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Concurrent Associations of Past-3-Month Cannabis Use with Fitbit Sleep and Pain Among Participants in the All of Us Research Program

Liva LaMontagne
University of Florida

Co-Authors: Hanzhi Gao, Linda B Cottler, Roger B Fillingim, John B Williamson, Vijaya Seegulam, Yan Wang, Catalina Lopez-Quintero
University of Florida

Background: Sleep is vital for overall health, yet over a quarter of Americans report insufficient sleep. With increasing cannabis legalization, people may turn to it to improve sleep, especially when coping with pain. Among patients who use medical cannabis, more than half may also use non-medical cannabis recreationally. However, findings on how cannabis affects sleep are mixed. The All of Us program allows objective sleep assessment via Fitbit wearables, supplemented by self-reports of cannabis use and pain.

Objective: We examined how participants’ past-3-month cannabis use related to concurrent Fitbit sleep measurements and pain, controlling for sociodemographic factors.

Methods: The study included 3794 participants with Fitbit sleep data with a median age of 49.60 [IQR: 34.58, 63.04], 70.6% female, 87% White, and 59.3% had income > $75.000. Of these, 759 (20%) reported past-3-month cannabis use. We selected past-7-day pain intensity and sleep data recorded within the 3-month period before the date of reporting past-3-month cannabis use (yes/ no). Using robust SEM regression analyses in R, we separately regressed average minutes of nightly total sleep and sleep latency (total time in bed – total time asleep) on cannabis use, pain, and sociodemographic factors (age, gender, race, income, relationship status).

Results: Based on Chi-square tests, participants who used cannabis in the past 3 months disproportionally had lower income, higher pain intensity, were younger, and Black/ African American compared to non-users. Based on multivariate regression analysis, participants who used cannabis in the past 3 months compared to non-users had 2.7 minutes longer sleep latency during that time, all other variables held constant. Overall pain intensity among participants was low (<5 on a 10-point scale), and a unit-increase in pain was associated with a 1.46-minute decrease in average nightly total sleep and a 0.51-minute increase in sleep latency, all other variables held constant. Each year-increase in age was associated with 0.79-minute decrease in total sleep. Black/African American participants had 42.39 minutes less total sleep than White participants, independently of cannabis use (all p values < 0.05).

Conclusions: Our findings among the relatively high-SES Fitbit users in the All of Us program suggest that cannabis use may be concurrently associated with taking longer to fall asleep. Our study also aligns with previous reports of shorter sleep durations among Black/ African Americans compared to Whites. More research is needed on the interaction effects between sociodemographic factors and cannabis use on pain and sleep outcomes.