Tippin Jon, Sparks JonDavid, Rizzo Matthew
Department of Neurology, University of Iowa, Iowa City, IA 52242, USA.
J Psychosom Res. 2009 Aug;67(2):143-51. doi: 10.1016/j.jpsychores.2009.03.015. Epub 2009 May 19.
To determine the effects of obstructive sleep apnea (OSA) on visual vigilance during simulated automobile driving.
Twenty-five drivers with OSA and 41 comparison drivers participated in an hour-long drive in a high-fidelity driving simulator. Drivers responded to light targets flashed at seven locations across the forward horizon. Dependent measures were percent correct [hit rate (HR)] and reaction time (RT). Self-assessment of sleepiness used the Stanford Sleepiness Scale (SSS) before and after the drive and the Epworth Sleepiness Scale (ESS).
OSA drivers showed reduced vigilance based on lower HR than comparison drivers, especially for peripheral targets (80.7+/-14.8% vs. 86.7+/-8.8%, P=.03). OSA drivers were sleepier at the end of the drive than comparison drivers (SSS=4.2+/-1.2 vs. 3.6+/-1.2, P=.03), and increased sleepiness correlated with decreased HR only in those with OSA (r=-0.49, P=.01). Lower HR and higher post-drive SSS predicted greater numbers of driving errors in all subjects. Yet, ESS, predrive SSS, and most objective measures of disease severity failed to predict driving and vigilance performance in OSA.
Reduced vigilance for peripheral visual targets indicates that OSA drivers have restriction of their effective field of view, which may partly explain their increased crash risk. This fatigue-related decline in attention is predicted by increased subjective sleepiness during driving. These findings may suggest a means of identifying and counseling high-risk drivers and aid in the development of in-vehicle alerting and warning devices.
确定阻塞性睡眠呼吸暂停（OSA）对模拟汽车驾驶过程中视觉警觉性的影响。
25名患有OSA的驾驶员和41名对照驾驶员参与了在高保真驾驶模拟器中长达一小时的驾驶。驾驶员对在前视范围内七个位置闪烁的灯光目标做出反应。相关测量指标为正确百分比[命中率（HR）]和反应时间（RT）。驾驶前后使用斯坦福嗜睡量表（SSS）和爱泼华嗜睡量表（ESS）进行嗜睡程度的自我评估。
与对照驾驶员相比，OSA驾驶员基于较低的HR显示出警觉性降低，尤其是对于周边目标（80.7±14.8%对86.7±8.8%，P = 0.03）。与对照驾驶员相比，OSA驾驶员在驾驶结束时更困倦（SSS = 4.2±1.2对3.6±1.2，P = 0.03），并且仅在OSA患者中，嗜睡程度增加与HR降低相关（r = -0.49，P = 0.01）。较低的HR和较高的驾驶后SSS预测所有受试者中更多的驾驶错误。然而，ESS、驾驶前SSS以及大多数疾病严重程度的客观测量指标均未能预测OSA患者的驾驶和警觉性能。
对周边视觉目标的警觉性降低表明OSA驾驶员的有效视野受限，这可能部分解释了他们增加的碰撞风险。驾驶过程中主观嗜睡程度增加预示着这种与疲劳相关的注意力下降。这些发现可能提示一种识别和咨询高危驾驶员的方法，并有助于开发车载警报和警告装置。
