Study finds medical cannabis provided relief for those with obstructive sleep apnea

NINA MOINI: Sleep apnea is a condition that affects millions of people, often without them even knowing it. It's more than just loud snoring or restless nights. It can have serious health consequences. And the State Office of Cannabis Management has new data about using cannabis to treat the condition. They conducted the largest survey on record about the condition and cannabis, and their findings show it could really help patients.

So here to explain is Grace Christensen. She's a research analyst at the Office of Cannabis Management for the state. Thank you for joining me this afternoon, Grace.

GRACE CHRISTENSEN: Hi, thanks for having me.

NINA MOINI: For starters, listeners may not know much about sleep apnea and just the disruptions it causes. Could you explain what it is and how serious it could be?

GRACE CHRISTENSEN: Oh, absolutely. So sleep apnea occurs when a patient's-- sorry, when--

NINA MOINI: It's OK.

GRACE CHRISTENSEN: --patients have trouble breathing at night, and they actually stop breathing during sleep. And so sleep apnea really causes a disruption of sleep because when a patient stops breathing, they wake up from their sleep. And long-term sleep apnea can cause cardiovascular morbidities like hypertension, reduced cognitive function, and depressed mood and quality of life due to this lack of sleep.

NINA MOINI: Yeah, and sometimes people don't even know that's why they're waking up, right? So they're--

GRACE CHRISTENSEN: Absolutely.

NINA MOINI: --just kind of in this loop, and they don't know why. So why did you all and researchers think that medical marijuana could help with sleep apnea symptoms? What was behind the idea to research that?

GRACE CHRISTENSEN: Great question. So cannabinoids are hypothesized to reduce these apneas or the collapse of the airway by suppressing vagal nerve activity. And there have been pretty encouraging studies in rats which have found that THC reduced sleep apnea.

There are also a few clinical trials done in humans on drugs with synthetic THC that have showed improved sleep and reduced sleep apneas. That led to, in 2018, the Minnesota Medical Cannabis Program approving obstructive sleep apnea as one of our qualifying conditions.

NINA MOINI: OK. So this was a survey, correct? How did you gather the information?

GRACE CHRISTENSEN: Yeah, so the Minnesota Medical Cannabis Program is unique among medical cannabis programs in the United States, where we actually require every single medical cannabis patient to take a survey, or we call it our patient self-evaluation, before every single medical cannabis purchase.

So the PSE, or the Patient Self-Evaluation, includes information about their current medications, which they discuss with their medical cannabis pharmacist. We ask them about eight standard symptoms, including disturbed sleep and fatigue, which we discuss in the report. We also discuss adverse side effects that they may be experiencing with their medical cannabis.

NINA MOINI: OK, but so overall, what was the conclusion?

GRACE CHRISTENSEN: Overall, we found that over 90% of patients reported having disturbed sleep at enrollment into the program. And among those patients, 60% reported a 30% score improvement for their disturbed sleep within four months of their first medical cannabis purchase. And then over the course of follow-up of the study, overall, about 40% were able to improve their disturbed sleep score and then maintain that score for at least four months after their initial improvement.

NINA MOINI: OK. So important to mention to folks, though, too, that this is medical marijuana. So how is it being administered? Because we wouldn't want folks to think that they could just run out to a dispensary and, oh, now I'm going to solve my sleep issues or my sleep apnea. How did it happen in that setting?

GRACE CHRISTENSEN: Yeah, that's a really great question. So in our medical cannabis program, patients will first consult with their physician or their health care practitioner to get enrolled into the program. And then once enrolled, they will go to a medical cannabis dispensary and have a consultation with medical cannabis pharmacists.

And these pharmacists will discuss with the patient about their needs, their symptoms, their current medications, and maybe some of their concerns about taking cannabis. And then they will provide a plan that is best for that particular patient.

NINA MOINI: OK. What are the concerns about-- you mentioned maybe some adverse side effects? Were there some?

GRACE CHRISTENSEN: Yeah. So on this patient self-evaluation that I discussed earlier, about 16% of patients in this study reported having adverse side effects. And I would say a majority, about 3/4, were reported to be mild side effects. And only 4% reported to be severe side effects. Our patients are reporting dry mouth is by far the most common side effect that they see, followed by increased appetite and drowsiness.

