Visual Vigilance in Drivers with Obstructive Sleep Apnea

OBJECTIVE: To determine the effects of obstructive sleep apnea (OSA) on visual vigilance during simulated automobile driving.

METHODS: Twenty-five drivers with OSA and 41 comparison drivers participated in an hour-long drive in a high-fidelity driving simulator. Drivers responded to light targets flashed at seven locations across the forward horizon. Dependent measures were percent correct [hit rate (HR)] and reaction time (RT). Self-assessment of sleepiness used the Stanford Sleepiness Scale (SSS) before and after the drive and the Epworth Sleepiness Scale (ESS).

RESULTS: OSA drivers showed reduced vigilance based on lower HR than comparison drivers, especially for peripheral targets (80.7+/-14.8% vs. 86.7+/-8.8%, P=.03). OSA drivers were sleepier at the end of the drive than comparison drivers (SSS=4.2+/-1.2 vs. 3.6+/-1.2, P=.03), and increased sleepiness correlated with decreased HR only in those with OSA (r=-0.49, P=.01). Lower HR and higher post-drive SSS predicted greater numbers of driving errors in all subjects. Yet, ESS, predrive SSS, and most objective measures of disease severity failed to predict driving and vigilance performance in OSA.

CONCLUSIONS: Reduced vigilance for peripheral visual targets indicates that OSA drivers have restriction of their effective field of view, which may partly explain their increased crash risk. This fatigue-related decline in attention is predicted by increased subjective sleepiness during driving. These findings may suggest a means of identifying and counseling high-risk drivers and aid in the development of in-vehicle alerting and warning devices.