Residual excessive sleepiness (ES) and impaired cognition can occur despite 
effective and regular nasal continuous positive airway pressure (nCPAP) therapy 
in some patients with obstructive sleep apnea (OSA). A pooled analysis of two 
12-week, randomized, double-blind studies in nCPAP-adherent patients with ES 
associated with OSA evaluated the effect of armodafinil on wakefulness and 
cognition. Three hundred and ninety-one patients received armodafinil (150 or 
250 mg) and 260 patients received placebo once daily for 12 weeks. Efficacy 
assessments included the Maintenance of Wakefulness Test (MWT), Cognitive Drug 
Research cognitive performance battery, Epworth Sleepiness Scale, and Brief 
Fatigue Inventory. Adverse events were monitored. Armodafinil increased mean MWT 
sleep latency from baseline to final visit by 2.0 min vs a decrease of 1.5 min 
with placebo (P < 0.0001). Compared with placebo, armodafinil significantly 
improved quality of episodic secondary memory (P < 0.05) and patients' ability 
to engage in activities of daily living (P < 0.0001) and reduced fatigue (P < 
0.01). The most common adverse events were headache, nausea, and insomnia. 
Armodafinil did not adversely affect desired nighttime sleep, and nCPAP use 
remained high (approximately 7 h/night). Adjunct treatment with armodafinil 
significantly improved wakefulness, long-term memory, and patients' ability to 
engage in activities of daily living in nCPAP-adherent individuals with ES 
associated with OSA. Armodafinil also reduced patient-reported fatigue and was 
well tolerated.