Sleep-Wake-Epilepsy-Centre, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
Sleep-Wake-Epilepsy-Centre, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Primary Care and Public Health, Imperial College London, United Kingdom.
Sleep Med Rev. 2018 Apr;38:86-100. doi: 10.1016/j.smrv.2017.04.004. Epub 2017 May 4.
Road traffic injuries are projected to be the leading cause of death for those aged between 15 and 29 years by the year 2030, and sleepiness is estimated to be the underlying cause in up to 15-20% of all motor vehicle accidents. Sleepiness at the wheel is most often caused by socially induced sleep deprivation or poor sleep hygiene in otherwise healthy individuals, medical disorders, or the intake of drugs. Validated methods for objectifying sleepiness are urgently sought, particularly in the context of driving. Based on the assumption that the identification and treatment of sleepiness, and its causes, may prevent motor vehicle accidents, driving simulators are a seemingly promising diagnostic tool. Despite the rising use of these in research, the reliability of their conclusions in healthy sleepy individuals and patients is still unclear. This systematic review aims to evaluate the practical value of driving simulators in a clinical environment when judging fitness to drive in sleepy individuals. From the 1674 records screened, 12 studies in sleepy individuals containing both simulated and real driving data were included. In general, simulated driving did not reliably predict real-life motor vehicle accidents, and especially not on an individual level, despite the moderate relationship between simulated and real-road test driving performance. The severity of sleepiness is most likely not the critical factor leading to motor vehicle accidents, but rather the perception of sleepiness. The self-perception of sleepiness related impairment, and risky behaviour while at the wheel should also be considered as key influencing factors.
道路交通伤害预计将成为 2030 年 15 至 29 岁人群的主要死因，而据估计，在所有机动车事故中，高达 15-20%的事故是由于困倦导致的。在通常情况下，车轮上的困倦主要是由社会诱导的睡眠剥夺或睡眠卫生不良引起的，而在其他健康个体中，医学疾病或药物摄入也可能导致困倦。目前急需寻求客观评估困倦的方法，尤其是在驾驶方面。基于识别和治疗困倦及其原因可能预防机动车事故的假设，驾驶模拟器似乎是一种很有前途的诊断工具。尽管这些工具在研究中的使用越来越多，但在健康困倦个体和患者中，其结论的可靠性仍不清楚。本系统评价旨在评估驾驶模拟器在临床环境中评估困倦个体驾驶能力时的实际价值。在筛选出的 1674 条记录中，有 12 项研究纳入了困倦个体的模拟和真实驾驶数据。一般来说，尽管模拟和实际道路测试驾驶性能之间存在中度相关性，但模拟驾驶并不能可靠地预测现实生活中的机动车事故，尤其是不能在个体层面上进行预测。导致机动车事故的关键因素很可能不是困倦的严重程度，而是对困倦的感知。与困倦相关的自我感知损伤以及在车轮上的危险行为也应被视为关键影响因素。
