Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Clin Sleep Med. 2018 Apr 15;14(4):679-681. doi: 10.5664/jcsm.7070.
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.
成人阻塞性睡眠呼吸暂停（OSA）的诊断和有效治疗是一项紧迫的健康优先事项。尽管其他治疗选择仍在探索中，但气道正压（PAP）治疗仍然是治疗 OSA 的最有效方法。有限的证据表明，小型试点或概念验证研究表明，合成医用大麻提取物大麻隆可能改善呼吸稳定性，并有助于治疗 OSA。然而，大多数患者报告了与治疗相关的嗜睡等副作用，并且长期对其他睡眠质量指标、耐受性和安全性的影响仍不清楚。大麻隆未获得美国食品和药物管理局（FDA）批准用于治疗 OSA，并且尚未在 OSA 患者中研究医用大麻和除大麻隆以外的合成提取物。医用大麻中的大麻素成分差异很大，不受监管。医用大麻的合成可能具有不同的作用，在治疗 OSA 方面具有不同的疗效和副作用。因此，美国睡眠医学学会（AASM）的立场是，由于不可靠的给药方法和有效性、耐受性和安全性的证据不足，医用大麻和/或其合成提取物不应用于治疗 OSA。OSA 应从州医用大麻计划的慢性医疗条件清单中排除，并且 OSA 患者应与经认可的睡眠机构的持牌医疗提供者讨论其治疗选择。在推荐它们作为 OSA 的治疗方法之前，需要进一步研究医用大麻提取物的功能。
