Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

Vakulin, Andrew; Baulk, Stuart D.; Catcheside, Peter; Antic, Nick A.; Heuvel, Corinna van den; Dorrian, Jillian; McEvoy, R. Doug

doi:10.5664/jcsm.1062

Cited by 35 publications

(15 citation statements)

References 59 publications

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“…This indicates that lure performance was in part related to depressed oxygenation. Interestingly, number connection A/B also improved only in non-cirrhotic OSA patients, which is consistent with prior studies in non-cirrhotic OSA patients that showed only focused cognitive improvement in selected domains with an enhancement of driving simulator performance 22-24 . Interestingly, both cirrhosis+OSA and OSA only groups improved lane deviations after CPAP showing that vigilance is related to hypoxemia in OSA independent of cirrhosis.…”

Section: Discussionsupporting

confidence: 90%

Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With Cirrhosis

Bajaj

Thacker

Leszczyszyn

et al. 2015

Clinical Gastroenterology and Hepatology

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Background & Aims: In patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. Methods: We performed a cross-sectional, prospective study of 118 subjects. Subjects were assigned to 1 of 4 groups: those with OSA and cirrhosis (without HE or ascites, n=34), those with only cirrhosis (n=30), those with only OSA only (n=29), and those without OSA or cirrhosis (controls, n=25). None of OSA patients were receiving continuous positive airway pressure (CPAP) therapy. Subjects underwent cognitive testing (paper–pencil tests for psychomotor speed and attention, as well as executive function tests), sleep assessment (daytime sleepiness and night-time sleep quality) and a monotonous driving simulation (worsening lane deviations over time indicate poor performance). We also tested patients with OSA, with cirrhosis (n=10) and without cirrhosis (n=7), before and after CPAP therapy. Results: Daytime sleepiness and sleep quality were worse in subjects in the OSA groups (with or without cirrhosis) than subjects with cirrhosis alone or controls. Of subjects with only OSA, 36% had impaired psychomotor speed and attention, compared to >60% of subjects in both cirrhosis groups. In contrast, executive function was uniformly worse in subjects with OSA, with or without cirrhosis, than groups without OSA. Simulator performance (lane deviations) worsened over time in both OSA groups. CPAP therapy significantly increased executive function and sleep quality, and reduced simulator lane deviations and sleepiness, in subjects with and without cirrhosis. After CPAP therapy, performance on the paper–pencil test performance improved significantly only in subjects with OSA without cirrhosis. Conclusion: OSA should be considered in evaluating sleep impairment in patients with cirrhosis. In patients with cirrhosis and OSA, psychomotor speed and attention issues are likely related to the cirrhosis, whereas executive function and simulator performance are affected by the OSA. CPAP therapy improves executive function and simulator performance in patients with OSA, regardless of cirrhosis.

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Section: Discussionsupporting

confidence: 90%

Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With Cirrhosis

Bajaj

Thacker

Leszczyszyn

et al. 2015

Clinical Gastroenterology and Hepatology

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“…Although much of the literature indicates a positive result of CPAP therapy for individuals diagnosed with OSA, some literature suggests that residual consequences of OSA may persist even with CPAP treatment. Using driving simulator data, Vakulin et al found that even after individuals with severe OSA followed their CPAP prescription closely for three months, their driving performance was still worse than the healthy control group 67 ) . The authors suggested that neurobehavioral deficits may cause some long-term driving impairment in individuals with severe OSA despite a high adherence to CPAP treatment.…”

Section: Management Of Osa Risk In the Transportation Industrymentioning

confidence: 99%

Obstructive Sleep Apnea in North American Commercial Drivers

Kales

Straubel

2014

Ind Health

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The most common medical cause of excessive daytime sleepiness (EDS) is obstructive sleep apnea (OSA). Specifically, among an estimated 14 million US commercial drivers, 17–28% or 2.4 to 3.9 million are expected to have OSA. Based on existing epidemiologic evidence, most of these drivers are undiagnosed and not adequately treated. Untreated OSA increases the risk of vehicular crashes as documented in multiple independent studies and by meta-analysis. Therefore, identifying commercial drivers with OSA and having them effectively treated should decrease crash-related fatalities and injuries. Several strategies are available for screening and identifying drivers with OSA. The simplest and most effective objective strategies use body mass index (BMI) cutoffs for obesity. Functional screens are promising adjuncts to other objective tests. The most effective approach will likely be a combination of a good questionnaire; BMI measures; and a careful physician-obtained history complemented by a functional screen.

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“…Baseline clinical and functional variables identified a priori as potential confounders or predictors of MVC risk were age, sex, falls in the previous year, assistance with daily activities, MVC in the past 2 years, prior stroke or transient ischemic attack (TIA), myocardial infarction, diabetes mellitus, treatment for retinopathy, cataracts, limb amputation, systolic blood pressure (SBP), postural hypotension, medications (including oral hypoglycemic and antihypertensive agents), sleep apnea, depression, physical activity, alcohol use, and stress. 3,[22][23][24][25][26][27] Postural hypotension was defined as a greater than 20 mmHg decrease in SBP or a greater than 10 mmHg decrease in diastolic blood pressure between the supine and sitting positions. Physical activity was selfreported and categorized as sedentary (reference), less than once per week, one or two times per week, three to six times per week, and daily.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

The Mini‐Mental State Examination, Clinical Factors, and Motor Vehicle Crash Risk

Joseph

O’Donnell

Teo

et al. 2014

J American Geriatrics Society

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Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

Cited by 35 publications

References 59 publications

Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With Cirrhosis

Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients With Cirrhosis

Obstructive Sleep Apnea in North American Commercial Drivers

The Mini‐Mental State Examination, Clinical Factors, and Motor Vehicle Crash Risk

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