Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 06/2011; 7(3):246-53. DOI: 10.5664/JCSM.1062
Source: PubMed

ABSTRACT To assess the effectiveness of CPAP treatment in improving 90-minute driving simulator performance in severe OSA patients compared to age/gender matched controls.
Driving simulator performance was assessed at baseline and 3 months later, with OSA patients treated with CPAP during the interval.
University Teaching Hospital.
Patients with severe OSA (n = 11) and control subjects without OSA (n = 9).
CPAP MEASUREMENTS AND RESULTS: Simulator driving parameters of steering deviation, braking reaction time and crashes were measured at baseline and ∼3 months follow-up. At baseline, OSA subjects demonstrated significantly greater steering deviation compared to controls (mean [95% CI], OSA group, 49.9 cm [43.7 to 56.0 cm] vs control group, 34.9 cm [28.1 to 41.7 cm], p = 0.003). Following ∼3 months of CPAP treatment (mean ± SD 6.0 ± 1.4 h/night), steering deviation in OSA subjects improved by an average of 3.1 cm (CI, 1.4 to 4.9), p < 0.001, while no significant steering changes were observed in the control group. Despite the improvement, steering deviation in the OSA group remained significantly higher than in controls (OSA group, 46.7 cm [CI, 40.6 to 52.8 cm] vs control group, 36.1 cm [CI, 29.3 to 42.9 cm], p = 0.025).
While driving simulator performance improved after ∼3 months of CPAP treatment with high adherence in patients with severe OSA, performance remained impaired compared to control subjects. These results add to the growing body of evidence that some neurobehavioral deficits in patients with severe OSA are not fully reversed by treatment. Further studies are needed to assess causes of residual driving simulator impairment and to determine whether this is associated with persistent elevated real-life accident risk.
Data presented in this manuscript was collected as part of a clinical trial "Experimental Investigations of Driving Impairment in Obstructive Sleep Apnoea" ACTRN12610000009011,

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Available from: Andrew Vakulin, Sep 26, 2015
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    • "Vakulin et al. showed that OSA patients had performance impairments in a driving simulator when compared with the control group. The authors also reported that after three months of CPAP treatment, the OSA group had improved their driving performance.[50] "
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    ABSTRACT: Studies have shown that a large proportion of traffic accidents around the world are related to inadequate or disordered sleep. Recent surveys have linked driver fatigue to 16% to 20% of serious highway accidents in the UK, Australia, and Brazil. Fatigue as a result of sleep disorders (especially obstructive sleep apnea), excessive workload and lack of physical and mental rest, have been shown to be major contributing factors in motor vehicle accidents. A number of behavioral, physiological, and psychometric tests are being used increasingly to evaluate the impact of fatigue on driver performance. These include the oculography, polysomnography, actigraphy, the maintenance of wakefulness test, and others. Various strategies have been proposed for preventing or reducing the impact of fatigue on motor vehicle accidents. These have included: Educational programs emphasizing the importance of restorative sleep and the need for drivers to recognize the presence of fatigue symptoms, and to determine when to stop to sleep; The use of exercise to increase alertness and to promote restorative sleep; The use of substances or drugs to promote sleep or alertness (i.e. caffeine, modafinil, melatonin and others), as well as specific sleep disorders treatment; The use of CPAP therapy for reducing excessive sleepiness among drivers who have been diagnosed with obstructive sleep apnea. The evidence cited in this review justifies the call for all efforts to be undertaken that may increase awareness of inadequate sleep as a cause of traffic accidents. It is strongly recommended that, for the purpose of promoting highway safety and saving lives, all disorders that cause excessive sleepiness should be investigated and monitored.
    International journal of preventive medicine 03/2013; 4(3):246-57.
