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Volume 10 No. 08
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Scientific Investigations

Drug Testing in Children with Excessive Daytime Sleepiness During Multiple Sleep Latency Testing

http://dx.doi.org/10.5664/jcsm.3966

Eliot S. Katz, M.D.1; Kiran Maski, M.D.2; Amanda J. Jenkins, Ph.D.3
1Division of Respiratory Diseases, Boston Children's Hospital; ; 2Department of Neurology, Boston Children's Hospital; Harvard Medical School, Boston, MA; ; 3Division of Clinical Pathology, UMASS Memorial Medical Center, Worcester, MA

Study Objective:

To determine the incidence of positive drug screens in children undergoing a multiple sleep latency test (MSLT) for evaluation of excessive daytime sleepiness (EDS).

Methods:

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.

Results:

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.

Conclusions:

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.

Citation:

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.




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