Karimi M, Hedner J, Zou D, Eskandari D, Lundquist A-C, Grote L
Centre for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, Gothenburg 405 30, Sweden.
Centre for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, Gothenburg 405 30, Sweden.
Sleep Med. 2015 Apr;16(4):528-33. doi: 10.1016/j.sleep.2014.11.015. Epub 2015 Feb 4.
Obstructive sleep apnea (OSA) is associated with an increased motor vehicle accident (MVA) risk. Conventional measures of OSA severity do not predict individual risk. Cognitive function tests have failed to incorporate outcomes in risk prediction. We aimed to identify markers of cognitive function for MVA risk prediction in OSA.
OSA patients [n = 114, 75% male, median age 51 (43-61) years, body mass index (BMI) 30 (27-33) kg/m2, apnea-hypopnea index 25 (6-49) n/h, and Epworth Sleepiness (ESS) score 11 (8-16)] were recruited from a sleep laboratory. Two cognitive function tests, the Attention Network Test (ANT) and a modified Oxford Sleep Resistance Test (OSLER) test (GOSLING), were assessed.
OSA patients with (n = 11) or without (n = 103) a MVA record in the Swedish traffic accident registry were identified. In patients with a MVA, 64% were commercial drivers. In patients with a MVA history, more lapses [42 (5-121) vs. 5 (1-25), P = 0.02] and fewer responses [238 (158-272) vs. 271 (256-277), P = 0.03] to stimuli in the ANT were found. In the GOSLING, the number of lapses was higher (29 (10-97) vs. 7 (2-19), P = 0.01) and the reaction time was longer [462 (393-551) vs. 407 (361-449) ms, P = 0.05]. OSA severity and ESS score poorly predicted MVAs (P > 0.2).
We have demonstrated that deficit in sustained attention, assessed by daytime neurocognitive function tests, was associated with MVA risk in OSA patients. We were unable to detect an association between MVA history and severity of OSA or the ESS score. The findings provide a rationale for further development of objective MVA risk assessment tools in OSA.
阻塞性睡眠呼吸暂停（OSA）与机动车事故（MVA）风险增加相关。传统的OSA严重程度测量方法无法预测个体风险。认知功能测试未能将结果纳入风险预测。我们旨在识别OSA中用于MVA风险预测的认知功能标志物。
从睡眠实验室招募OSA患者[n = 114，75%为男性，年龄中位数51（43 - 61）岁，体重指数（BMI）30（27 - 33）kg/m²，呼吸暂停低通气指数25（6 - 49）次/小时，Epworth嗜睡量表（ESS）评分11（8 - 16）]。评估了两项认知功能测试，注意力网络测试（ANT）和改良牛津睡眠抵抗测试（OSLER）测试（GOSLING）。
在瑞典交通事故登记处识别出有（n = 11）或无（n = 103）MVA记录的OSA患者。在有MVA的患者中，64%为职业司机。在有MVA病史的患者中，发现ANT中对刺激的失误更多[42（5 - 121）对5（1 - 25），P = 0.02]，反应更少[238（158 - 272）对271（256 - 277），P = = 0.03]。在GOSLING测试中，失误次数更高（29（10 - 97）对7（2 - 19），P = 0.01），反应时间更长[462（393 - 551）对407（361 - 449）毫秒，P = 0.05]。OSA严重程度和ESS评分对MVA的预测效果较差（P > 0.2）。
我们已经证明通过白天神经认知功能测试评估的持续注意力缺陷与OSA患者中的MVA风险相关。我们未能检测到MVA病史与OSA严重程度或ESS评分之间的关联。这些发现为进一步开发OSA中客观的MVA风险评估工具提供了理论依据。
