The influence of antidepressants and actigraphy-derived sleep characteristics on pediatric multiple sleep latency testing.

STUDY

OBJECTIVES

Research evaluating the influence of rapid eye movement suppressing antidepressants (REMS-AD) on multiple sleep latency test (MSLT) results and the value of performing actigraphy prior to this test in children and adolescents is lacking. We examined the impact of REMS-AD and actigraphy parameters on mean sleep latency (MSL) and sleep-onset REM episodes (SOREMs) on MSLT in a pediatric clinical sample.

METHODS

This was a retrospective chart review at a quarternary referral center. We identified 164 MSLTs conducted in patients aged less than 18 years between 2014 and 2017. Correlations between REMS-AD, self-reported sleep duration, actigraphy parameters, and each of the outcomes (MSL and SOREMs) were examined. Regression analyses accounting for clinical characteristics were performed.

RESULTS

Mean age of the sample was 11.9 ± 4.19 years, 62% were female, 28 (17%) were on REMS-AD (48% of whom were able to discontinue these medications prior to MSLT), and mean pediatric daytime sleepiness score was 21.7 ± 6.1. MSL was 11.27 ± 5.77 min and mean number of SOREMs 0.55 ± 1.04. Patients on a REMS-AD at initial assessment had fewer SOREMs compared to those not taking these medications (0.17 ± 0.19 vs 0.62 ± 0.09; P = .04); no difference was noted in MSL (10.36 ± 1.10 vs 11.47 ± 0.50; P = .36). Increased time in bed on actigraphy correlated with a longer MSL and fewer SOREMs (r = .23; P = .04 and r = .316; P = .004, respectively). Following regression analyses, use of REMS-AD continued to remain associated with fewer SOREMs; greater time in bed on actigraphy, but not self-reported sleep duration, was associated with a longer MSL (all P < .05).

CONCLUSIONS

Clinicians should account for the use of REMS-AD and utilize actigraphy to determine time in bed while interpreting the results of a pediatric MSLT.

CITATION: Mansukhani MP, Dhankikar S, Kotagal S, Kolla BP. The influence of antidepressants and actigraphy-derived sleep characteristics on pediatric multiple sleep latency testing. J Clin Sleep Med. 2021;17(11):2179-2185.