Department of Medicine, Sleep Disorders Program, Brigham and Women's Hospital, Boston, MA, USA.
Department of Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA ; Department of Occupational Medicine, The Cambridge Health Alliance, Cambridge, MA, USA.
Nat Sci Sleep. 2014 May 23;6:65-71. doi: 10.2147/NSS.S53721. eCollection 2014.
Obstructive sleep apnea (OSA) is a highly prevalent disorder with considerable morbidity and mortality. Vigilance and attentiveness are often impaired in OSA patients. In occupational medicine settings, subjective reports of sleepiness are notoriously inaccurate, making the identification of objective measures of vigilance potentially important for risk assessments of fitness for duty. In order to evaluate the effects of OSA on attentiveness and vigilance, we conducted a cross-sectional study to examine the association between OSA and psychomotor vigilance task (PVT) performance.
Patients attending sleep clinics for evaluation of possible sleep apnea were recruited. The subjects underwent either a standard overnight laboratory polysomnography or home sleep study. Subjective daytime sleepiness was assessed by Epworth sleepiness scale, and vigilance was tested using a portable device. The participants were asked to respond to the PVT signals using their dominant hand. Each PVT administration lasted 10 minutes, with stimuli signals appearing randomly at variable intervals of 2-10 seconds.
Mean age of the participants was 46±15 years, and mean body mass index was 34.3±9.8 kg/m(2). Participants with higher Epworth scores had worse PVT performance (P<0.05). In multivariate analyses, age, body mass index, and poor sleep efficiency (measured by Pittsburgh sleep quality index score) were associated with worse PVT performance (P<0.05). In contrast, PVT performance did not differ significantly across categories of apnea hypopnea index severity. Subgroup analysis demonstrated that women had worse performance on all PVT measures (P<0.05).
PVT performance can be utilized for risk assessments of sleepiness and may be particularly useful among populations where subjective reports are unreliable.
阻塞性睡眠呼吸暂停（OSA）是一种发病率高、病死率高的疾病。OSA 患者的警觉性和注意力往往受损。在职业医学环境中，睡眠困乏的主观报告准确性较差，因此，识别警觉性的客观测量指标可能对评估是否适合履行职责的风险很重要。为了评估 OSA 对注意力和警觉性的影响，我们进行了一项横断面研究，以检验 OSA 与精神运动警觉任务（PVT）表现之间的关联。
我们招募了因疑似睡眠呼吸暂停而就诊于睡眠诊所的患者。受试者接受了标准的过夜实验室多导睡眠图或家庭睡眠研究。通过 Epworth 嗜睡量表评估日间嗜睡程度，使用便携式设备测试警觉性。参与者被要求用优势手对 PVT 信号做出反应。每次 PVT 测试持续 10 分钟，刺激信号以 2-10 秒的可变间隔随机出现。
参与者的平均年龄为 46±15 岁，平均体重指数为 34.3±9.8kg/m²。Epworth 评分较高的参与者 PVT 表现较差（P<0.05）。多元分析显示，年龄、体重指数和睡眠效率差（通过匹兹堡睡眠质量指数评分测量）与 PVT 表现较差相关（P<0.05）。相反，呼吸暂停低通气指数严重程度的分类中，PVT 表现没有显著差异。亚组分析表明，女性在所有 PVT 指标上的表现均较差（P<0.05）。
PVT 表现可用于评估困倦风险，在主观报告不可靠的人群中可能特别有用。
