary Artery Disease or Myocardial infarcts

 -  Mitral valve prolapse

 -  Cyclosporine, contraceptive drugs

 -  Known allergic reaction to Modafinil or any of its products