Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France; CNRS, SANPSY, USR 3413, Bordeaux, France; CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France.
CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France.
Sleep Med. 2019 Mar;55:1-5. doi: 10.1016/j.sleep.2018.02.009. Epub 2018 Mar 8.
To assess the relationship between real and simulated driving performance and the objective level of alertness as measured by the Maintenance of Wakefulness Test (MWT) in patients suffering from narcolepsy or idiopathic hypersomnia.
Twenty-seven patients (10 patients with narcolepsy, type 1 (n = 7) and type 2 (n = 3), and 17 patients with idiopathic hypersomnia, mean age = 33.8 ± 11.1 years, range = 18-65 y; four males) were recruited in a randomized, crossover, double-blind placebo-controlled trial, and compared to 27 matched healthy controls. Patients were randomly assigned to receive modafinil (400 mg) or placebo before the driving test (2 h of real and 2 h of simulated highway driving for each patient). Standard deviation of lateral position (SDLP) of the vehicle in real and simulated driving and mean sleep latency in a 4 × 40 min MWT were assessed.
Untreated patients presented shorter sleep latencies on the MWT (20.8 (IQ range 16.1-32.9) vs. 34.9 min (IQ range 28.1-40.0)) and worse simulated driving performance (P < 0.001) than treated patients. Nevertheless, treated patients still exhibited shorter mean sleep latencies on the MWT than controls (34.9 (IQ range 28.1-40.0) vs. 40 min (IQ range 37.1-40.0), P < 0.05), but driving performance was identical in both groups. The SDLP of the vehicle in real driving conditions and the MWT score correlated with the SDLP in simulated driving (respectively, r = 0.34, P < 0.05 and r = -0.56, P < 0.001).
In patients with narcolepsy/idiopathic hypersomnia, simulated driving and MWT explore different dimensions of fitness-to-drive and could be used complementarily to better evaluate sleep-related driving impairment.
评估真实驾驶表现和模拟驾驶表现与警觉性的客观水平之间的关系，警觉性的客观水平通过维持觉醒测试（MWT）进行测量，研究对象为患有发作性睡病或特发性嗜睡症的患者。
27 名患者（10 名发作性睡病患者，1 型（n=7）和 2 型（n=3）；17 名特发性嗜睡症患者，平均年龄 33.8±11.1 岁，范围 18-65 岁；4 名男性）参与了一项随机、交叉、双盲安慰剂对照试验，与 27 名匹配的健康对照者进行了比较。患者被随机分配在驾驶测试前接受莫达非尼（400mg）或安慰剂治疗（每位患者进行 2 小时真实驾驶和 2 小时模拟高速公路驾驶）。评估真实和模拟驾驶中车辆的横向位置标准差（SDLP）和 4×40 分钟 MWT 的平均睡眠潜伏期。
未经治疗的患者在 MWT 上的睡眠潜伏期更短（20.8（IQ 范围 16.1-32.9）vs.34.9 分钟（IQ 范围 28.1-40.0）），模拟驾驶表现更差（P<0.001），而治疗患者的 MWT 平均睡眠潜伏期仍短于对照组（34.9（IQ 范围 28.1-40.0）vs.40 分钟（IQ 范围 37.1-40.0），P<0.05），但两组的驾驶表现相同。真实驾驶条件下车辆的 SDLP 和 MWT 评分与模拟驾驶中的 SDLP 相关（分别为 r=0.34，P<0.05 和 r=-0.56，P<0.001）。
在发作性睡病/特发性嗜睡症患者中，模拟驾驶和 MWT 探索了不同的驾驶适应性维度，可互补使用以更好地评估与睡眠相关的驾驶障碍。
