Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment
Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment
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DOI：
10.5664/jcsm.1062
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发表时间：
2011-01-01
影响因子：
4.3
通讯作者：
McEvoy, R. Doug
中科院分区：
文献类型：
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作者：
Vakulin, Andrew;Baulk, Stuart D.;McEvoy, R. Doug
研究目的：与年龄/性别匹配的对照组比较，评估CPAP治疗对改善重度OSA患者90分钟驾驶模拟器性能的有效性。设计：在基线和3个月后对OSA患者进行驾驶模拟器性能评估，间歇期接受CPAP治疗。地点：大学教学医院。参与者：重度OSA患者(n=11)和对照组(n=9)。干预：CPAP测量和结果：在基线和类似3个月的随访中测量模拟器驾驶参数，包括转向偏差、制动反应时间和撞车。在基线时，阻塞性睡眠呼吸暂停综合征患者的转向偏差显著大于对照组(平均[95%CI]，阻塞性睡眠呼吸暂停综合征组49.9 cm[43.7至56.0cmvs对照组34.9cm[28.1至41.7cm]，p=0.003)。在持续持续正压治疗3个月后(平均+/-SD6.0+/-1.4h/夜)，阻塞性睡眠呼吸暂停患者的转向偏差平均改善了3.1cm1.4~4.9p<；0.001，而对照组没有观察到明显的转向变化。尽管有改善，但阻塞性睡眠呼吸暂停患者的转向偏差仍显著高于对照组(阻塞性睡眠呼吸暂停组，46.7 cm[CI，40.6~52.8 cm]vs.对照组，36.1 cm[CI，29.3~42.9 cm]，p=0.025)。结论：虽然重度阻塞性睡眠呼吸暂停患者在接受持续正压治疗3个月后，驾驶模拟器的表现有所改善，但与对照组相比，驾驶模拟器的表现仍然不佳。这些结果增加了越来越多的证据表明，严重阻塞性睡眠呼吸暂停综合征患者的一些神经行为缺陷不能通过治疗完全逆转。需要进一步的研究来评估剩余驾驶模拟器损伤的原因，并确定这是否与持续升高的真实生活中的事故风险有关。试验登记：本手稿中提供的数据是作为临床试验的一部分收集的，《阻塞性睡眠呼吸暂停中驾驶损害的实验研究》，ACTRN12610000009011，http://www.anzctr.org.au/trial_view.aspx?ID=334979
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: CPAPMeasurements and Results: Simulator driving parameters of steering deviation, braking reaction time and crashes were measured at baseline and similar to 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 similar to 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 similar to 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