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Fidler AL, Zhang N, Simakajornboon N, Epstein JN, Kirk S, Beebe DW. Comparing the Driving Skills of Adolescents with Obstructive Sleep Apnea to Healthy Controls: The Results of a Case-Controlled Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1624. [PMID: 37892287 PMCID: PMC10605283 DOI: 10.3390/children10101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Auto crashes are a leading cause of death and injury among adolescents. Untreated obstructive sleep apnea (OSA) can cause sleepiness and inattention, which could negatively impact novice drivers, but OSA-related studies have focused on older drivers. This study used a driving simulator to examine whether licensed 16-19-year-old adolescents with OSA have diminished driving skills. Twenty-one adolescents with OSA and twenty-eight without OSA (both confirmed using polysomnography) completed two randomly ordered driving trials in a simulator (with induced distractions versus without). A mixed ANOVA examined the between-subjects effect of the OSA group, the within-subjects effect of the distraction condition, and the group-by-condition interaction effect on the ability to maintain lane position and the frequency of extended eye glances away from the roadway. T-tests were also used to examine group differences in reported sleepiness and inattention during daily life. The distraction task increased extended off-road glances and difficulties maintaining lane position (p < 0.001). However, adolescents with OSA did not display worse eye glance or lane position than controls and there were no significant group-by-condition interactions. Although the groups differed on polysomonographic features, there were also no significant differences in reported sleepiness or inattention. The distraction task negatively impacted both groups of adolescent drivers, but those with OSA did not fare differentially worse. Most adolescents in our study had mild OSA (median obstructive apnea-hypopnea index = 4.4), the most common form in the community. It remains possible that youth with more severe OSA would show increased driving impairment.
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Affiliation(s)
- Andrea L. Fidler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Narong Simakajornboon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Sleep Center, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- The Center for Better Health and Nutrition of the Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Dean W. Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Variability of Reaction Time as a Marker of Executive Function Impairments in Fibromyalgia. Behav Neurol 2022; 2022:1821684. [PMID: 35846978 PMCID: PMC9277204 DOI: 10.1155/2022/1821684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
In addition to chronic widespread pain and depression and anxiety symptoms, patients with fibromyalgia frequently experience cognitive problems. This study investigated executive functions in fibromyalgia via a Go/No-Go task. To obtain comprehensive information about performance, traditional and ex-Gaussian parameters of reaction time (RT) variability were used, in addition to speed and accuracy indices. Ex-Gaussian parameters show an excellent fit to empirical RT distributions. Fifty-two female fibromyalgia patients and twenty-eight healthy controls participated. The task included 60 visual stimuli, which participants had to respond to (Go stimuli) or withhold the response to (No-Go stimuli). After 30 trials, the task rule changed, such that previous No-Go stimuli had to be responded to. Performance was indexed by the hit rate, false alarm rate, and mean (M) and intraindividual standard deviation (SD) of RT and the ex-Gaussian parameters mu, sigma, and tau. Mu and sigma indicate the M and SD of the Gaussian distribution; tau reflects the M and SD of the exponential function. Patients exhibited a lower hit rate, higher M RT, and higher tau than controls. Moreover, patients showed greater decrease of the hit rate after the change of task rule. In the entire sample, SD, sigma, and tau were inversely associated with the hit rate and positively associated with the false alarm rate. While the greater decline in hit rate after the change in task rule indicates deficient cognitive flexibility, the lack of any difference in false alarm rate suggests intact response inhibition. Higher M RT reflects reduced cognitive or motor speed. Increased tau in fibromyalgia indicates greater fluctuations in executive control and more frequent temporary lapses of attention. For the first time, this study demonstrated that indices of RT variability, in particular those derived from the ex-Gaussian function, may complement speed and accuracy parameters in the assessment of executive function impairments in fibromyalgia. Optimized assessment may facilitate the personalization of therapies aimed at improving the cognitive function of those with the disorder.
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Faria A, Allen AH, Fox N, Ayas N, Laher I. The public health burden of obstructive sleep apnea. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2021; 14:257-265. [PMID: 35186204 PMCID: PMC8848533 DOI: 10.5935/1984-0063.20200111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/06/2021] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea (OSA) is the most common respiratory disorder of sleep. The vast majority (>80%) of adults with moderate to severe OSA remain undiagnosed. The economic costs associated with OSA are substantial for both the individual and society as a whole; expenses are likely to be underestimated given that the disease remains undiagnosed in such a large percentage of individuals. The economic burden of motor vehicle collisions related to OSA alone is significant; it is estimated that 810,000 collisions and 1400 fatalities from car crashes in the United States were attributable to sleep apnea in 2000. The many health consequences of OSA include daytime sleepiness, reduced quality of life, decreased learning skills, and importantly, neurocognitive impairments that include impaired episodic memory, executive function, attention and visuospatial cognitive functions. Untreated OSA leads to numerous medical problems such as cardiovascular diseases that can potentially increase healthcare utilization. Untreated patients with sleep apnea consume a disproportionate amount of healthcare resources, expenditures that decrease after treatment. The gold-standard management of OSA remains treatment with CPAP (Continuous Positive Airway Pressure), which is effective in eliminating sleep fragmentation and preserving nocturnal oxygenation, thereby improving daytime sleepiness and quality of life. However, its impacts in reversing neurocognitive function are still uncertain. A significant impediment to CPAP effectiveness is low adherence rates (ranges from 50% to 75%). It is commonly accepted that CPAP improves excessive drowsiness; hence meliorates attention, and accumulating data suggest that CPAP improves a variety of other outcomes such as the risk of motor vehicle crashes.
