The Psychomotor Vigilance Test Compared to a Divided Attention Steering Simulation in Patients with Moderate or Severe Obstructive Sleep Apnea

Abstract

Background

Sleepiness at the wheel affects 10% to 15% of drivers and is one major cause of death on highways with one-third of fatal accidents. