New research published in NEJM Evidence and conducted by investigators at the Division of Sleep and Circadian Medicine at Brigham and Women's Hospital has found that solriamfetol, a selective dopamine and norepinephrine reuptake inhibitor, significantly improves wakefulness in individuals with shift work disorder (SWD) who work early-morning shifts. While most shift work studies focus on overnight workers, this trial specifically targeted those starting work between 3 and 7 a.m., a group that often faces severe sleepiness due to waking up during their body's natural circadian low point. After four weeks of treatment, patients receiving solriamfetol were able to stay awake significantly longer during objective testing than those receiving a placebo, showing a 9.4-minute greater increase in sleep latency.
Beyond objective measures, the study demonstrated that solriamfetol improved the daily lives and work performance of early-morning shift workers. Participants reported a noticeable reduction in both acute and chronic sleepiness, alongside improvements in overall work productivity and a decrease in the functional impairments that often affect their social and family responsibilities. Importantly, the medication’s alerting effects were sustained throughout the duration of a typical eight-hour work shift without negatively impacting the quality or length of the sleep participants obtained once they returned home.
The treatment was generally well-tolerated, with side effects such as headache and nausea being the most common, and no serious adverse events were reported. These findings are particularly significant because early-morning shifts are three times more common than overnight shifts, yet this population has historically lacked evidence-based pharmacological treatments for shift work disorder. By effectively bridging the gap between a worker's internal biological clock and their early work schedule, solriamfetol offers a promising option for improving safety and quality of life in this high-risk workforce.
https://pubmed.ncbi.nlm.nih.gov/41590992/
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500190?query=featured_home