Perspectives and controversiesMedical Cannabis for Obstructive Sleep Apnea: Premature and Potentially Harmful
Section snippets
Effects of Cannabis on Sleep Apnea
The initial study conducted in rats revealed that direct injection of dronabinol into the nodose ganglia, which contain most cell bodies of the vagus nerve, resulted in a reduction in serotonin-induced reflex apnea duration.2 An increase in phasic, but not tonic, activation of the genioglossus muscle was observed. These findings suggest that dronabinol results in increased upper airway muscle tone and potentially stabilizes respiration in rats when directly injected into the brain. The second
Effective Treatments for Sleep Apnea
There are multiple effective treatment modalities available for OSA.6 The CPAP is considered first-line therapy for OSA, and there are no known serious side effects. The American Academy of Sleep Medicine (AASM), in published clinical guidelines on the management and long-term care of patients with OSA, outlines interventions that can help improve CPAP adherence in patients who might find it difficult to tolerate CPAP therapy.6 These guidelines also clearly detail the role and effectiveness of
Potential Adverse Effects of Cannabis Use in Patients with Sleep Apnea
There are several potential adverse effects of cannabis that raise concerns with its use, especially as first- or second-line therapy, in the treatment of OSA. A study that examined the impact of nighttime administration of THC (the psychoactive component of cannabis), alone and in combination with cannabidiol, demonstrated an increase in both subjective and objective measures of sleepiness the following morning.8 Somnolence is also a common side effect associated with dronabinol use.9 In
Conclusion
The evidence examining the impact of cannabis on OSA is very limited. The results of studies conducted in rat models of OSA were conflicting with regard to apnea duration. In humans, there appeared to be marked heterogeneity in the response to cannabinoids for OSA in a proof-of-concept study, with only a proportion of subjects showing improvement and some showing no change or worsening in the severity of OSA. In the one randomized controlled trial to date that examined the effects of the
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Cited by (5)
What is the evidence for cannabis use in otolaryngology?: A narrative review
2019, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Ramar and the AASM stood by their original statement in a response to these comments [68]. Kolla et al. concluded that the approval of the use of cannabis to treat OSA is extremely premature and has the potential to result in inadequate treatment and possible harm [69]. One letter to the editor published on this study agreed with Kolla et al. and provided a deeper understanding of the background relating to the laws and regulations in the state of Minnesota [70].
Cannabis and sleep disorders: not ready for prime time? A qualitative scoping review
2023, Journal of Clinical Sleep MedicineMeta-analysis of the Prediction Model of Obstructive Sleep Apnea Based on Image Fusion Algorithm
2023, Lecture Notes on Data Engineering and Communications TechnologiesThe Effects of Cannabinoids on Sleep
2022, Journal of Primary Care and Community HealthClinical management of sleep and sleep disorders with cannabis and cannabinoids: Implications to practicing psychiatrists
2022, Clinical Neuropharmacology
Potential Competing Interests: Dr Mansukhani was the principal investigator (PI) on industry grant (ResMed Corp) 2016-2018 and the PI on benefactor-sponsored career development award at Mayo Clinic (2017-2019). She was also a speaker at the CME conference-ARCS sleep conference 2016. Dr Olson has board membership of the American Academy of Sleep Medicine and is author for 3 sections of UpToDate regarding obstructive sleep apnea and perioperative care. Dr St Louis received consultancy fees from Axovant consultancy; has grants/grants pending from the National Institutes of Health and the Michael J. Fox Foundation; and receives royalties from Wiley Blackwell for the book Epilepsy and the Interictal State: Co-Morbidities and Quality of Life. The rest of the authors report no competing interests.