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Abstract
Patients with obstructive sleep apnoea (OSA) are reported to have an increased risk of road traffic accidents. This study examines the nature of the impairment during simulated steering in patients with OSA, compared to normal subjects following either sleep deprivation or alcohol ingestion.
Twenty-six patients with OSA and 12 normal subjects, either deprived of one night's sleep or following alcohol ingestion [mean (SD) alcohol blood level 71.6 mg dl−1(19·6)], performed a simulated steering task for a total of 90 min. Performance was measured using the tendency to wander (SD), deterioration across the task, number of ‘off-road’ events and the reaction time to peripheral events. Control data for OSA, sleep deprivation and alcohol were obtained following treatment with nasal continuous positive airway pressure (nCPAP), after a normal night of sleep, and following no alcohol, respectively.
Patients with untreated OSA, and sleep-deprived or alcohol-intoxicated normal subjects performed significantly less well, compared to their respective controls (P<0·01 for all tests), with untreated OSA lying between that of alcohol intoxication and sleep deprivation. Alcohol impaired steering error equally throughout the whole drive, whilst sleep deprivation caused progressive deterioration through the drive, but not initially. Untreated OSA was more like sleep deprivation than alcohol, although there was a wide spread of data.
This suggests that the driving impairment in patients with OSA is more compatible with sleep deprivation or fragmentation as the cause, rather than abnormal cognitive or motor skills.
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References
References
- The association between sleep apnoea and the risk of traffic accidents.N Engl J Med. 1999; 340: 847-851
- Sleep apnoea patients have more automobile accidents.Lancet. 1987; 2: 447
- Automobile accidents in patients with obstructive sleep apnea.Am Rev Respir Dis. 1988; 138: 337-340
- Automobile accidents in patients with sleep disorders.Sleep. 1989; 12: 487-494
- Clinical symptoms of sleep apnea syndrome and automobile accidents.J Otorhinolaryngol Rel Spec. 1990; 52: 57-62
- Self-reported automobile accidents involving patients with obstructive sleep apnea.Neurology. 1996; 46: 1254-1257
- Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP.Eur Respir J. 1996; 9: 2606-2611
- Sleep apnea and automobile crashes.Sleep. 1999; 22: 790-795
- Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial.Lancet. 1999; 353: 2100-2105
- Deficits of cognitive executive functions in patients with sleep apnea syndrome.Sleep. 1995; 18: 43-52
- Frontal lobe-related cognitive functions in patients with sleep apnea syndrome before and after treatment.Acta Neurol Belg. 1997; 97: 96-107
- Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome.Thorax. 1993; 48: 911-914
- Tolerance to severe hypoxia: lessons from Mt.Acta Anaesthesiol Scand. 1990; 94: 18-23
- Simulated driving performance in patients with obstructive sleep apnea.Am J Respir Crit Care Med. 1996; 154: 175-181
- Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea.Thorax. 1997; 52: 648-653
- Driving simulator performance in patients with sleep apnea.Am Rev Respir Dis. 1989; 140: 529-530
- Steering simulation performance in patients with obstructive sleep apnoea (OSA) and matched control subjects.Eur Resp J. 2000; 15: 590-595
- Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea.Thorax. 2000; 55: 224-231
- Which parts of the road guide steering?.Nature. 1995; 377: 339-340
- Interactive effects of sleep deprivation, time of day, and driving experience on a driving task.Sleep. 1998; 21: 38-44
- A comparative model: reaction time performance in sleep-disordered breathing versus alcohol-impaired controls.Laryngoscope. 1999; 109: 1648-1654
- Changes in pulse transit time and pulse rate as markers of arousal from sleep in normal subjects.Clin Sci. 1994; 87: 269-273
- Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnoea.Eur Respir J. 1995; 8: 1669-1674
- Autonomic markers of arousal during sleep in patients undergoing investigation for obstructive sleep apnoea, their relationship to EEG arousals, respiratory events and subjective sleepiness.J Sleep Res. 1998; 7: 53-60
- Value of beat-to-beat blood pressure changes, detected by pulse transit time, in the management of the obstructive sleep apnoea/hypopnoea syndrome.Eur Resp J. 1998; 12: 685-692
- Sleep fragmentation indices as predictors of daytime sleepiness and nCPAP response in OSA.Am J Respir Crit Care Med. 1998; 158: 778-786
- Differentiating obstructive and central sleep respiratory events through pulse transit time.Am J Respir Crit Care Med. 1998; 158: 1778-1783
- Martindale Extra Pharmacopeia. Royal Pharmaceutical Society of Great Britain, London1996 (p. 1114)
- Automatic nasal continuous positive airway pressure titration in the laboratory, patient outcomes.Thorax. 1997; 52: 72-75
- Time-on-task decrements in ‘steer clear’ performance of patients with sleep apnea and narcolepsy.Sleep. 1999; 22: 804-809
- Is more NCPAP better?.Sleep. 2000; 23: S150-S153
- Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.Sleep. 1997; 20: 608-613
- Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study.Chest. 1997; 112: 1561-1566
- Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea.Am J Respir Crit Care Med. 2000; 161: 857-859
Article info
Publication history
Accepted:
March 27,
2001
Received:
January 25,
2001
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© 2001 Harcourt Publishers Ltd. Published by Elsevier Inc.
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