What question did this study set out to answer?

Assess the impact of cannabinoid use on multiple sleep latency test (MSLT) outcomes in patients with suspected central disorders of hypersomnolence.

May 10, 2026

0719 Much Ado About Nothing? Cannabinoids Do Not Impact Multiple Sleep Latency Test Variables in Suspected Central Disorders of Hypersomnolence Patients

Key Points

Assess the impact of cannabinoid use on multiple sleep latency test (MSLT) outcomes in patients with suspected central disorders of hypersomnolence.
Retrospective analysis of 1,031 patients with confirmed ICSD-3 diagnoses undergoing PSG/MSLT from 3/2009 to 2/2025.
Cannabinoid status determined by urine drug testing (UDT), comparing UDT+ to UDT- groups.
Analysis of MSLT parameters and demographic factors for both groups.
8.8% of the analyzed cohort tested positive for cannabinoids, with no significant variance across different hypersomnolence subtypes (p=0.84).
Higher Epworth Sleepiness Scale scores noted in UDT+ patients (15.2 vs 14.0; p=0.025) and lower apnea-hypopnea index (AHI) on polysomnography (1.00 vs 1.8; p=0.011).
No significant differences observed in MSLT outcomes, including total SOREMPs or mean sleep latency, between UDT+ and UDT- groups (p>0.45).

Abstract

Abstract Introduction Urine drug testing (UDT) during MSLT is performed to rule out the presence of confounding substances. The 2021 AASM recommendations highlight cannabinoids as particularly relevant to MSLT interpretation, citing reports of shortened sleep latency or, after recent discontinuation, REM rebound. However, conflicting reports exist. Prevalence of cannabinoid use among patients with central disorders of hypersomnolence (CDH) is unknown. Methods Retrospective analysis was performed of patients with suspected CDH undergoing PSG/MSLT at Cleveland Clinic, 3/2009-2/2025, who had immunoassay UDT prior to MSLT. Included patients met ICSD-3 criteria for narcolepsy type 1/2 (NT1/2), idiopathic hypersomnia (IH) or undifferentiated hypersomnia (UH). For analyses involving MSLT parameters, the “cannabinoid positive” group (UDT+) was comprised of patients with UDT positive for cannabinoids alone. Results From 1,031 cases with verified ICSD-3 diagnoses, 91 (8.8%) had UDT positive for cannabinoids. Positivity did not differ between CDH subgroups (6/55 (10.9%) in NT1, 7/98 (7.1%) NT2, 21/258 (8.1%) IH, 57/620 (9.2%) UH; p=0.84). Overall N = 1,019 (54 NT1, 97 NT2, 256 IH, 612 UH) after excluding cases positive for 1 substance. UDT+ and UDT- groups did not differ in age (34.0±11.9 vs 35.0±14.5; p=0.89), female sex (61 (77.2%) vs 686 (73.0%); p=0.49), BMI (26.622.7, 31.5 vs 27.223.3, 32.3; p=0.46), or race/ethnicity composition (58 (73.4%) Caucasian vs 734 (78.4%) Caucasian; p=0.49). However, UDT+ had higher Epworth Sleepiness Scale scores (15.2±5.1 vs 14.0±5.2; p=0.025) and lower AHI on PSG (1.000.30,3.4 vs 1.80.70,5.0; p=0.011). For MSLT outcomes, UDT+ and UDT- did not differ by total SOREMPs (0.000.00,1.00 UDT+ vs 0.000.00,1.00 UDT-; p=0.45) or mean sleep latency (MSL) (10.65.3,13.5 UDT+ vs 10.05.9,14.6 UDT-; p=0.89). Likewise, UDT+ had similar likelihood as UDT- of reaching 2+ SOREMPs (13 (16.5%) UDT+ vs 184 (19.6%) UDT-; p=0.63) or MSL ≤ 8 (30 (30.8%) UDT+ vs 373 (39.7%) UDT-; p=0.75). Conclusion These findings demonstrate that a clinically important percentage of patients with suspected CDH use cannabinoids. Additionally, our results do not support ruling MSLTs as invalid solely due to cannabinoid use. Given the similar prevalence of MSLTs with MSL ≤ 8 and/or 2+ SOREMPs between groups, cannabinoids may not impact classification of CDH subtypes; further research is needed. Support (if any)

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0719 Much Ado About Nothing? Cannabinoids Do Not Impact Multiple Sleep Latency Test Variables in Suspected Central Disorders of Hypersomnolence Patients

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