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Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea

journal contribution
posted on 06.12.2017, 00:00 by A Vakulin, P Catcheside, Stuart Baulk, N Antic, S Banks, J Dorrian, R McEvoy
Study Objectives: Obstructive sleep apnea (OSA) is associated with driving impairment and road crashes. However, daytime function varies widely between patients presenting a clinical challenge when assessing crash risk. This study aimed to determine the proportion of patients showing “normal” versus “abnormal” driving simulator performance and examine whether anthropometric, clinical, and neurobehavioral measures predict abnormal driving. Methods: Thirty-eight OSA patients performed a 90-minsimulated driving task under 3 conditions: normal sleep, restricted sleep (4 h in bed), and normal sleep + alcohol (BAC~0.05 g/dL). Patients were classified as “resilient” drivers if, under all 3 experimental conditions their mean steering deviation fell within 2 standard deviations of the mean steering deviation of 20 controls driving under baseline normal sleep conditions, or a “vulnerable” driver if mean steering deviation was outside this range in at least one experimental condition. Potentially predictive baseline anthropometric, clinical, neurocognitive, and cortical activation measures were examined. Results: Of the 38 OSA patients examined, 23 (61%) and15 (39%) were classified as resilient and vulnerable drivers, respectively. There were no differences in baseline measures between the groups, although the proportion of females was greater and self-reported weekly driving exposure was less among vulnerable drivers (p < 0.05). On univariate analysis gender, weekly driving hours, and auditory event related potential P2 amplitude were weakly associated with group status. Multivariate analysis showed weekly driving hours (OR 0.69, 95%CI, 0.51-0.94, p = 0.02) and P2 amplitude (OR1.34, 95%CI 1.02-1.76, p = 0.035) independently predicted vulnerable drivers. Conclusions: Most OSA patients demonstrated normal simulated driving performance despite exposure to further sleep loss or alcohol. Most baseline measures did not differentiate between resilient and vulnerable drivers, although prior driving experience and cortical function were predictive. Novel measures to assist identification of OSA patients at risk of driving impairment and possibly accidents are needed.

Funding

Category 1 - Australian Competitive Grants (this includes ARC, NHMRC)

History

Volume

10

Issue

6

Start Page

647

End Page

655

Number of Pages

9

eISSN

1550-9397

ISSN

1550-9389

Location

United States

Publisher

American Academy of Sleep Medicine

Language

en-aus

Peer Reviewed

Yes

Open Access

No

External Author Affiliations

Appleton Institute for Behavioural Sciences; Flinders University; Repatriation General Hospital (Daw Park, S.A.); TBA Research Institute; University of South Australia; University of Sydney;

Era Eligible

Yes

Journal

Journal of clinical sleep medicine.

Exports