(1303) Association of Cannabis Use Disorder with Incident Obstructive Sleep Apnea

Introduction: The impact of cannabis use on obstructive sleep apnea (OSA) risk remains unclear, especially as cannabis is often inhaled, used for sleep, and may cause upper airway inflammation. This study evaluates and association between cannabis use disorder (CUD) and subsequent OSA incidence.

Methods: Using the TriNetX US Research Network (2005–2020), we performed a retrospective, propensity-matched cohort study comparing adults with CUD vs controls. We excluded prior OSA, central sleep apnea, and head/neck cancer. Cohorts were matched on demographic and clinical covariates, including tobacco/alcohol use and metabolic comorbidities. Outcomes included 5-year incident OSA, analyzed using hazard ratios (HRs) from Cox proportional hazards models and log-rank tests. A second analysis examined patients with OSA with and without subsequent CUD.

Results: Before matching, there were 87,701 patients with CUD and 6,777,672 patients without CUD. Post-matching (n=87,365 per group), 5-year OSA prevalence was higher in those with CUD (8.6% vs 6.5% , p< 0.001). CUD was associated with a higher prevalence of OSA at 1 year (HR 1.4, 95%CI 1.3–1.5) and 5 years (95%CI 1.30,1.25–1.34). Five-year risk was increased among each CUD diagnosis rising in severity; cannabis use (95%CI 1.44, 1.36-1.52), abuse (1.23, 95%CI 1.15-1.31) and dependence (1.26, 95%CI 1.11-1.43). Among patients with diagnosed OSA, CUD trended towards a higher prevalence of CPAP prescription at 5 years (17.9% vs 8.7%, p=0.057).

Conclusions: Cannabis use disorder was independently associated with an increased incidence of subsequent OSA. These findings suggest that CUD may exacerbate OSA severity, necessitating vigilant screening and potentially earlier sleep surgery evaluations in this population.