Don't Use Medical Marijuana for Sleep Apnea, AASM Warns

Megan Brooks

April 19, 2018

Medical cannabis and synthetic marijuana extracts should not be used to treat obstructive sleep apnea (OSA), the American Academy of Sleep Medicine (AASM) has advised in a position statement.

In November 2017, the Minnesota State Department of Health (MDH) added OSA  to the state's list of qualifying conditions for use of medical cannabis.

However, on the basis of currently available evidence, the AASM has concluded that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA because of unreliable delivery methods and a lack of sufficient evidence of effectiveness, tolerability, and safety.  It is their position that OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs.

The AASM position statement on medical cannabis for treatment of OSA is published in the April 15 issue of the Journal of Clinical Sleep Medicine.  

Health Department Misstep

The MDH decided to authorize medical marijuana for the treatment of OSA "despite very limited evidence on its efficacy published to date," lead author, Kannan Ramar, MD, told Medscape Medical News.

This prompted the AASM Board of Directors to "approve the development of this position statement paper to recommend that medical cannabis and/or its synthetic extracts not be used to treat OSA until further evidence is available," said Ramar, professor of medicine, Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.

"[P]atients should discuss proven treatment options with a licensed medical provider at an accredited sleep facility," said Ramar.

Scott Smith, public information officer for MDH, told Medscape Medical News that "Minnesota's medical cannabis program relies on clinicians to use their best medical judgement to determine whether medical cannabis is the correct choice for their patients, regardless of which of the approved conditions they are seeking to treat. The decision to use medical cannabis is one that must be made within the context of an ongoing patient-provider relationship."

"MDH encourages clinicians working with sleep apnea patients to review the American Academy of Sleep Medicine statement, as well as other research, to ensure treatment decisions are based on the best available information," said Smith.

OSA an "Urgent Health Priority"

The AASM position statement notes that nearly 30 million adults have OSA and detecting it and treating it effectively are an "urgent health priority."  Positive airway pressure therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. "There is currently 'no easy' pill that can be used to treat OSA," said Ramar.

Limited evidence from small pilot or proof-of-concept studies have suggested that dronabinol, a synthetic form of the cannabis compound tetrahydrocannabinol, may improve respiratory stability and provide benefit to treat OSA. However, side effects of treatment, such as somnolence, were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are unknown, the AASM says. 

Dronabinol is not approved by the US Food and Drug Administration for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA.

Minnesota's decision to add OSA to the list of qualifying conditions for the state's medical cannabis program "appeared to be based on a few small studies of dronabinol, a cannabinoid agonist, which improved but did not cure OSA in short-term use studies," Douglas Kirsch, MD, president-elect of the AASM, told Medscape Medical News.

"Thus, the AASM board of directors felt that using medical cannabis to treat OSA, a chronic and dangerous condition, was concerning, because a) dronabinol is not the same as medical marijuana and b) dronabinol was not studied over long time periods, which is what treatment of OSA would likely require. Thus, we were mostly concerned about patients whose undertreated OSA might lead to negative outcomes like hypertension, cardiac disease, or motor vehicle accidents," said Kirsch, medical director, Carolinas HealthCare Sleep Centers, Charlotte, North Carolina.

The AASM says there is a need for increased funding and further research on the use of synthetic medical cannabis extracts to treat OSA.

"Until there is sufficient scientific evidence of safety and efficacy, neither marijuana nor synthetic medical cannabis should be used for the treatment of sleep apnea," AASM President Ilene Rosen, MD, said in the news release.

J Clin Sleep Med. 2018;14:679-681. Abstract

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