Elsevier

Sleep Medicine

Volume 36, August 2017, Pages 182-183
Sleep Medicine

Letter to the Editor
Cannabis for restless legs syndrome: a report of six patients

https://doi.org/10.1016/j.sleep.2017.04.019Get rights and content

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    A small number of studies have examined cannabinoid effects in restless legs syndrome and REM sleep behavior disorder (RBD). Two case series found that smoked and sublingually administered cannabis (formulation unspecified), adjunctive to standard treatment, significantly improved symptoms in patients with restless legs syndrome.47,48 Another case series reported positive effects of CBD (75-300 mg/d over 6 weeks) on RBD-related events in patients with Parkinson disease.45

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    However, this has not prevented patients from using nonprescription cannabinoids either recreationally or for the treatment of symptoms as most respondents reported having taken care of patients taking cannabinoids for these reasons.28 This may be due to the fact that many uremic symptoms lack safe and effective treatments (e.g., alpha 2 delta ligands29 and opioids30 for chronic pain and are associated with adverse events in hemodialysis), a familiarity or preference for cannabinoids, and their potential to target multiple symptoms concurrently.31–34 Most nephrologists endorsed support for the use of cannabinoids to treat refractory symptoms.

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    The study characteristics and outcomes for each of the 14 preclinical studies (11 full-text articles and three abstracts) and the 12 clinical studies (10 full-text articles, one abstract, and one Letter to the Editor) are summarised in Tables 1 and 2, respectively. All clinical studies involved oral cannabinoid administration aside from one case study reporting on five individuals with severe restless legs syndrome (RLS) who smoked illicit cannabis to manage symptoms [45] – an exception for inclusion in the current review due to the specific focus of the research on a sleep disorder. Nine preclinical studies (all conducted by the same research group) investigated the therapeutic effects of dronabinol (synthetic THC), AM251 and SR141716A (CB1 receptor antagonists), AM630 (CB2 receptor antagonist), chromenopyrazole 13a (CB1 receptor agonist), and HU-308 (CB2 receptor agonist) in a variety of animal models of OSA: four studies using acute serotonin (5-HT)-induced reflex apnea (intravenous administration of 5-HT can reduce upper airway muscle tone and increase apnea susceptibility in anesthetized rats) [46–49], four studies using adult rats as natural models of central sleep apnea [50–53], and one study using mechanical airway obstruction [54].

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