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    • "in CPAP treated OSA patients. However, a growing body of more recent evidence suggests that sleepiness (Santamaria et al., 2007; Weaver et al., 2007) cognitive executive function (Barbe et al., 2001; Ferini-Strambi et al., 2003; Antic et al., 2011) and driving simulator performance (Vakulin et al., 2011) do not return to the level of healthy controls, even when OSA patients are optimally treated with CPAP (Weaver et al., 2007). Event related potentials (ERPs) provide objective markers of cortical information processing (Polich and Kok, 1995; Polich and Herbst, 2000) and are sensitive to the state of arousal, attention and vigilance (Ferrara et al., 2002; Bonnefond et al., 2010), as well as cognitive deficits in many neurological conditions (Polich and Herbst, 2000; Jansen et al., 2010) and sleep deprivation/fragmentation (Lee et al., 2004; Trujillo et al., 2009). "
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    ABSTRACT: To assess the effects of 3 months of optimal CPAP treatment on auditory event related potentials (AERP) in patients with severe obstructive sleep apnoea (OSA) compared with healthy controls. Auditory odd-ball related N1, P2, N2 and P3 AERP components were assessed in 9 severe OSA subjects and 9 healthy controls at baseline evaluation and at ∼3 months follow-up in both groups, with OSA subjects treated with continuous positive air-way pressure (CPAP) during this period. Severe OSA subjects showed significantly delayed, P2, N2 and P3 latencies, and significantly different P2 and P3 amplitudes compared to controls at baseline (group effect, all p<0.05). At follow-up evaluation P3 latency shortened in treated OSA patients but remained prolonged compared to controls (group by treatment interaction, p<0.05) despite high CPAP compliance (6h/night). The earlier AERP (P2 and N2) components did not change in either controls or OSA patients at follow-up and remained different in patients versus controls. This study demonstrates that in severe OSA patients AERP responses show minimal or no improvement and remain abnormal following 3 months of optimal CPAP treatment. Persistent cortical sensory processing abnormalities despite treatment in severe OSA may have implications for daytime neurobehavioral performance and safety in OSA patients. AERP responses may help identify residual performance deficits and risks.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 08/2011; 123(2):310-7. DOI:10.1016/j.clinph.2011.07.004 · 3.10 Impact Factor
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    ABSTRACT: Context:Few prospective intervention studies have examined the effect of continuous positive airway pressure (CPAP) therapy on cardiovascular disease (CVD) risk factors in diabetes.Objective:Our objective was to determine whether CPAP improves CVD risk factors in patients with type 2 diabetes and obstructive sleep apnea (OSA).Design and Setting:This was a randomized parallel group intervention trial in an urban Australian community.Patients:Fifty-nine participants of the Fremantle Diabetes Study Phase II at high risk for OSA consented to confirmatory polysomnography followed by randomization to a 3-month CPAP intervention initiated early (<1 wk) or late (1-2 months).Main Outcome Measures:Patients were assessed before and 1 and 3 months after CPAP started. Tests for repeated measures were used to compare variables of interest over time.Results:Forty-four patients (75%) completed the study. Their mean ±sd age was 66.1 ± 8.8 yr, and 61.4% were male. Completers and noncompleters had similar age, sex, diabetes duration, apnea-hypopnea index, and Epworth Sleepiness Scale (P ≥ 0.29). There were no differences in outcome between early and late randomization, and the data were pooled. The Epworth Sleepiness Scale decreased between entry and 1 month [-4.8 (-6.5 to -3.1), P < 0.001]. Blood pressure improved between entry and 3 months (from 149 ± 23/80 ± 12 to 140 ± 18/73 ± 13 mm Hg; P ≤ 0.007). Pulse rate declined within the first month [-6 (-10 to -2) beats/min, P = 0.002]. Glycemic control and serum lipids, which were mostly within recommended target ranges at entry, did not change.Conclusions:Three months of CPAP in community-based people with type 2 diabetes significantly decreased blood pressure and pulse rate but did not influence metabolic control.
    The Journal of Clinical Endocrinology and Metabolism 09/2012; 97(11). DOI:10.1210/jc.2012-2107 · 6.21 Impact Factor
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