Authors :
Presenting Author: Garima Shukla, MBBS, MD, DM, FRCPC – Queen's University, Kingston, ON, Canada
Zaitoon Shivji, MSc – Technologist Researcher, Medicine, Queen's University, Kingston, ON, Canada; Ana Johnson, PhD – Professor, Public Health Sciences, Queen's University, Kingston, ON, Canada; Elizabeth Hore, M.Sc. – PhD Scholar, Public Health Sciences, Queen's University, Kingston, ON, Canada; Stuart Fogel, PhD – Director, Sleep Research Laboratory, University of Ottawa, Ottawa, ON, Canada; Gavin Winston, PhD – Professor of Neurology, Medicine, Queen's University, Kingston, ON, Canada; Lysa Boisse Lomax, MD, MSc, FRCPC – Associate Professor of Neurology, Medicine, Queen's University, Kingston, ON, Canada; Helen Driver, PhD, RPSGT, DABSM – Assistant Professor of Sleep Medicine, Medicine, Queen's University, Kingston, ON, Canada
Rationale:
Along with growing interest in the anti-seizure properties of cannabinoids, the prevalence of recreational and medical cannabis use has also been rising, especially across Canada. In a recent study on people with epilepsy (PWE), a strong association was demonstrated between cannabis use and poor psychosocial health. Sleep and mood remain important components of quality of life in epilepsy, and also among the commonest motivations for cannabis use. The primary objective of this study was to conduct subjective and objective assessment of sleep quality and mood among PWE, who are regular cannabis users, in comparison to those who are not.
Methods:
Consecutive consenting patients with confirmed diagnosis of epilepsy, admitted to our Epilepsy Monitoring Unit over a three year period (2019-2022) were enrolled. Detailed epilepsy related data and self-reported sleep related [Pittsburgh Sleep quality index (PSQI)], Epworth Sleepiness Scale (ESS)], mood related [(Beck’s Depression Inventory (BDI) and Beck’s Anxiety inventory (BAI)] and cannabis use data were collected on an institutional RedCap® database. Overnight polysomnography (PSG) was conducted on the first night of admission, with simultaneous 18-channel video-EEG. Sleep (PSG) scoring was conducted in accordance with the American Academy of Sleep Medicine guidelines by a scorer blinded to clinical details. Tests of statistical significance appropriate to type and distribution of data and correlation analysis were conducted.
Results:
Among 51 consenting patients with similar seizure control, 25 (13F) reported cannabis use (mean age 36.3+14.8 years) and were significantly younger than 26 (18F) who denied cannabis use (mean age 48.3+15 years). Subjective sleep quality was significantly better in those reporting cannabis use (mean PSQI scores 7.2+2.9 vs 10.2+5.2 respectively). Most patients endorsed sleepiness (ESS scores greater than 10; 91.3% in group 1, 77.3% in group 2) and moderate to extreme depression (BDI) scores. (Details in Table-1; minimal variation in N for some variables due to missing values for 2 participants). No significant differences were observed in sleep onset latencies, sleep efficiency (Figure 1), REM and N3 sleep percentages and other objective sleep parameters. On multiple logistic regression analysis, the BDI score was found to be a significant predictor of PSQI and ESS scores.
Conclusions:
Self-reported sleep quality was significantly better among PWE who report regular cannabis use and were also younger. However, there was no difference on objective polysomnographic assessment of sleep quality between PWE who are cannabis users versus those who are not. Importantly, severe depression and excessive daytime sleepiness are extremely common in both groups, with a linear correlation.
Funding:
Department of Medicine, Queen’s University Research grant - CIHR pillars #374002