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Relationships Between Baseline Measures of Sleep and Intentions to Start Medical Cannabis among Patients with Chronic Non-Cancer Pain

Liva LaMontagne
University of Florida

Co-Authors: Catalina Lopez-Quintero, Yancheng Li, Roger B Fillingim, John B Williamson, Kimberly Sibille, Zhigang Li, Robert L Cook, Yan Wang
University of Florida

Background: More than 70% of chronic pain patients report sleep disturbances. Older adults are increasingly seeking medical cannabis (MC) to relieve chronic pain and improve sleep. The relationships between self-report measures of sleep quality and objective time asleep are weak, suggesting they might have different relationships with intentions to start MC.

Objective: The goals of this study are to evaluate the relationships between sleep and intentions to start medical cannabis at baseline. We examine the associations of self-reported sleep quality and Fitbit-measured sleep with intentions to start MC.

Methods: Our analysis included baseline data from 96 participants in the Study on medical Marijuana and Its Long-term Effects (SMILE), 48 planning to start MC treatment, 48 – not; 81 (84%) White, 65 (67%) female, median (IQR) age = 66 (57,70.25). At intake participants reported whether they planned to start MC (yes/ no), rated past-30-day sleep quality (1 -very bad; 4 – very good) and started wearing Fitbit Charge 4s. We averaged total time asleep over the first week. We regressed sleep measures on MC intentions, controlling for pain intensity, opioid use, and sociodemographic factors (age, gender, race, income, relationship status) with robust SEM regressions in R.

Results: Based on Mann-Whitney U-tests, there were no differences in self-reported sleep quality by MC intention groups. Participants intending to start MC had less sleep, Mdn (IQR) = 6.83 (5.41, 7.16) than participants who did not, Mdn (IQR) = 7 (6.18, 7.56) hours. Based on multivariate regression analysis, subjective sleep quality was not associated with intentions to start MC. First-week Fitbit average total sleep time was negatively associated with intentions to start MC (B = -61.46, p = 0.014) with interested participants sleeping over an hour less on average. Subjective sleep quality was also negatively associated with pain intensity (B = – 0.02, p = 0.000) and positively – with opioid use (B = 0.67, p = 0.000) and age (B = 0.02, p = 0.009, all p-values FDR-adjusted for multiple testing).

Conclusions: As hypothesized, our initial findings indicate that getting less sleep on average may be associated with higher interest in MC treatment. Our findings also align with an established body of work showing a concurrent negative relationship between pain and self-reported sleep quality. A future research direction is to better understand the prospective effects of MC treatment and opioid use on subjective and objective sleep measures among older adults with chronic pain.