Abschätzung des Unfallrisikos bei obstruktivem Schlafapnoe-Syndrom (OSAS) durch Fahrsimulation

Abstract

Abstract. Patients with obstructive sleep apnea syndrome (OSAS) have an accident rate between two and seven times higher than normals. Investigations on accident frequency are based on case history, insurancy reports, and driving simulator investigations. The present controlled study was planned to test whether an increased accident risk could be demonstrated in patients with OSAS before and on CPAP (continuous positive airway pressure)-therapy using the driving simulator C.A.R. Driving simulator performance was investigated in 31 patients with polysomnographically confirmed OSAS (apnea-hypopnea-index 24.8 +/- 21.5/h) before, 2 and 42 days after initiation of CPAP and was compared to 10 healthy controls in whom OSAS was excluded by polysomnography. Driving simulator performance was significantly worse in OSAS as compared to normals especially in terms of accident frequency (OSAS: 2.7 +/- 2.0, controls: 1.3 +/- 1.5, p < 0.05) and concentration faults (OSAS: 12.4 +/- 5.1, controls: 7.1 +/- 3.2, p < 0.01). On CPAP accident frequency (OSAS before therapy: 12.4 +/- 5.1, 2 days CPAP: 1.5 +/- 1.4, p < 0.01; 42 days CPAP: 0.9 +/- 1.3, p < 0.001) and frequency of concentration faults (OSAS before therapy: 12.4 +/- 5.1, 2 days CPAP: 6.5 +/- 3.9, p < 0.001; 42 days CPAP: 4.9 +/- 3.3, p < 0.001) could be lowered significantly both in the short and medium term of therapy. The driving simulator C.A.R. is an adequate tool for the evaluation of an increased accident risk in OSAS-patients and demonstrates the efficiency of CPAP-therapy.

Driving after cerebral ischemia – a driving simulator investigation

“…1) was used in cooperation with the German traffic board (Deutscher Verkehrsrat) in order to examine its clinical relevance. In other studies, patients with multiple sclerosis, sleep apnea and narcolepsy were investigated [9][10][11]. The number of errors depends especially on age and disease-specific handicaps, control groups are tested in every single study.…”

“…According to the above-mentioned problems of choosing the adequate off-road test, patients were investigated with a driving simulator, which has been used for driving evaluation in other diseases in our hospital [9][10][11].…”

Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator

“…® was used in cooperation with the German traffic board (Deutscher Verkehrsrat) in order to examine its clinical relevance. In other studies, patients with narcolepsy, sleep apnea and cerebrovascular disease were investigated [14]. The maximal number of errors that can be tolerated (normative data) still has to be evaluated.…”

Fahrsimulatoruntersuchung bei Patienten mit obstruktivem Schlafapnoe-Syndrom: Konsequenzen für die Beurteilung der Fahrtüchtigkeit?

“…® nach 6-wöchiger Therapie nachweisen(18,19). Der Untersuchungszeitpunkt 6 Wochen nach Therapieeinleitung wurde entsprechend den Empfehlungen der DGSM gewählt.Vor dem Hintergrund, dass eine Arbeitsunfähigkeit über 6 Wochen nach eingeleiteter CPAP-Therapie für zahlreiche Berufskraftfahrer Arbeitslosigkeit bedeutet, und viele daher die gegebenen Empfehlungen ignorieren, wurde die vorliegende Studie mit der Frage durchgeführt, ob sich anhand der Fahrsimulatoruntersuchung Hinweise für eine Besserung der Fahrleistung bereits nach 14 Tagen finden.Hinsichtlich der polysomnographischen Messdaten zeigte sich unter CPAP eine statistisch auffällige Besserung der respiratorischen Parameter sowie des Schlafprofils mit einer Absenkung des Arousal-Index sowie einer Zunahme des Tiefschlafanteils.…”