El síndrome de apnea obstructiva del sueño, como trastorno respiratorio del sueño que provoca ronquidos y peligrosas pausas durante la respiración, distingue dos tipos: la apnea obstructiva del sueño y el síndrome de apnea central del sueño. La primera es la más común, la que padece un 90% de los pacientes y que ocurre por la obstrucción de la vía aérea al dormir. La apnea central del sueño, por otro lado, ocurre cuando el cerebro no envía las señales adecuadas a los músculos que controlan la respiración. En ambos casos, el mejor tratamiento conocido (o gold standard) son las tecnologías de ventiladores de presión positiva o CPAP, cuyo uso reduce los síntomas de somnolencia y los indicadores de eventos respiratorios.
Sin embargo, existe literatura médica que, desde el año 2002, proponen el uso del dronabinol, nombre común del tetrahidrocannabinol (principal constituyente psicoactivo del cannabis, aislado en 1964) como tratamiento alternativo de la apnea del sueño, síndrome que no cuenta hoy con medicamentos complementarios para esta terapia. Las más recientes de estas investigaciones, datan del 2018 y, tras alcanzar la fase II de implementación en la la Universidad de Illinois, Chicago y la Universidad del Northwest, Washington; determinaron que el uso de dronabinol probó ser “seguro y bien tolerado en participantes con apnea obstructiva del sueño de moderada a grave”.
“Sigue existiendo una necesidad importante y no satisfecha de tratamientos totalmente eficaces y aceptables en la apnea obstructiva del sueño. En la actualidad, no existen tratamientos farmacológicos aprobados. El dronabinol se ha mostrado prometedor para la farmacoterapia de la apnea obstructiva del sueño en un pequeño estudio piloto de escalada de dosis”, señala la presentación de este estudio que recurrió a ensayos aleatorios, de doble ciego y placebos para evitar sesgos en 73 participantes adultos en el experimento ( y que puedes descargar aquí)
Los participantes señalaron sentir “mayor satisfacción general” con el tratamiento, reportaron una mejora en los indicadores de somnolencia y dejaron la puerta abierta a la necesitan de nuevos ensayos clínicos más amplios para encontrar mejores enfoques para plantear el tratamiento con cannabinoides para la apnea del sueño. La líder de la investigación, neuróloga Phyllis Zee, explica a Sleep Review que “El uso de CPAP como alternativa de tratamiento se dirige al problema físico pero no a la causa. El tratamiento con dronabinol se dirige al cerebro y los nervios que regulan los músculos de las vías respiratorias superiores. Altera los neurotransmisores del cerebro que se comunican con los músculos. Creemos que una mejor comprensión de esto, nos ayudará a desarrollar tratamientos más eficaces y personalizados para la apnea del sueño”.
En busca de mayor evidencia
A pesar de estos resultados, existen otras voces críticas al uso de cannabinoides contra la apnea del sueño. Informes que, al menos, exigen mayores investigaciones antes de sumar a las propiedades del cannabis medicinal, su uso en este tipo de terapias. La revista Journal of Clinical Sleep Medicine publicó poco después de los hallazgos del equipo de Zee una declaración (disponible aquí) de la Academia Estadounidense de Medicina del Sueño (AASM) que aseguran que los compuestos -naturales o sintéticos- de la marihuana no deben usarse para el tratamiento de la apnea obstructiva del sueño. Esto, debido a que “no hay suficiente evidencia de efectividad, tolerabilidad y seguridad en el tratamiento de esta condición”.
“Hasta que tengamos más pruebas sobre la eficacia del cannabis medicinal para el tratamiento de la apnea del sueño, y hasta que se establezca su perfil de seguridad, los pacientes deben someterse a tratamiento probados, con un proveedor médico autorizado y en un hospital acreditado“, escribe Kannan Ramar, especialista en Medicina Pulmonar y de Cuidados Intensivos de la Clínica Mayo.
El dronabinol aún no ha sido aprobado por la Administración de Drogas y Alimentos de EEUU (FDA) para el tratamiento de la apnea del sueño. Actualmente, se usa para tratar la náusea y los vómitos ocasionados por la quimioterapia y en el tratamiento la falta de apetito y pérdida de peso en personas con el síndrome de inmunodeficiencia adquirida.
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