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. 2004 Jan;59(1):56–59.

Time course of changes in driving simulator performance with and without treatment in patients with sleep apnoea hypopnoea syndrome

P Turkington 1, M Sircar 1, D Saralaya 1, M Elliott 1
PMCID: PMC1758840  PMID: 14694250

Abstract

Methods: Eighteen patients with severe SAHS performed a driving simulator test at baseline (before treatment) and at days 1, 3, and 7 of a 2 week CPAP trial period. CPAP was then discontinued and the patients performed three further driving simulator tests after 1, 3, and 7 days. Eighteen patients with severe SAHS acted as controls and performed the driving simulator test on seven occasions in a pattern similar to that of the treated patients.

Results: Significant improvements in tracking error (p = 0.004), reaction time (p = 0.036), and the number of off road events per hour (p = 0.032) were seen in the CPAP treated group compared with the controls at 7 days. Following discontinuation of CPAP for 7 days a significant difference in driving simulator performance persisted between the two groups, but the size of the difference had reduced.

Conclusion: Driving simulator performance in patients with severe SAHS improves within the first few days of starting CPAP and these improvements appear to be sustained for up to 1 week after withdrawal. Further data about the usefulness of driving simulators in predicting safe driving are needed before these results can be used in advising patients on driving. However, the data appear to suggest that driving can be safely resumed after a few days of effective CPAP treatment.

