经 CPAP 治疗后，严重阻塞性睡眠呼吸暂停（OSA）患者的驾驶模拟器性能仍受损。
Driving simulator performance remains impaired in patients with severe OSA after CPAP treatment.
机构信息
Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia.
出版信息
J Clin Sleep Med. 2011 Jun 15;7(3):246-53. doi: 10.5664/JCSM.1062.
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
CPAP MEASUREMENTS AND RESULTS: Simulator driving parameters of steering deviation, braking reaction time and crashes were measured at baseline and ∼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 ∼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 ∼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
研究目的
评估 CPAP 治疗对严重阻塞性睡眠呼吸暂停（OSA）患者 90 分钟驾驶模拟器性能的影响，并与年龄/性别匹配的对照组进行比较。
设计
在基线和 3 个月后评估驾驶模拟器性能，OSA 患者在间隔期间接受 CPAP 治疗。
地点
大学教学医院。
参与者
患有严重 OSA 的患者（n=11）和无 OSA 的对照组受试者（n=9）。
干预措施
CPAP 测量。
结果
在基线和大约 3 个月的随访时，测量了转向偏差、制动反应时间和碰撞的模拟器驾驶参数。在基线时，OSA 患者的转向偏差明显大于对照组（平均[95%CI]，OSA 组 49.9cm[43.7 至 56.0cm]vs 对照组 34.9cm[28.1 至 41.7cm]，p=0.003）。在接受大约 3 个月的 CPAP 治疗（平均±SD 6.0±1.4 小时/夜）后，OSA 患者的转向偏差平均改善了 3.1cm（CI，1.4 至 4.9），p<0.001，而对照组则没有观察到显著的转向变化。尽管有所改善，但 OSA 组的转向偏差仍明显高于对照组（OSA 组 46.7cm[CI，40.6 至 52.8cm]vs 对照组 36.1cm[CI，29.3 至 42.9cm]，p=0.025）。
结论
尽管严重 OSA 患者在高依从性的情况下接受大约 3 个月的 CPAP 治疗后驾驶模拟器性能有所改善，但与对照组相比，性能仍存在障碍。这些结果增加了越来越多的证据，即严重 OSA 患者的一些神经行为缺陷不能通过治疗完全逆转。需要进一步研究以评估残留驾驶模拟器障碍的原因，并确定这是否与持续升高的现实生活事故风险有关。
试验注册
本文中介绍的数据是作为临床试验“阻塞性睡眠呼吸暂停的驾驶障碍实验研究”（ACTRN12610000009011）的一部分收集的，网址为：http://www.anzctr.org.au/trial_view.aspx?ID=334979
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