Use of Cannabinoids for the Treatment of OSA
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INSOMNIA AND PHARMACOTHERAPY (H ATTARIAN AND M KAY-STACEY, SECTION EDITORS)
Use of Cannabinoids for the Treatment of OSA Malvika Kaul 1 & Tomas Munoz 1 & Ashima Sahni 1 Accepted: 27 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Obstructive sleep apnea (OSA) is associated with increased risk of morbidity and mortality. Positive airway pressure (PAP) therapy remains the gold standard treatment, but its use is often limited by patient compliance, hence the need to consider other potential therapies. Preliminary data may suggest potential role of cannabinoids in the treatment of OSA. We aim to summarize the current knowledge on cannabinoid use and its impact on the pathophysiology of OSA as well as its role as a potential management option. Recent Findings Recently, a phase II placebo-controlled trial of dronabinol reported dose-dependent reduction in the apneahypopnea index (AHI). A phase III trial exploring this link further is planned. Summary Cannabinoid use has variable effects in the treatment of OSA. Preliminary data are promising but insufficient regarding both efficacy and safety. Further research is needed to understand its role in management of OSA. Keywords Obstructive sleep apnea . Apnea-hypopnea index . Cannabis . Cannabinoids
Introduction Obstructive sleep apnea (OSA) is a sleep-related breathing disorder caused by airflow limitation resulting from upper airway (UA) collapse, intermittent hypoxia and sleep disruption. Estimated prevalence of OSA is 170 million in Americans making it one of most prevalent sleep-related breathing disordered in the USA [1]. OSA is known to be associated with morbidity and mortality related to cardiovascular diseases like hypertension, atrial fibrillation and coronary artery disease. Positive airway pressure (PAP) therapy This article is part of the Topical Collection on Insomnia and Pharmacotherapy. * Ashima Sahni [email protected] Malvika Kaul [email protected] Tomas Munoz [email protected] 1
Department of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital and Health Sciences System, University of Illinois at Chicago, 909 S. Wolcott Avenue, Room 3135 (MC 719), Chicago, IL 60612, USA
is the gold standard treatment but often its use is limited due to decreased adherence. Alternate therapies including pharmacological agents, while previously investigated, have not been proven to be effective enough to warrant routine use. Cannabinoids are active compounds found in the cannabis plant with over 100 known varieties [2]. The 2 major compounds are delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). Since the legalization of marijuana, its use has been rampant, and primary being used to assist with sleep and sleep-related issues. Recent animal and human studies have renewed the interest of the medical community in its potential use in sleep-related breathing disorders especially after the discovery of endocannabinoid system. The endocannabinoid system comprises of endogenous lipid ligands and cannabinoid receptors. The two