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Selected References

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  1. Barbé, Pericás J., Muñoz A., Findley L., Antó J. M., Agustí A. G. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med. 1998 Jul;158(1):18–22. doi: 10.1164/ajrccm.158.1.9709135. [DOI] [PubMed] [Google Scholar]
  2. Bradley P. A., Mortimore I. L., Douglas N. J. Comparison of polysomnography with ResCare Autoset in the diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax. 1995 Nov;50(11):1201–1203. doi: 10.1136/thx.50.11.1201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cassel W., Ploch T., Becker C., Dugnus D., Peter J. H., von Wichert P. Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. Eur Respir J. 1996 Dec;9(12):2606–2611. doi: 10.1183/09031936.96.09122606. [DOI] [PubMed] [Google Scholar]
  4. Douglas N. J., Thomas S., Jan M. A. Clinical value of polysomnography. Lancet. 1992 Feb 8;339(8789):347–350. doi: 10.1016/0140-6736(92)91660-z. [DOI] [PubMed] [Google Scholar]
  5. Findley L. J., Fabrizio M. J., Knight H., Norcross B. B., LaForte A. J., Suratt P. M. Driving simulator performance in patients with sleep apnea. Am Rev Respir Dis. 1989 Aug;140(2):529–530. doi: 10.1164/ajrccm/140.2.529. [DOI] [PubMed] [Google Scholar]
  6. Findley L. J., Suratt P. M., Dinges D. F. Time-on-task decrements in "steer clear" performance of patients with sleep apnea and narcolepsy. Sleep. 1999 Sep 15;22(6):804–809. doi: 10.1093/sleep/22.6.804. [DOI] [PubMed] [Google Scholar]
  7. Findley L. J., Unverzagt M. E., Suratt P. M. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis. 1988 Aug;138(2):337–340. doi: 10.1164/ajrccm/138.2.337. [DOI] [PubMed] [Google Scholar]
  8. Findley L., Smith C., Hooper J., Dineen M., Suratt P. M. Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):857–859. doi: 10.1164/ajrccm.161.3.9812154. [DOI] [PubMed] [Google Scholar]
  9. Findley L., Unverzagt M., Guchu R., Fabrizio M., Buckner J., Suratt P. Vigilance and automobile accidents in patients with sleep apnea or narcolepsy. Chest. 1995 Sep;108(3):619–624. doi: 10.1378/chest.108.3.619. [DOI] [PubMed] [Google Scholar]
  10. George C. F., Boudreau A. C., Smiley A. Comparison of simulated driving performance in narcolepsy and sleep apnea patients. Sleep. 1996 Nov;19(9):711–717. doi: 10.1093/sleep/19.9.711. [DOI] [PubMed] [Google Scholar]
  11. George C. F., Boudreau A. C., Smiley A. Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea. Thorax. 1997 Jul;52(7):648–653. doi: 10.1136/thx.52.7.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. George C. F., Boudreau A. C., Smiley A. Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1996 Jul;154(1):175–181. doi: 10.1164/ajrccm.154.1.8680676. [DOI] [PubMed] [Google Scholar]
  13. George C. F. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001 Jul;56(7):508–512. doi: 10.1136/thorax.56.7.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. George C. F., Smiley A. Sleep apnea & automobile crashes. Sleep. 1999 Sep 15;22(6):790–795. [PubMed] [Google Scholar]
  15. Hack M., Davies R. J., Mullins R., Choi S. J., Ramdassingh-Dow S., Jenkinson C., Stradling J. R. 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 Mar;55(3):224–231. doi: 10.1136/thorax.55.3.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Haraldsson P. O., Carenfelt C., Lysdahl M., Tingvall C. Does uvulopalatopharyngoplasty inhibit automobile accidents? Laryngoscope. 1995 Jun;105(6):657–661. doi: 10.1288/00005537-199506000-00019. [DOI] [PubMed] [Google Scholar]
  17. Haraldsson P. O., Carenfelt C., Lysdahl M., Törnros J. Long-term effect of uvulopalatopharyngoplasty on driving performance. Arch Otolaryngol Head Neck Surg. 1995 Jan;121(1):90–94. doi: 10.1001/archotol.1995.01890010070012. [DOI] [PubMed] [Google Scholar]
  18. Horstmann S., Hess C. W., Bassetti C., Gugger M., Mathis J. Sleepiness-related accidents in sleep apnea patients. Sleep. 2000 May 1;23(3):383–389. [PubMed] [Google Scholar]
  19. Johns M. W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Dec;14(6):540–545. doi: 10.1093/sleep/14.6.540. [DOI] [PubMed] [Google Scholar]
  20. Juniper M., Hack M. A., George C. F., Davies R. J., Stradling J. R. Steering simulation performance in patients with obstructive sleep apnoea and matched control subjects. Eur Respir J. 2000 Mar;15(3):590–595. doi: 10.1034/j.1399-3003.2000.15.27.x. [DOI] [PubMed] [Google Scholar]
  21. Kribbs N. B., Pack A. I., Kline L. R., Getsy J. E., Schuett J. S., Henry J. N., Maislin G., Dinges D. F. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 May;147(5):1162–1168. doi: 10.1164/ajrccm/147.5.1162. [DOI] [PubMed] [Google Scholar]
  22. Krieger J., Meslier N., Lebrun T., Levy P., Phillip-Joet F., Sailly J. C., Racineux J. L. Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study. The Working Group ANTADIR, Paris and CRESGE, Lille, France. Association Nationale de Traitement à Domicile des Insuffisants Respiratoires. Chest. 1997 Dec;112(6):1561–1566. doi: 10.1378/chest.112.6.1561. [DOI] [PubMed] [Google Scholar]
  23. Lamphere J., Roehrs T., Wittig R., Zorick F., Conway W. A., Roth T. Recovery of alertness after CPAP in apnea. Chest. 1989 Dec;96(6):1364–1367. doi: 10.1378/chest.96.6.1364. [DOI] [PubMed] [Google Scholar]
  24. Lloberes P., Montserrat J. M., Ascaso A., Parra O., Granados A., Alonso P., Vilaseca I., Rodriguez-Roisin R. Comparison of partially attended night time respiratory recordings and full polysomnography in patients with suspected sleep apnoea/hypopnoea syndrome. Thorax. 1996 Oct;51(10):1043–1047. doi: 10.1136/thx.51.10.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Noda A., Yagi T., Yokota M., Kayukawa Y., Ohta T., Okada T. Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci. 1998 Apr;52(2):221–222. doi: 10.1111/j.1440-1819.1998.tb01041.x. [DOI] [PubMed] [Google Scholar]
  26. Ohayon M. M., Guilleminault C., Priest R. G., Caulet M. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ. 1997 Mar 22;314(7084):860–863. doi: 10.1136/bmj.314.7084.860. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Risser M. R., Ware J. C., Freeman F. G. Driving simulation with EEG monitoring in normal and obstructive sleep apnea patients. Sleep. 2000 May 1;23(3):393–398. [PubMed] [Google Scholar]
  28. Ross S. D., Sheinhait I. A., Harrison K. J., Kvasz M., Connelly J. E., Shea S. A., Allen I. E. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep. 2000 Jun 15;23(4):519–532. [PubMed] [Google Scholar]
  29. Terán-Santos J., Jiménez-Gómez A., Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999 Mar 18;340(11):847–851. doi: 10.1056/NEJM199903183401104. [DOI] [PubMed] [Google Scholar]
  30. Turkington P. M., Sircar M., Allgar V., Elliott M. W. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax. 2001 Oct;56(10):800–805. doi: 10.1136/thorax.56.10.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Young T., Blustein J., Finn L., Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997 Aug;20(8):608–613. doi: 10.1093/sleep/20.8.608. [DOI] [PubMed] [Google Scholar]

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