title: Drug testing in children with excessive daytime sleepiness during multiple sleep latency testing.
abstract: 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.
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital;
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.affiliation: Department of Neurology, Boston Children's Hospital; Harvard Medical School, Boston, MA;
authors.forename: Kiran
authors.initials: K
authors.lastname: Maski
authors.affiliation: Division of Clinical Pathology, UMASS Memorial Medical Center, Worcester, MA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D002110:Caffeine / Q000009:adverse effects / Q000652:urine; D002648:Child; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000652:urine
chemical_list: D002110:Caffeine
keywords: caffeine; hypersomnia; narcolepsy