Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials
AminiLari et al.·SleepImpact 0.6
MixedGRADEHigh95 citations
Samplek = 39 Studien n = 5.100 Pat.
DurationMedian 35 days follow-up
ControlPlacebo or non-cannabinoid control
EndpointSleep quality / sleep…
Blindingdoppelblind
DesignSystematische Review + Meta-Analyse
”Key finding
Small improvement in sleep quality and sleep disturbance in chronic pain patients, but markedly increased risk of adverse effects such as dizziness (29%), drowsiness, dry mouth, fatigue and nausea (6–10%).
Summary
Systematic review on medical cannabis for sleep disturbances; k=39 RCTs (n=5.100), median follow-up 35 days, 33 studies in chronic pain (cancer/non-cancer). Moderate evidence: cannabis probably leads to a small improvement in sleep quality vs. placebo in chronic pain (modeled RD for MID 8%, 95% CI 3–12%). Reduction in sleep disturbance: non-cancer pain RD 19% (95% CI 11–28%), cancer pain WMD -0.19 cm (95% CI -0.36 to -0.03 cm, p=0.03 for interaction). Adverse effects: dizziness RD 29% (95% CI 16–50%) at ≥3 months follow-up, somnolence/dry mouth/fatigue/nausea RD 6%–10%.
P
PopulationPatients with sleep disturbances, predominantly chronic pain (cancer and non-cancer), pooled n=5100
I
InterventionMedical cannabis/cannabinoids (predominantly oral, 1 study inhaled)
C
ControlPlacebo or non-cannabinoid control
O
OutcomeModerate evidence for small improvement in sleep quality in chronic pain (RD 8% [95% CI 3–12]); moderate to high evidence for small improvement in sleep disturbance in non-cancer pain (RD 19% [95% CI 11–28]); increased risk of dizziness (RD 29% [95% CI 16–50])
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Study Objectives: We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep.
Methods: We searched MEDLINE, EMBASE, CENTRAL, and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence.
Results: Thirty-nine trials (5100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (weighted mean difference of -0.19 cm [95%CI, -0.36 to -0.03 cm]; interaction p = .03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with >/=3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%).
Conclusion: Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.