Driving Skills of Adolescents with Obstructive Sleep Apnea (OSA)

项目摘要 尽管做出了重大的公共卫生努力，但车祸仍然是16-19岁人群的主要死亡原因。 是造成非致命伤害的主要原因。有一个明确的，不断需要确定 未解决的，可逆的条件，增加风险的青少年司机。我们建议， 睡眠呼吸暂停（OSA）是一种未被充分认识的、可治疗的疾病， 导致困倦和注意力不集中。暗示性的证据来自于（a）成年人的撞车风险研究 （B）OSA青少年的神经行为功能，以及（c）OSA青少年的神经行为和驾驶技能。 睡眠不足的青少年如果我们的假设是正确的，记录和解决 青少年OSA对驾驶技能的影响可以改善OSA护理并防止数千起与车祸有关的伤害 和死亡人数。然而，证据仍然是间接的， 从经验丰富的中年成年司机到经验不足的青少年司机的研究结果， 对他们来说，驾驶行为对警惕性和分散注意力的要求要高得多。我们的长期 计划是进行一项详细的道路研究，这可能明确地谈到驾驶相关的风险， 青少年OSA的可逆性。在投入时间和资源之前，我们首先必须明确 显示驾驶技能的缺陷，在一个严格诊断的青少年与非OSA的样本， 控制设置，允许敏感的测量效果和道德的驾驶介绍 挑战拟议的小规模研究将完成这些关键的第一步，同时还提供 关于可能的作用机制的关键指导。30名16-19岁的司机未经治疗的OSA和30名 无阻塞性睡眠呼吸暂停综合症的控制将进行驾驶模拟的性质是敏感的阻塞性睡眠呼吸暂停综合症在成人和睡眠 限制青少年。我们的第一个目标是测试青少年OSA是否会增加驾驶风险。相比 对照组，我们预计，青少年与OSA将有更多的困难，保持他们的车道， 模拟器，以及更长的眼睛从道路上扫视时，从事短信 谈话我们的第二个目标是测试注意力不集中和白天嗜睡是否是 诱发OSA相关的驾驶风险。这项新的研究将是第一个测试的存在和机制 青少年阻塞性睡眠呼吸暂停综合征的潜在驾驶技能缺陷。它利用了独特的设备， 辛辛那提儿童和我们的研究团队，其中包括专家在青少年的独特专长 睡眠病理学，神经行为评估，青少年注意力，驾驶模拟，统计分析， 并推广到现实世界的驾驶环境。虽然可以治疗，但青少年OSA很少被发现， 更别说治疗了如果我们的假设是正确的，这项研究将为改善健康提供新的机会。 和安全的年轻司机与目前未被发现的OSA，以及数百万人与他们 共享道路。

Project Summary Despite major public health efforts, auto crashes remain by far the leading cause of death among 16-19 year-olds and are a major cause of non-fatal injuries. There is a clear, ongoing need to identify unaddressed, reversible conditions that increase risk for adolescent drivers. We propose that obstructive sleep apnea (OSA) is an under-recognized, treatable condition that worsens driving skills in adolescents by inducing sleepiness and inattention. Suggestive evidence converges from studies of (a) crash risk in adults with OSA, (b) neurobehavioral functioning in youth with OSA, and (c) neurobehavioral and driving skills in sleep-deprived adolescents. If our hypotheses are correct, documenting and addressing the effect of adolescent OSA on driving skills could improve OSA care and prevent thousands of crash-related injuries and deaths every year. However, evidence remains circumstantial and it is questionable to generalize findings from research on highly-experienced middle-aged adult drivers to inexperienced adolescent drivers, for whom the act of driving places much greater demands on vigilance and divided attention. Our long-term plan is to conduct a detailed on-road study which could definitively speak to the driving-related risk and reversibility of adolescent OSA. Before making that investment of time and resources, we first must clearly show driving skill deficits in a sample of rigorously-diagnosed adolescents with and without OSA in a controlled setting that allows for sensitive measurement of effects and ethical presentation of driving challenges. The proposed small-scale study will accomplish those critical first steps, while also providing key guidance on likely mechanisms of effect. Thirty 16-19-year-old drivers with untreated OSA and thirty OSA-free controls will undergo driving simulation of a nature that is sensitive to OSA in adults and to sleep restriction in teens. Our first aim is to test whether adolescent OSA increases driving risk. Compared to controls, we expect that that adolescents with OSA will have more difficulty maintaining their lanes in the simulator, as well as more protracted eye glances from the roadway when engaged in a text messaging conversation. Our second aim is to test whether inattention and daytime sleepiness are key mechanism in inducing OSA-linked driving risk. This novel study will be the first to test the presence and mechanisms underlying driving skill deficits in youth with OSA. It capitalizes on the unique equipment available at Cincinnati Children's and the unique expertise of our research team, which includes experts in adolescent sleep pathology, neurobehavioral assessment, adolescent attention, driving simulation, statistical analyses, and generalization to real-world driving settings. While quite treatable, adolescent OSA is rarely detected, let alone treated. If our hypotheses are correct, this study will open new opportunities to improve the health and safety of young drivers with currently undetected OSA, as well as the millions more with whom they share the road.