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New study finds marijuana use linked to sleep problems and narcolepsy in teenagers (2016-03-11)

Researchers hypothesized that symptoms consistent with narcolepsy including excessive daytime sleepiness, cataplexy, sleep paralysis or hypnagogic/hypnopompic hallucinations might be reported by some pediatric patients who use marijuana. They also hypothesized that THC use/withdrawal might be associated with a decreased mean sleep onset latency and an increased number of sleep onset REM periods on multiple sleep latency testing (MSLT) consistent with narcolepsy.

Samuel Dzodzomenyo, MD, knows all about teenagers and their infamous sleep habits. They stay up too late, sleep in too long – at least for their parent’s liking. When they come to him, chances are they are having troubles beyond the average adolescent. Many of his patients at Dayton Children’s pediatric sleep center complain of extreme daytime sleepiness. Sleep tests can help determine what the problem is, from sleep apnea to narcolepsy.

Dr. Dzodzomenyo became concerned that some patients who had sleep patterns consistent with narcolepsy might actually have been influenced by drugs, specifically marijuana.
Narcolepsy is a disorder in which the brain can’t control the sleeping and waking cycles properly.

There are an estimated 4 million people in the world that suffer from narcolepsy and it most often develops during adolescence.
Narcoleptics may have periods of extreme daytime sleepiness (EDS) and “sleep attacks” in which they fall asleep suddenly. Although it presents as excessive daytime sleepiness, they may also have fragmented sleep and trouble sleeping at night.

Researchers launched a study looking at standardized sleep tests over a ten year period and the drug screenings done just before those tests, a retrospective study of urine drug screens performed the morning before MSLT in 383 patients < 21 years old referred for EDS.

MSLT results were divided into those with urine drug screens, urine drug screens for tetrahydrocannabinol (THC) alone or THC plus other drugs, and urine drug screens for drugs other than THC.

The study found 43 percent of pediatric patients who tested positive for marijuana use had sleep tests that were consistent with a diagnosis of narcolepsy, compared with only 24 percent of pediatric patients with a negative drug screen.

Ten percent of all pediatric patients ≥ 13 years who presented with excessive daytime sleepiness without cataplexy and also had a multiple sleep latency test consistent with narcolepsy were found to have a urine drug screen for THC. Drug screening is important in interpreting MSLT findings for children ≥ 13 years.

“We were most surprised by the fact that patients referred for evaluation for excessive daytime sleepiness who tested positive for marijuana were almost twice as likely to meet the objective criteria for narcolepsy,” said Dr. Dzodzomenyo, medical director of the pediatric sleep center at Dayton Children’s Hospital and associate professor of pediatric neurology at Wright State University Boonshoft School of Medicine in Dayton, Ohio.

According to a survey by the Centers for Disease Control and Prevention, in 2013 more than 40 percent of U.S. teens reported using marijuana at least once. Almost a quarter of teens said they used it once in the last 30 days.

“It is an important finding, as more states legalize the recreational or medicinal use of marijuana. Clinicians need to be aware of the potential effects of marijuana use on diagnostic tests for narcolepsy.”

For more information
Journal of Clinical Sleep Medicine
Dzodzomenyo S, Stolfi A, Splaingard D, Earley E, Onadeko O, Splaingard M. Urine toxicology screen in multiple sleep latency test: the correlation of positive tetrahydrocannabinol, drug negative patients, and narcolepsy. J Clin Sleep Med 2015;11(2):93–99
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Dayton Children's
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Boonshoft School of Medicine
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MDN