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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