Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
Chest. 2022 Aug;162(2):452-465. doi: 10.1016/j.chest.2022.04.151. Epub 2022 May 7.
Sleep disturbances are often cited as a primary reason for medicinal cannabis use, and there is increasing clinical interest in the therapeutic potential of cannabinoids in treating sleep disorders. Burgeoning evidence suggests a role of the endocannabinoid system in regulating the circadian sleep-wake cycle, highlighting a potential avenue for developing novel therapeutics. Despite widespread use of cannabis products as sleep aids globally, robustly designed studies verifying efficacy in sleep-disordered populations are limited. Although some study outcomes have suggested cannabinoid utility in insomnia disorder and sleep apnea, most studies to date are limited by small sample sizes, lack of rigorously controlled study designs, and high risk of bias. This critical review summarizes the current evidence for the use of cannabinoids as a treatment for sleep disorders and provides an overview of endocannabinoid modulation of sleep-wake cycles, as well as the sleep-modulating effects of plant-derived cannabinoids such as delta-9-tetrahydrocannbinol, cannabidiol, and cannabinol. The review also discusses practical considerations for clinicians regarding cannabinoid formulations, routes of administration, respiratory concerns, dosing, potential side effects, drug interactions, and effects relevant to driving, tolerance, and withdrawal. Although current interest in, and uptake of, medicinal cannabis use for sleep disorders may have surpassed the evidence base, there is a strong rationale for continued investigation into the therapeutic potential of cannabinoids.
睡眠障碍常被认为是使用医用大麻的主要原因，且人们对大麻素治疗睡眠障碍的潜在治疗作用越来越感兴趣。越来越多的证据表明内源性大麻素系统在调节昼夜节律睡眠-觉醒周期中起作用，这突显了开发新型疗法的潜在途径。尽管大麻制品在全球范围内被广泛用作助眠药物，但在睡眠障碍人群中验证其疗效的设计严谨的研究仍十分有限。尽管一些研究结果表明大麻素在失眠症和睡眠呼吸暂停中的应用具有一定效果，但迄今为止的大多数研究都受到样本量小、缺乏严格对照的研究设计以及高偏倚风险的限制。本综述总结了目前关于大麻素治疗睡眠障碍的证据，并概述了内源性大麻素对睡眠-觉醒周期的调节，以及植物源性大麻素（如 Delta-9-四氢大麻酚、大麻二酚和大麻酚）对睡眠的调节作用。该综述还讨论了与大麻素制剂、给药途径、呼吸问题、剂量、潜在副作用、药物相互作用以及与驾驶、耐受和戒断相关的效应相关的临床医生的实际考虑因素。尽管目前对医用大麻治疗睡眠障碍的兴趣和应用可能已经超过了现有证据基础，但继续研究大麻素的治疗潜力具有很强的理由。
