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Cannabinoid drug found effective for treating sleep apnea

Sleep apnea is estimated to affect 1 in 5 American adults, and there are currently no drugs available to treat it. But a large-scale clinical trial now offers hope, proving that a drug that uses a synthetic version of the main psychoactive substance in cannabis is effective for treating the disorder.

Share on Pinterest A synthetic version of purified THC — the active substance found in marijuana — could be effective for treating sleep apnea.

The drug is called dronabinol, and it is based on a synthetic version of Delta-9 tetrahydrocannabinol (THC) — the main psychoactive compound responsible for the “high” in cannabis use.

The randomized clinical trial is the longest and largest of its kind, and the results are from its second phase. Dronabinol is already in use for the treatment of nausea and vomiting in patients undergoing chemotherapy.

David W. Carley, a professor of biobehavioral health sciences at the University of Illinois at Chicago (UIC), jointly led the study with Dr. Phyllis Zee, professor of neurology at Northwestern University Feinberg School of Medicine and director of the Northwestern Medicine Sleep Disorders Center, both in Chicago, IL.

At least a mild form of sleep apnea is thought to affect 1 in 5 Americans, and treatment options are limited. Obstructive sleep apnea — the most prevalent form of the condition — is usually treated mechanically with a continuous positive airway pressure (CPAP) device. However, treatment adherence to this mechanical option is very poor.

Recurrent, untreated sleep apnea may lead to cardiovascular problems, such as heart disease and stroke. “There is a tremendous need for effective, new treatments [for] obstructive sleep apnea,” says Prof. Carley, who is also the first author of the paper.

The drug tested in this trial — results of which are published in journal Sleep — works by targeting the brain. Dr. Zee explains, “The CPAP device targets the physical problem but not the cause.”

“The drug targets the brain and nerves that regulate the upper airway muscles. It alters the neurotransmitters from the brain that communicate with the muscles.”

“When people take a pill to treat apnea, they are treated for the entire night,” adds Prof. Carley.

The largest and longest trial of a drug for obstructive sleep apnea finds the cannabinoid drug dronabinol safe and effective for treating the condition.

Position statement: Avoid using medical marijuana to treat sleep apnea

DARIEN, IL – Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea, 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 apnea as a new qualifying condition for the state’s medical cannabis program. However, the AASM has concluded that sleep apnea should be excluded from the list of chronic medical conditions for state medical cannabis programs 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 apnea, 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.

The position statement is published in the April 15 issue of the Journal of Clinical Sleep Medicine.

Nearly 30 million adults in the U.S. have obstructive sleep apnea, 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 apnea.

However, dronabinol has not been approved by the U.S. Food and Drug Administration for the treatment of sleep apnea, 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 apnea,” said AASM President Dr. Ilene Rosen. “Effective and safe treatments for sleep apnea are available from licensed medical providers at accredited sleep facilities.”

AASM recommends that sleep apnea should be excluded from state medical cannabis programs. Learn more about medical marijuana and sleep apnea now.