P130 An audit of urinary drug screening use in multiple sleep latency and maintenance of wakefulness testing in an Australian tertiary centre

Abstract Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) are objective measures of excessive daytime sleepiness, used in diagnosing and monitoring patients with sleep disorders. MSLT and MWT can be affected by substances such as psychotropics, stimulants, opioids and sedatives. Recent studies demonstrate high prevalence of positive urine drug screening (UDS) results in patients undergoing MSLT and MWT. We retrospectively audited patients who underwent UDS with MSLT/MWT at a tertiary centre from 1st January 2019 to 1st January 2020. The following data was collected: MSLT/MWT/UDS results, sleep disorder diagnosis/es, return to driving/work after testing and pre-existing and subsequent prescription of stimulants/wakefulness-promoting agents/psychotropics/sodium oxybate. Our cohort featured 32 patients (23 female). 29 MSLTs and 3 MWTs were performed. Median age was 31 years old. 13 patients were on wakefulness-promoting agents/psychotropics when tested, where 8 were on serotonin–norepinephrine reuptake inhibitors/selective serotonin reuptake inhibitors. 13 patients (~45%) had a reduced mean sleep latency (MSL), where 10 minutes was used as the cut-off. All 3 MWTs were within normal limits. 5 patients (~16%) had a positive UDS. 1 patient had a low MSL and tested positive for cannabinoids and opioids. The other 4 patients with normal MSL tested positive for benzodiazepines (2), cannabinoids (1) and opioids (1). All patients were cleared for work and 85% of patients who had a low MSL returned to work during follow-up. The rate of positive UDS in patients undergoing MSLT/MWT was comparable to existing publications and re-emphasizes the relevance of mandating UDS prior to MSLT/MWT.

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

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.6348 ◽

2016 ◽

Vol 12 (12) ◽

pp. 1633-1640 ◽

Cited By ~ 4

Author(s):

Angela M. Anniss ◽

Alan Young ◽

Denise M. O'Driscoll

Keyword(s):

Drug Screening ◽

Sleep Latency ◽

Multiple Sleep Latency Test ◽

Maintenance Of Wakefulness Test ◽

Multiple Sleep Latency

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Periodic hypersomnia, congenital ectodermal disorders and multiple exostosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1989000100010 ◽

1989 ◽

Vol 47 (1) ◽

pp. 76-79 ◽

Cited By ~ 2

Author(s):

Rubens Reimão ◽

Aron Diament

Keyword(s):

Acanthosis Nigricans ◽

Sleep Latency ◽

Mental Deficiency ◽

Multiple Sleep Latency Test ◽

Incontinentia Pigmenti ◽

Congenital Disorders ◽

Hereditary Multiple Exostosis ◽

Multiple Sleep Latency

A case of periodic hypersomnia in an 11-year-old female with the unique features of mental deficiency, incontinentia pigmenti, acanthosis nigricans and hereditary multiple exostosis (diaphysial aclasis) is reported. The clinical, Polysomnographic and Multiple Sleep Latency test features of this case with a follow up of seven years are consistent with a diagnosis of periodic (intermittent) excessive somnolence. The unique presentation, however, does differ from Kleine-Levin syndrome and suggests a relationship between the predominantly ectodermal, congenital disorders and the sleep-wake, pattern dysfunction.

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Polysomnography

10.1093/med/9780190228484.003.0036 ◽

2017 ◽

Author(s):

Sudhansu Chokroverty ◽

Roberto Vertugno

Keyword(s):

Neurological Disorders ◽

Clinical Presentation ◽

Sleep Latency ◽

Clinical Aspects ◽

Physiological Changes ◽

Functional Neuroanatomy ◽

Maintenance Of Wakefulness Test ◽

Laboratory Procedures ◽

Clinical Considerations ◽

Multiple Sleep Latency

This chapter covers the technical and clinical aspects of polysomnography (PSG). Section 1 includes a brief review of the historical milestones, functional neuroanatomy of sleep, physiological changes (emphasizing those pertinent to overnight PSG interpretation) and clinical relevance as well as homeostatic and circadian factors, and functions of sleep. Section 2 deals with laboratory procedures, including PSG recording and scoring techniques, indications for PSG, video-PSG, ambulatory and computerized PSG, artifacts during PSG recording, and pitfalls of PSG. Section 3 includes clinical considerations, briefly describing the clinical presentation, diagnosis, and treatment but mainly focusing on PSG findings in common sleep disorders as well as sleep-related movement disorders, neurological disorders, and sleep-related epilepsies. Section 4 addresses related laboratory procedures for the assessment of sleep, including the multiple sleep latency test, the maintenance-of-wakefulness test, and actigraphy.

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The Assessment of ‘Sleepiness’ in Human Drug Trials: A New Perspective

Current Psychopharmacologye ◽

10.2174/2211556007666180503170231 ◽

2019 ◽

Vol 8 (1) ◽

pp. 5-26

Author(s):

Murray Johns

Keyword(s):

Sleep Latency ◽

Sleep Onset ◽

Face Validity ◽

Drug Trials ◽

Efficacy And Safety ◽

Short Term ◽

Maintenance Of Wakefulness Test ◽

New Perspective ◽

The Relationship ◽

Multiple Sleep Latency

The investigation of the efficacy and safety of drugs requires assessments of their effects on alertness/sleepiness. Unfortunately, there is confusion about the nature of ‘sleepiness’, the factors which influence it, and how it can be measured under different circumstances. This review aims to clarify these matters and to offer some suggestions about how current difficulties might be overcome. Different meanings of the word ‘sleepiness’ are examined initially. Methods that purport to measure ‘sleepiness’ are then examined, including their testretest reliability and the relationship between the results of different measurements within the same subjects. Some objective methods are found not to be as reliable as was initially reported. Information about the reliability of several other methods is either inadequate or nonexistent. One assumption which underlies two frequently used objective methods for measuring ‘sleepiness’ (the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test) is that the ‘sleepier’ a person is, the quicker they will fall asleep. While this assumption has face validity, other assumptions about these tests are re-examined and are found wanting, at least sometimes. The difficulty arises in part because it is not always clear when the sleep onset process begins and ends. ‘Sleepiness’ is found to be influenced much more by short-term factors, such as the subject’s posture at the time and during the preceding few minutes, than has been acknowledged previously. Some possible solutions to these difficulties are suggested, including a new conceptual model of sleep-wake control, with implications for the design of drug trials.

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