AASM position statement on medical cannabis and obstructive sleep apnoea

Organisation: Position: Deadline Date: Location:

Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnoea, according to a position statement from the American Academy of Sleep Medicine (AASM).

In November 2017 the Minnesota Department of Health announced the decision to add obstructive sleep apnoea as a new qualifying condition for the state’s medical cannabis programme. However, the AASM has concluded that sleep apnoea should be excluded from the list of chronic medical conditions for state medical cannabis programmes due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability and safety.

“Until we have further evidence on the efficacy of medical cannabis for the treatment of sleep apnoea, and until its safety profile is established, patients should discuss proven treatment options with a licensed medical provider at an accredited sleep facility,” said lead author Dr Kannan Ramar, professor of medicine in the division of pulmonary and critical care medicine at Mayo Clinic in Rochester, Minnesota.

Nearly 30m adults in the US have obstructive sleep apnoea, a chronic disease that involves the repeated collapse of the upper airway during sleep. Common warning signs include snoring and excessive daytime sleepiness. After early animal studies demonstrated that the synthetic cannabis extract dronabinol improved respiratory stability, recent studies in humans have explored the potential use of dronabinol as an alternative treatment for sleep apnoea.

However, dronabinol has not been approved by the US Food and Drug Administration for the treatment of sleep apnoea, and its long-term tolerability and safety are still unknown. Furthermore, there have been no studies of the safety and efficacy of other delivery methods such as vaping or liquid formulation. Treatment with the use of medical cannabis also has shown adverse effects such as daytime sleepiness, which may lead to unintended consequences such as motor vehicle accidents.

“Until there is sufficient scientific evidence of safety and efficacy, neither marijuana nor synthetic medical cannabis should be used for the treatment of sleep apnoea,” said AASM president Dr Ilene Rosen. “Effective and safe treatments for sleep apnoea are available from licensed medical providers at accredited sleep facilities.”

There are more than 2,500 AASM-accredited sleep facilities across the US. Treatment options for sleep apnoea include CPAP therapy, which uses mild levels of air pressure, provided through a mask, to keep the throat open while you sleep.

Abstract
The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have differential effects, with variable efficacy and side effects in the treatment of OSA. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs, and patients with OSA should discuss their treatment options with a licensed medical provider at an accredited sleep facility. Further research is needed to understand the functionality of medical cannabis extracts before recommending them as a treatment for OSA.

Authors
Kannan Ramar, Ilene M Rosen, Douglas B Kirsch, Ronald D Chervin, Kelly A Carden, R Nisha Aurora, David A Kristo, Raman K Malhotra, Jennifer L Martin, Eric J Olson, Carol L Rosen, James A Rowley

Academy of Sleep Medicine material
Journal of Clinical Sleep Medicine abstract


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