Adverse driving behaviors are associated with sleep apnea severity and age in cognitively normal older adults at risk for Alzheimer’s disease

Abstract

Alzheimer disease (AD) pathology accumulates for decades before the onset of cognitive decline. Cognitively normal individuals with biomarker evidence of AD brain pathology (i.e., biomarker+ or preclinical AD) can be differentiated from individuals without AD brain pathology based on naturalistic driving data, such as hard acceleration or braking and speeding, measured using in-vehicle dataloggers. Older adults are at increased risk of injury and death from motor vehicle crashes and driving cessation is also linked to negative health outcomes. Identifying potential modifiable risk factors that increase driving risk may prolong safe driving in old age. Sleep apnea is associated with adverse driving behaviors across the age-span. In this study, we hypothesized that high-risk driving behaviors would be associated with increased sleep apnea severity and AD pathology. We found that higher sleep apnea severity measured by a home sleep apnea test was associated with a higher incidence of adverse driving behaviors even after controlling for multiple confounders (β=0.24±0.09,p<0.01). This association was independent of AD biomarker positivity (i.e., increased t-tau/Aβ42 ratio. Increasing age was associated with a higher likelihood of high-risk driving behaviors in individuals with AD brain pathology (β=0.12±0.04,p<0.01), but a lower likelihood in individuals without AD brain pathology (β=-0.06±0.03,p<0.05). These findings suggest that adverse driving behaviors linked to a higher rate of traffic crashes in older adults are associated with sleep apnea severity and AD pathology even in cognitively unimpaired individuals. Futures studies are needed to determine if treatment of sleep apnea decreases high-risk driving behaviors and therefore motor vehicle crashes.

Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review

“…Very recently, Doherty et al, found that higher sleep apnea severity was associated with a higher incidence of adverse driving behavior, such as hard acceleration, braking and speeding. These findings were also observed in cognitively unimpaired old individuals [31].…”

“…Another recent study was performed in older subjects to assess the effect of sleep apnea on driving behavior. OSA severity, measured by AHI, increased the likelihood of an adverse driving event, with a 1.25 times increase in the odds of an event for each eight-point increase in the AHI [31]. This is the first study that reported a "dose-effect" association between OSA severity and the risk of MVA.…”

Adverse driving behaviors increase over time as a function of preclinical Alzheimer's disease biomarkers

“…These three measures were selected, as previous research has found differences in baseline measures of these behaviors between AD biomarker negative and biomarker positive groups, 18 and age-related differences in the incidence of these behaviors between negative and positive groups. 22 The variable was summarized and coded at a trip level, with "1" if there were any incidences of adverse driving behaviors, and "0" otherwise.…”

“…A better understanding of how preclinical AD affects the incidence of high‐risk, or “adverse,” driving behavior over time may inform clinicians on how early intervention can prolong safe driving in old age and maintain independence in both those who are at risk of developing AD and those wishing to age‐in‐place. A recent study into the effects of preclinical AD on adverse driving behaviors found an unexpected interaction between age and biomarker status 22 . Drivers with older age and preclinical AD biomarkers exhibited increased incidences of adverse driving compared to lower age ranges, whereas the opposite was true for biomarker‐negative individuals for whom age was associated with decreased driving risk.…”

“…A recent study into the effects of preclinical AD on adverse driving behaviors found an unexpected interaction between age and biomarker status. 22 Drivers with older age and preclinical AD biomarkers exhibited increased incidences of adverse driving compared to lower age ranges, whereas the opposite was true for biomarker-negative individuals for whom age was associated with decreased driving risk. In the current study, we expand upon these findings and analyzed adverse driving behaviors (hard braking, hard acceleration, and speeding) longitudinally in a sample of communitydwelling older adults.…”