Effects of Alcohol and Sleep Restriction on Simulated Driving Performance in Untreated Patients With Obstructive Sleep Apnea

  1. Andrew Vakulin, BSc (Hons);
  2. Stuart D. Baulk, PhD;
  3. Peter G. Catcheside, PhD;
  4. Nick A. Antic, MBBS, PhD;
  5. Cameron J. van den Heuvel, PhD;
  6. Jillian Dorrian, PhD; and
  7. R. Doug McEvoy, MD
  1. From Repatriation General Hospital, University of Adelaide; Adelaide Institute for Sleep Health; University of South Australia, Center for Sleep Research; and Flinders University, Park, Australia.

    Abstract

    Background: Because of previous sleep disturbance and sleep hypoxia, patients with obstructive sleep apnea (OSA) might be more vulnerable to the effects of alcohol and sleep restriction than healthy persons.

    Objective: To compare the effects of sleep restriction and alcohol on driving simulator performance in patients with OSA and age-matched control participants.

    Design: Driving simulator assessments in 2 groups under 3 different conditions presented in random order.

    Setting: Adelaide Institute for Sleep Health, Sleep Laboratory, Adelaide, Australia.

    Participants: 38 untreated patients with OSA and 20 control participants.

    Measurements: Steering deviation, crashes, and braking reaction time.

    Intervention: Unrestricted sleep, sleep restricted to a maximum of 4 hours, and ingestion of an amount of 40% vodka calculated to achieve a blood alcohol level of 0.05 g/dL.

    Results: Patients with OSA demonstrated increased steering deviation compared with control participants (mean, 50.5 cm [95% CI, 46.1 to 54.9 cm] in the OSA group and 38.4 cm [CI, 32.4 to 44.4 cm] in the control group; P < 0.01) and significantly greater steering deterioration over time (group by time interaction, P = 0.02). The increase in steering deviation after sleep restriction and alcohol was approximately 40% greater in patients with OSA than in control participants (group by condition interaction, P = 0.04). Patients with OSA crashed more frequently than control participants (1 vs. 24 participants; odds ratio [OR], 25.4; P = 0.03) and crashed more frequently after sleep restriction (OR, 4.0; P < 0.01) and alcohol consumption (OR, 2.3; P = 0.02) than after normal sleep. In patients with OSA, prolonged eye closure (>2 seconds) and microsleeps (> 2 seconds of theta activity on electroencephalography) were significant crash predictors (OR, 19.2 and 7.2, respectively; P < 0.01). Braking reaction time was slower after sleep restriction than after normal sleep (mean, 1.39 [SD, 0.06] seconds vs. 1.22 [SD, 0.04] seconds; P < 0.01) but not after alcohol consumption. No group differences were found.

    Limitation: Simulated driving was assessed rather than on-road driving.

    Conclusion: Patients with OSA are more vulnerable than healthy persons to the effects of alcohol consumption and sleep restriction on various driving performance variables.

    Primary Funding Source: Australian National Health and Medical Research Council.

    Article and Author Information

    • Acknowledgment: The authors thank the developers of the AusEd driving simulator and all technical and research staff from the Adelaide Institute for Sleep Health.

    • Grant Support: By the Australian National Health and Medical Research Council (project grant 390400).

    • Potential Conflicts of Interest: None disclosed.

    • Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Catcheside (Peter.Catcheside{at}health.sa.gov.au). Data set: Not available.

    • Requests for Single Reprints: Andrew Vakulin, BSc (Hons), Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA 5041, Australia; e-mail, andrew.vakulin{at}health.sa.gov.au.

    • Current Author Addresses: Mr. Vakulin and Drs. Catcheside, Antic, and McEvoy: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA 5041, Australia.

    • Dr. Baulk: 19/10 Connaught Street, Grange, SA 5022, Australia.

    • Dr. van den Heuvel: Discipline of Paediatrics, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, SA 5006, Australia.

    • Dr. Dorrian: Centre for Sleep Research, University of South Australia, City East Campus, Frome Road, Adelaide, SA 5000, Australia.

    • Author Contributions: Conception and design: S.D. Baulk, N.A. Antic, C.J. van den Heuvel, R.D. McEvoy.

    • Analysis and interpretation of the data: A. Vakulin, S.D. Baulk, P.G. Catcheside, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

    • Drafting of the article: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, J. Dorrian, R.D. McEvoy.

    • Critical revision of the article for important intellectual content: A. Vakulin, P.G. Catcheside, N.A. Antic, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

    • Final approval of the article: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, C.J. van den Heuvel, J. Dorrian, R.D. McEvoy.

    • Provision of study materials or patients: R.D. McEvoy.

    • Statistical expertise: A. Vakulin, P.G. Catcheside, J. Dorrian.

    • Obtaining of funding: S.D. Baulk, N.A. Antic, C.J. van den Heuvel, R.D. McEvoy.

    • Administrative, technical, or logistic support: A. Vakulin, S.D. Baulk, P.G. Catcheside, N.A. Antic, R.D. McEvoy.

    • Collection and assembly of data: A. Vakulin, S.D. Baulk, P.G. Catcheside.

    Summary for Patients

    • Summaries for Patients:The Effects of Limited Sleep and Alcohol on Driving Performance in People With Untreated Sleep Apnea Ann Intern Med October 6, 2009 151:I-32; doi:10.1059/0003-4819-151-7-200910060-00002
    « Previous | Next Article »Table of Contents

    This Article

    1. Ann Intern Med October 6, 2009 vol. 151 no. 7 447-455
    1. » Abstract
    2. Figures
    3. Full Text
    4. Full Text (PDF)
      1. Summary for Patients

    Rapid Responses

    1. Submit a response
    2. No responses published

    Current Issue

    1. November 17, 2009, 151 (10)
    1. Alert me to current issues