The kind of funny thing about medical cannabis is that one patient's adverse side effect is another patient's benefit. So, for example, some patients take medical cannabis to increase their appetite where others might see that as an adverse side effect.

NINA MOINI: So at the Office of Cannabis Management, what are the different types of studies and the research that you all are doing? And why are you doing it?

GRACE CHRISTENSEN: Yeah, that's a really great question. So medical cannabis research is pretty sparse in the United States due to the Schedule 1 status of cannabis. So at the Office of Medical Cannabis, when medical cannabis was actually first introduced in Minnesota, it's written in statute that our office conduct research studies using the data from our patients. And using this patient self-evaluation, among other surveys that we administer periodically, we really hope to widen the research base on medical cannabis and our qualifying conditions.

NINA MOINI: So are you only researching medical cannabis situations? I'm only curious because of all the movement in the state of Minnesota to legalize recreational cannabis and the changes that are going on this year with the ability for dispensaries to open and to sell flower. So where does that factor in?

GRACE CHRISTENSEN: Yeah, that's a really great question. Currently, at the Office of Medical Cannabis, we are mostly looking at medical cannabis research. However, our colleagues at the Department of Health do look at the more adverse side effects, cannabis use, those kinds of recreational outcomes currently.

NINA MOINI: OK. So getting back to sleep apnea, what are the current treatments? And could medical cannabis take the place or be supportive in that process?

GRACE CHRISTENSEN: Yeah, currently, the most effective treatment is getting a CPAP machine, which you would be prescribed one by your doctor. However, medical cannabis could be involved in your sleep apnea treatment plan. I would say some of our patients do really see benefits. However, we could not compare the results of medical cannabis to a placebo or another comparison group. But I think patients should-- if they're interested in medical cannabis, to consult with their doctor.

NINA MOINI: Would it ever be a goal-- not that you could tell from probably one survey or study, but to have perhaps cannabis or medical marijuana take the place of that CPAP machine? Because for folks who don't know, I've seen other people, and they look pretty uncomfortable. You got to wear a mask over your face. There's sound. So what's going on with trying to maybe make treatment just more, I guess, just convenient?

GRACE CHRISTENSEN: Yeah, that's a really great question. And I think it's really up to the patient on how uncomfortable they find that CPAP machine. Some of the more anecdotal comments we see from our patients is that the medical cannabis may make them more comfortable in that CPAP. But I would not say that it would replace the CPAP.

NINA MOINI: OK. Are there any other areas of study that you're excited about or looking into?

GRACE CHRISTENSEN: Yeah, that's a really great question. And we at the Office of Cannabis Management are coming out with some more of these reports on our qualifying conditions. We just released one about our chronic pain patients that we're excited about, which is also on our website.

NINA MOINI: And what did that one say?

GRACE CHRISTENSEN: So that one showed that among patients with chronic pain, which is by far the most common qualifying condition in our program, about 20% found that lasting relief their pain that they were seeing.

NINA MOINI: OK. So overall, Grace, what is the goal when you have this data and these surveys? Are you hoping, because it's coming from the state, that lawmakers can use it or medical professionals can? What is the goal from gathering all this data?

GRACE CHRISTENSEN: Yeah, we're, at the Office of Cannabis Management, really hoping to just contribute to the overall research and knowledge base of medical cannabis. We're hoping that physicians can take a look at this. Lawmakers can take a look at this. Medical researchers can take this and write their own grants using these findings, hopefully to get some of that gold standard clinical trial data as well.

NINA MOINI: And just to have more data in general, right, about cannabis?

GRACE CHRISTENSEN: Absolutely.

NINA MOINI: All right.

GRACE CHRISTENSEN: Absolutely.

NINA MOINI: Grace, thank you very much for stopping by and breaking that down for us. I really appreciate it.

GRACE CHRISTENSEN: Thank you so much for having me.

NINA MOINI: That was Grace Christensen, a senior research analyst at the State Office of Cannabis Management.