Drug testing in children with excessive daytime sleepiness during multiple sleep latency testing

Area of Science:

• Pediatric Sleep Medicine
• Clinical Pharmacology
• Diagnostic Testing

Background:

• Excessive daytime sleepiness (EDS) in children often necessitates diagnostic testing, including the Multiple Sleep Latency Test (MSLT).
• The role of drug screens, particularly for substances like caffeine, in evaluating pediatric EDS is not well-defined.

Purpose of the Study:

• To determine the incidence of positive drug screens in children undergoing MSLT for EDS.
• To assess the utility of routine drug testing for illicit substances and common stimulants in this population.

Main Methods:

• Retrospective analysis of 210 pediatric patients undergoing MSLT for EDS between 1998-2013.
• Concurrent urine and/or serum drug screens were analyzed for various substances, including prescription medications, over-the-counter drugs, and drugs of abuse.

Main Results:

• No illicit drugs of abuse were detected in any of the tested children.
• Positive screens were found for caffeine (32%), prescription medications (5%), and over-the-counter drugs (4%).
• Children positive for caffeine were older and more likely female, but showed no significant differences in sleep study parameters.

Conclusions:

• Routine drug testing for drugs of abuse during MSLT for pediatric EDS is not indicated.
• Caffeine is a common substance detected in children undergoing MSLT for EDS, highlighting the need for sleep physicians to inquire about its intake.
• Documentation of caffeine intake history by sleep physicians during clinic visits for EDS was notably infrequent.