Cannabinoid therapies in the management of sleep disorders: A systematic review of preclinical and clinical studies

Anastasia S Suraev; Nathaniel S Marshall; Ryan Vandrey; Danielle McCartney; Melissa J Benson; Iain S McGregor; Ronald R Grunstein; Camilla M Hoyos

doi:10.1016/j.smrv.2020.101339

Cannabinoid therapies in the management of sleep disorders: A systematic review of preclinical and clinical studies

Sleep Med Rev. 2020 Oct:53:101339. doi: 10.1016/j.smrv.2020.101339. Epub 2020 May 16.

Authors

Anastasia S Suraev¹, Nathaniel S Marshall², Ryan Vandrey³, Danielle McCartney⁴, Melissa J Benson⁴, Iain S McGregor⁴, Ronald R Grunstein⁵, Camilla M Hoyos⁶

Affiliations

¹ The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia; The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.
² Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia; The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia.
³ Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
⁴ The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia.
⁵ Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia; RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia. Electronic address: camilla.hoyos@sydney.edu.au.

PMID: 32603954
DOI: 10.1016/j.smrv.2020.101339

Abstract

Cannabinoids, including the two main phytocannabinoids Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD), are being increasingly utilised as pharmacological interventions for sleep disorders. THC and CBD are known to interact with the endocannabinoid and other neurochemical systems to influence anxiety, mood, autonomic function, and circadian sleep/wake cycle. However, their therapeutic efficacy and safety as treatments for sleep disorders are unclear. The current systematic review assessed the available evidence base using PubMed, Scopus, Web of Science, Embase, CINAHL and PsycInfo databases. A total of 14 preclinical studies and 12 clinical studies met inclusion criteria. Results indicated that there is insufficient evidence to support routine clinical use of cannabinoid therapies for the treatment of any sleep disorder given the lack of published research and the moderate-to-high risk of bias identified within the majority of preclinical and clinical studies completed to-date. Promising preliminary evidence provides the rationale for future randomised controlled trials of cannabinoid therapies in individuals with sleep apnea, insomnia, post-traumatic stress disorder-related nightmares, restless legs syndrome, rapid eye movement sleep behaviour disorder, and narcolepsy. There is a clear need for further investigations on the safety and efficacy of cannabinoid therapies for treating sleep disorders using larger, rigorously controlled, longer-term trials.

Keywords: Cannabidiol; Cannabinoids; Cannabis; Insomnia; Obstructive sleep apnea; Sleep disorders; THC.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Animals
Cannabinoids / therapeutic use*
Humans
Rats
Sleep / drug effects
Sleep Initiation and Maintenance Disorders / drug therapy
Sleep Wake Disorders / drug therapy*

Substances

Cannabinoids