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Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea

Andrew Vakulin, BSc (Hons); Stuart D. Baulk, PhD; Peter G. Catcheside, PhD; Nick A. Antic, MBBS, PhD; Cameron J. van den Heuvel, PhD; Jillian Dorrian, PhD; and R. Doug McEvoy, MD
[+] Article and Author Information

From Repatriation General Hospital, University of Adelaide; Adelaide Institute for Sleep Health; University of South Australia, Center for Sleep Research; and Flinders University, Park, Australia.


Acknowledgment: The authors thank the developers of the AusEd driving simulator and all technical and research staff from the Adelaide Institute for Sleep Health.

Grant Support: By the Australian National Health and Medical Research Council (project grant 390400).

Potential Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Catcheside (Peter.Catcheside@health.sa.gov.au). Data set: Not available.

Requests for Single Reprints: Andrew Vakulin, BSc (Hons), Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA 5041, Australia; e-mail, andrew.vakulin@health.sa.gov.au.

Current Author Addresses: Mr. Vakulin and Drs. Catcheside, Antic, and McEvoy: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA 5041, Australia.

Dr. Baulk: 19/10 Connaught Street, Grange, SA 5022, Australia.

Dr. van den Heuvel: Discipline of Paediatrics, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, SA 5006, Australia.

Dr. Dorrian: Centre for Sleep Research, University of South Australia, City East Campus, Frome Road, Adelaide, SA 5000, Australia.

Author Contributions: Conception and design: S.D. Baulk, N.A. Antic, C.J. van den Heuvel, R.D. McEvoy.

Analysis and interpretation of the data: A. Vakulin, S.D. Baulk, P.G. Catcheside, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

Drafting of the article: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, J. Dorrian, R.D. McEvoy.

Critical revision of the article for important intellectual content: A. Vakulin, P.G. Catcheside, N.A. Antic, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

Final approval of the article: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

Provision of study materials or patients: R.D. McEvoy.

Statistical expertise: A. Vakulin, P.G. Catcheside, J. Dorrian.

Obtaining of funding: S.D. Baulk, N.A. Antic, C.J. van den Heuvel, R.D. McEvoy.

Administrative, technical, or logistic support: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, R.D. McEvoy.

Collection and assembly of data: A. Vakulin, S.D. Baulk, P.G. Catcheside.


Ann Intern Med. 2009;151(7):447-455. doi:10.7326/0003-4819-151-7-200910060-00005
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Background: Because of previous sleep disturbance and sleep hypoxia, patients with obstructive sleep apnea (OSA) might be more vulnerable to the effects of alcohol and sleep restriction than healthy persons.

Objective: To compare the effects of sleep restriction and alcohol on driving simulator performance in patients with OSA and age-matched control participants.

Design: Driving simulator assessments in 2 groups under 3 different conditions presented in random order.

Setting: Adelaide Institute for Sleep Health, Sleep Laboratory, Adelaide, Australia.

Participants: 38 untreated patients with OSA and 20 control participants.

Measurements: Steering deviation, crashes, and braking reaction time.

Intervention: Unrestricted sleep, sleep restricted to a maximum of 4 hours, and ingestion of an amount of 40% vodka calculated to achieve a blood alcohol level of 0.05 g/dL.

Results: Patients with OSA demonstrated increased steering deviation compared with control participants (mean, 50.5 cm [95% CI, 46.1 to 54.9 cm] in the OSA group and 38.4 cm [CI, 32.4 to 44.4 cm] in the control group; P < 0.01) and significantly greater steering deterioration over time (group by time interaction, P = 0.02). The increase in steering deviation after sleep restriction and alcohol was approximately 40% greater in patients with OSA than in control participants (group by condition interaction, P = 0.04). Patients with OSA crashed more frequently than control participants (1 vs. 24 participants; odds ratio [OR], 25.4; P = 0.03) and crashed more frequently after sleep restriction (OR, 4.0; P < 0.01) and alcohol consumption (OR, 2.3; P = 0.02) than after normal sleep. In patients with OSA, prolonged eye closure (>2 seconds) and microsleeps (> 2 seconds of theta activity on electroencephalography) were significant crash predictors (OR, 19.2 and 7.2, respectively; P < 0.01). Braking reaction time was slower after sleep restriction than after normal sleep (mean, 1.39 [SD, 0.06] seconds vs. 1.22 [SD, 0.04] seconds; P < 0.01) but not after alcohol consumption. No group differences were found.

Limitation: Simulated driving was assessed rather than on-road driving.

Conclusion: Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables.

Primary Funding Source: Australian National Health and Medical Research Council.

Figures

Grahic Jump Location
Figure.
Mean steering deviation at 4.9-minute intervals throughout 90-minute simulator driving in patients with OSA (n = 38) and control participants (n = 20).

Error bars represent SEs. ALC = low-dose alcohol; NS = normal sleep; OSA = obstructive sleep apnea; SR = sleep restriction. Top. NS versus SR conditions. Bottom. Normal sleep versus ALC conditions.

Grahic Jump Location

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Summary for Patients

The Effects of Limited Sleep and Alcohol on Driving Performance in People With Untreated Sleep Apnea

The summary below is from the full report titled “Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea.” It is in the 6 October 2009 issue of Annals of Internal Medicine (volume 151, pages 447-455). The authors are A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, C.J. van den Heuvel, J. Dorrian, and R.D. McEvoy.

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