Study Objectives We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep. Methods We searched MEDLINE, EMBASE, CENTRAL, and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence. Results Thirty-nine trials (5100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (weighted mean difference of –0.19 cm [95%CI, –0.36 to –0.03 cm]; interaction p = .03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with ≥3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%). Conclusion Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.

中文翻译：

---

用于睡眠障碍的医用大麻和大麻素：随机临床试验的系统评价和荟萃分析

研究目标 我们进行了系统评价，以探索医用大麻对睡眠障碍的有效性。方法 我们检索了截至 2021 年 1 月的 MEDLINE、EMBASE、CENTRAL 和 PsychINFO，以查找医用大麻或大麻素治疗睡眠障碍与任何非大麻对照的随机试验。在可能的情况下，我们汇总了所有患者重要的睡眠相关结果的效应估计值，并使用 GRADE 方法评估证据的确定性。结果 39 项试验（5100 名患者）符合审查条件，其中 38 项评估了口服大麻素和 1 项吸入大麻。中位随访时间为 35 天，大多数试验（39 项中的 33 项）招募了患有慢性癌症或非癌症慢性疼痛的患者。在慢性疼痛患者中，中等确定性证据发现，与安慰剂相比，医用大麻可能会导致睡眠质量略有改善（实现最小重要差异 [MID] 的模型风险差异 [RD]，8% [95% CI，3 至 12]）。中等到高确定性的证据表明，医用大麻与安慰剂相比，对慢性非癌症疼痛的睡眠障碍有小幅改善（为实现 MID 建模的 RD，19% [95% CI，11 至 28]）和非常小的改善慢性癌痛的睡眠障碍（加权平均差为 –0.19 cm [95%CI, –0.36 to –0.03 cm]；交互作用 p = .03）。中度至高度确定性的证据表明，与安慰剂相比，医用大麻会导致头晕风险显着增加（RD 29% [95%CI，16 至 50]，对于随访时间≥3 个月的试验），嗜睡、口干、疲劳和恶心的风险略有增加（RD 范围从 6% 到 10%）。结论 医用大麻和大麻素可能会改善慢性疼痛患者的睡眠障碍，但益处可能很小。