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


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, http://www.anzctr.org.au/trial_view.aspx?ID=334979

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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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