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Affiliation(s)
- Andre Faria
- Universidade Federal de Minas Gerais, Faculdade de Medicina - Pampulha - Belo Horizonte - Brazil
| | - Aj Hirsch Allen
- University of British Columbia, Department of Medicine, Faculty of Medicine - Vancouver - British - Columbia - Canada
| | - Nurit Fox
- University of British Columbia, Department of Medicine, Faculty of Medicine - Vancouver - British - Columbia - Canada
| | - Najib Ayas
- University of British Columbia, Department of Medicine, Faculty of Medicine - Vancouver - British - Columbia - Canada
| | - Ismail Laher
- University of British Columbia, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine - Vancouver - British - 'Columbia - Canada
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Bonsignore MR, Randerath W, Schiza S, Verbraecken J, Elliott MW, Riha R, Barbe F, Bouloukaki I, Castrogiovanni A, Deleanu O, Goncalves M, Leger D, Marrone O, Penzel T, Ryan S, Smyth D, Teran-Santos J, Turino C, McNicholas WT. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J 2020; 57:13993003.01272-2020. [DOI: 10.1183/13993003.01272-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
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Dwarakanath A, Elliott MW. Assessment of Sleepiness in Drivers: Current Methodology and Future Possibilities. Sleep Med Clin 2019; 14:441-451. [PMID: 31640872 DOI: 10.1016/j.jsmc.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many patients with obstructive sleep apnea syndrome (OSAS) drive a vehicle both for pleasure and as part of their employment. Some, but not all, patients with OSAS are at increased risk of being involved in road traffic accidents. Clinicians are often asked to make recommendations about an individual's fitness to drive, and these are likely to be inconsistent in the absence of objective criteria. This article discusses the current practice of the assessment of individuals' sleepiness with respect to driving, the limitations of available techniques, and future possibilities.
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Affiliation(s)
- Akshay Dwarakanath
- Department of Respiratory Medicine, Sleep and Non-invasive Ventilation Service, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, West Yorkshire WF2 9EU, UK
| | - Mark W Elliott
- Department of Respiratory Medicine, Sleep and Non-invasive Ventilation Service, St. James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
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Noda A, Yasuma F, Miyata S, Iwamoto K, Yasuda Y, Ozaki N. Sleep Fragmentation and Risk of Automobile Accidents in Patients with Obstructive Sleep Apnea—Sleep Fragmentation and Automobile Accidents in OSA. Health (London) 2019. [DOI: 10.4236/health.2019.112015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liu SY, Perez MA, Lau N. The impact of sleep disorders on driving safety—findings from the Second Strategic Highway Research Program naturalistic driving study. Sleep 2018; 41:4835112. [DOI: 10.1093/sleep/zsy023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Shu-Yuan Liu
- The Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | | | - Nathan Lau
- The Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA
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Abstract
Obstructive sleep apnea (OSA) is a main cause of excessive daytime sleepiness and increases the risk for driving accidents, which can be normalized by treatment with continuous positive airway pressure ventilation. Since it is estimated that OSA is not diagnosed in about 80% of cases, recognition of patients at risk for driving accidents is a problem from both medical and societal points of view. Strategies to screen and identify subjects at high risk for driving accidents are under study in order to improve safety on the road, especially for commercial drivers, who show a high prevalence of OSA.
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Affiliation(s)
- Maria Bonsignore
- DiBiMIS, University of Palermo, Palermo, Italy.,CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo , Italy
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Perrier J, Leufkens T, Bulla J, Jongen S, Bocca M, Ramaekers J, Vermeeren A. Electroencephalography during on-the-road driving in older untreated insomnia patients and normal sleepers. Biol Psychol 2015; 109:20-8. [DOI: 10.1016/j.biopsycho.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 03/20/2015] [Accepted: 04/02/2015] [Indexed: 11/26/2022]
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Lapointe E, Frenette É. Periodic or Rhythmic Movements During Sleep. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rabelo Guimarães MDL, Hermont AP. Sleep apnea and occupational accidents: Are oral appliances the solution? Indian J Occup Environ Med 2014; 18:39-47. [PMID: 25568596 PMCID: PMC4280775 DOI: 10.4103/0019-5278.146887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dental practitioners have a key role in the quality of life and prevention of occupational accidents of workers with Obstructive Sleep Apnea Syndrome (OSAS). AIM The aim of this study was to review the impact of OSAS, the Continuous Positive Airway Pressure (CPAP) therapy, and the evidence regarding the use of oral appliances (OA) on the health and safety of workers. MATERIALS AND METHODS Searches were conducted in MEDLINE (PubMed), Lilacs and Sci ELO. Articles published from January 1980 to June 2014 were included. RESULTS The research retrieved 2188 articles and 99 met the inclusion criteria. An increase in occupational accidents due to reduced vigilance and attention in snorers and patients with OSAS was observed. Such involvements were related to excessive daytime sleepiness and neurocognitive function impairments. The use of OA are less effective when compared with CPAP, but the results related to excessive sleepiness and cognitive performance showed improvements similar to CPAP. Treatments with OA showed greater patient compliance than the CPAP therapy. CONCLUSION OSAS is a prevalent disorder among workers, leads to increased risk of occupational accidents, and has a significant impact on the economy. The CPAP therapy reduces the risk of occupational accidents. The OA can improve the work performance; but there is no scientific evidence associating its use with occupational accidents reduction. Future research should focus on determining the cost-effectiveness of OA as well as its influence and efficacy in preventing occupational accidents.
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Affiliation(s)
| | - Ana Paula Hermont
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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