To determine the incidence of positive drug screens in children undergoing a multiple sleep latency test (MSLT) for evaluation of excessive daytime sleepiness (EDS).
A retrospective analysis was performed in children evaluated at the Boston Children's Hospital Sleep Center between 1998 and 2013 who underwent MSLT for EDS with a concurrent urine and/or serum drug screen.
A total of 210 MSLTs were accompanied by drug testing. Children were 12.7 ± 3.7 years old (mean ± SD), 43% were female, and 24% had narcolepsy. Positive tests were obtained in 32% for caffeine, 5% for prescription medications, and 4% for over-the-counter drugs. No drugs of abuse were identified. Children testing positive for caffeine were older (13.8 ± 3.5 vs. 12.4 ± 3.7) and more likely female (59% vs. 36%), but did not differ in MSLT or overnight polysomnographic parameters compared to children without caffeine detected. Overall, only 14% had specific documentation regarding caffeine intake, though 90% were referred from a sleep clinic. Of the children testing positive for caffeine, 5% acknowledged use, 3% denied use, and 92% did not have a documented caffeine intake history during their sleep clinic visit.
Routine drug testing for drugs of abuse during an MSLT for EDS yielded no positive results over a 15-year period, indicating that this routine practice is unnecessary in our pediatric population without specific concerns. However, objective evidence for caffeine exposure was found in 32% of tested children undergoing an MSLT. Sleep physicians rarely documented the caffeine intake history during clinic visits for EDS.
Katz ES, Maski K, Jenkins AJ. Drug testing in children with excessive daytime sleepiness during multiple sleep latency testing. J Clin Sleep Med 2014;10(8):897-901.