Importance of Urinary Drug Screening in the Multiple Sleep Latency Test and Maintenance of Wakefulness Test

Sep 23, 2016Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Why Urine Drug Tests Matter During Sleepiness and Wakefulness Tests

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Abstract

In a study of 69 patients undergoing sleep testing, 16% tested positive for drugs impacting sleep assessments.

Positive drug screens were found in 7 patients undergoing Multiple Sleep Latency Tests (MSLT) and 4 patients undergoing the Maintenance of Wakefulness Test (MWT).
Detected substances included amphetamines, cannabinoids, opiates, and benzodiazepines.
No patients reported using these drugs prior to testing.
Statistical comparisons showed no significant differences in demographics or sleep study results between those with positive and negative drug screens.
Among MSLT patients with positive screens, one was diagnosed with narcolepsy and five with idiopathic hypersomnia.
Three of the four MWT patients who tested positive had a history of motor vehicle accidents.

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STUDY OBJECTIVES: Multiple sleep latency testing (MSLT) and the maintenance of wakefulness test (MWT) are gold-standard objective tests of daytime sleepiness and alertness; however, there is marked variability in their interpretation and practice. This study aimed to determine the incidence of positive drug screens and their influence on MSLT, MWT, and polysomnographic variables.

METHODS: All patients attending Eastern Health Sleep Laboratory for MSLT or MWT over a 21-mo period were included in the study. Urinary drug screening for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates was performed following overnight polysomnography (PSG). Demographics and PSG variables were compared.

RESULTS: Of 69 studies, MSLT (43) and MWT (26), 16% of patients had positive urinary drug screening (7 MSLT; 4 MWT). Drugs detected included amphetamines, cannabinoids, opiates, and benzodiazepines. No patient self-reported use of these medications prior to testing. No demographic, MSLT or MWT PSG data or overnight PSG data showed any statistical differences between positive and negative drug screen groups. Of seven MSLT patients testing positive for drug use, one met criteria for the diagnosis of narcolepsy and five for idiopathic hypersomnia. On MWT, three of the four drug-positive patients had a history of a motor vehicle accident and two patients were occupational drivers.

CONCLUSIONS: These findings indicate drug use is present in patients attending for daytime testing of objective sleepiness and wakefulness. These data support routine urinary drug screening in all patients undergoing MSLT or MWT studies to ensure accurate interpretation in the context of illicit and prescription drug use.

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Importance of Urinary Drug Screening in the Multiple Sleep Latency Test and Maintenance of Wakefulness Test

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