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. 2011 Jun 15;7(3):246-53.
doi: 10.5664/JCSM.1062.

Driving simulator performance remains impaired in patients with severe OSA after CPAP treatment

Andrew Vakulin  1 , Stuart D Baulk, Peter G Catcheside, Nick A Antic, Cameron J van den Heuvel, Jillian Dorrian, R Doug McEvoy
Affiliations

Driving simulator performance remains impaired in patients with severe OSA after CPAP treatment

Andrew Vakulin et al. J Clin Sleep Med. .

Abstract

Study objectives: To assess the effectiveness of CPAP treatment in improving 90-minute driving simulator performance in severe OSA patients compared to age/gender matched controls.

Design: Driving simulator performance was assessed at baseline and 3 months later, with OSA patients treated with CPAP during the interval.

Setting: University Teaching Hospital.

Participants: Patients with severe OSA (n = 11) and control subjects without OSA (n = 9).

Interventions: 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).

Conclusions: 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.

Trial registration: 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

Keywords: CPAP; OSA; driving performance.

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Figures

Figure 1
Figure 1
(A) Mean (SEM) steering deviation throughout the 90 minute simulator drive in OSA and control groups at baseline evaluation and 3 months follow-up. (B) Mean (SEM) steering deviation collapsed across time in OSA and control groups at baseline evaluation and 3 months follow-up. BL, baseline; FU, follow-up. Symbols indicate significant difference, p < 0.05: *OSA different from controls within the same evaluation, #baseline different from follow-up.
See this image and copyright information in PMC

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