Findley L, Unverzagt M, Guchu R, Fabrizio M, Buckner J, Suratt P
Department of Internal Medicine, University of Virginia, Charlottesville, USA.
Chest. 1995 Sep;108(3):619-24. doi: 10.1378/chest.108.3.619.
Patients with obstructive sleep apnea or narcolepsy report difficulty remaining alert and attentive. To detect impaired vigilance, we designed Steer Clear, a computer program simulating a long and monotonous highway drive that presents 780 obstacles in 30 min. Sixty-two patients with sleep apnea hit a higher percentage of obstacles (4.3 +/- 0.6% [SEM]) than 12 age- and sex-matched subjects without sleep apnea (1.4 +/- 0.3%; p < 0.05) and 10 age- and sex-matched volunteers (1.2 +/- 0.3%; p < 0.05). Ten patients with untreated narcolepsy hit a higher percentage of obstacles while performing on Steer Clear (7.7 +/- 3.2%) than 10 age- and sex-matched subjects without narcolepsy (1.2 +/- 0.3%; p < 0.05). Poor performance on Steer Clear was associated with a higher auto accident rate in the patients with sleep apnea or narcolepsy (p < 0.01). Twenty-one patients who performed normally on Steer Clear had 1 accident in 5 years (0.05 accident/driver/5 yr), and in none of these accidents were they at fault as drivers. Twenty-five patients who performed poorly on Steer Clear had 5 auto accidents in 5 years (0.20 accident/driver/5 yr), and in 20% of these accidents they were at fault as drivers. Twenty-one patients who performed very poorly on Steer Clear had 8 auto accidents in 5 years (0.38 accident/driver/5 yr), and in 38% of these accidents they were at fault as drivers. These 21 patients who performed very poorly on Steer Clear (hitting > 4.5% of obstacles) had a significantly higher auto accident rate than the patients who performed normally (hitting < 1.8%). We conclude: (1) Patients with sleep apnea or narcolepsy performed more poorly on a test of vigilance, Steer Clear, than did control subjects; (2) Impaired vigilance as measured by Steer Clear is associated with a high automobile accident rate in patients with either sleep apnea or narcolepsy.
患有阻塞性睡眠呼吸暂停或发作性睡病的患者报告称难以保持警觉和专注。为了检测警觉性受损情况，我们设计了“保持清醒”程序，这是一个模拟漫长而单调的高速公路驾驶的计算机程序，在30分钟内会出现780个障碍物。62名睡眠呼吸暂停患者撞上障碍物的比例（4.3±0.6%[标准误]）高于12名年龄和性别匹配的无睡眠呼吸暂停受试者（1.4±0.3%；p<0.05）以及10名年龄和性别匹配的志愿者（1.2±0.3%；p<0.05）。10名未经治疗的发作性睡病患者在执行“保持清醒”程序时撞上障碍物的比例（7.7±3.2%）高于10名年龄和性别匹配的无发作性睡病受试者（1.2±0.3%；p<0.05）。在“保持清醒”程序中表现不佳与睡眠呼吸暂停或发作性睡病患者较高的汽车事故率相关（p<0.01）。在“保持清醒”程序中表现正常的21名患者在5年内发生了1起事故（0.05起事故/驾驶员/5年），并且在这些事故中他们无一作为驾驶员有过错。在“保持清醒”程序中表现不佳的25名患者在5年内发生了5起汽车事故（0.20起事故/驾驶员/5年），并且在这些事故中有20%他们作为驾驶员有过错。在“保持清醒”程序中表现非常差的21名患者在5年内发生了8起汽车事故（0.38起事故/驾驶员/5年），并且在这些事故中有38%他们作为驾驶员有过错。这21名在“保持清醒”程序中表现非常差（撞上超过4.5%的障碍物）的患者的汽车事故率显著高于表现正常（撞上低于1.8%的障碍物）的患者。我们得出结论：（1）睡眠呼吸暂停或发作性睡病患者在警觉性测试“保持清醒”中的表现比对照组受试者更差；（2）通过“保持清醒”程序测量的警觉性受损与睡眠呼吸暂停或发作性睡病患者的高汽车事故率相关。
