DRIVING PERFORMANCE AND DRIVER STATE IN OBSTRUCTIVE SLEEP APNEA: WHAT CHANGES WITH POSITIVE AIRWAY PRESSURE?

Area of Science:

• Sleep Medicine
• Traffic Safety
• Neurology

Background:

• Obstructive sleep apnea (OSA) is linked to increased motor vehicle accident risk.
• Impaired driving performance and reduced alertness are common in OSA patients.
• Positive airway pressure (PAP) therapy is a standard treatment for OSA.

Purpose of the Study:

• To evaluate the impact of obstructive sleep apnea (OSA) on naturalistic driving performance and driver state.
• To assess the effectiveness of positive airway pressure (PAP) therapy in mitigating driving impairments in OSA patients.
• To determine the relationship between PAP usage, driver alertness, and driving performance.

Main Methods:

• Naturalistic driving study comparing 65 OSA drivers (pre- and post-PAP therapy) with 43 comparison drivers.
• Collected driving performance data (speed, acceleration) and driver state measures (sleepiness, attention) via video analysis.
• Analyzed the correlation between average nightly PAP use and improvements in alertness and sleepiness.

Main Results:

• OSA drivers exhibited reduced speed variability and lateral acceleration at speeds <45 mph, persisting after PAP therapy.
• No significant driving performance differences were observed between OSA and control groups at speeds >45 mph.
• OSA drivers consistently showed lower alertness levels than controls, irrespective of PAP treatment.
• Higher average nightly PAP use was associated with improved alertness and reduced sleepiness in OSA drivers.

Conclusions:

• The increased crash risk in OSA drivers may stem from sustained attention deficits leading to performance lapses, rather than overt vehicle control deficits.
• PAP therapy can improve alertness and reduce sleepiness in OSA drivers, but may not fully restore driving performance at lower speeds.
• Maintaining consistent PAP use is crucial for enhancing driver safety in individuals with OSA.