Sleep Apnea

Insufficient evidence for routine clinical use of cannabinoid therapies for sleep disorders due to lack of research and moderate to high risk of bias.

Systematic review on cannabinoid therapies for sleep disorders, k=26 studies (14 preclinical, 12 clinical). Insufficient evidence for routine clinical use in sleep disorders due to limited study data and moderate to high risk of bias. Promising preliminary evidence for sleep apnea, insomnia, PTSD-associated nightmares, restless legs syndrome, REM sleep behavior disorder and narcolepsy justifies future RCTs. Clear need for larger, rigorous long-term studies on safety and efficacy.

Eight of nine studies showed statistically significant positive effects on OSA markers (reduced apnea-hypopnea index, improved daytime sleepiness), but 70–80% of participants reported neuropsychiatric and gastrointestinal side effects.

Systematic review on cannabinoids in obstructive sleep apnea, k=9 studies (5 full text, 4 abstracts) from 170 screened records. Seven experimental studies (predominantly dronabinol), two observational studies (cannabis). Median therapy duration 3 weeks (range 1-6 weeks). Eight of nine studies report statistically significant positive OSA outcomes: AHI reduction and improvement of daytime sleepiness. 70-80% of participants report neuropsychiatric and gastrointestinal adverse events. Quality Appraisal: 2 studies low risk, 1 some concerns, 2 high risk of bias.

Meta-analysis on substance use and sleep apnea, k=28 studies from 3784 screening hits. Higher AHI in alcohol users (SMD: 0,46, 95% CI [0,21-0,71], z=3,62, p<0.001) and increased central sleep apnea prevalence in opioid users (SMD: 0,44, 95% CI [0,24-0,64], z=4,37, p<0.001). Only one study on cannabis users vs. non-users identified. Sex and age as potential moderators.

Dronabinol reduced the apnea-hypopnea index (AHI) dose-dependently and improved self-reported sleepiness (ESS) compared with placebo.

Phase II RCT (PACE Trial), n=73 adults with moderate/severe OSA, dronabinol 2,5 mg vs. 10 mg vs. placebo over 6 weeks. Dose-dependent AHI reduction: 2,5 mg -10,7±4,4 events/h (p=0.02), 10 mg -12,9±4,3 events/h (p=0.003) vs. placebo. Epworth Sleepiness Scale at 10 mg: -3,8±0,8 points (p<0.0001), -2,3±1,2 vs. placebo (p=0.05). Highest treatment satisfaction at 10 mg (p=0.04). No significant changes in sleep architecture or oxygenation.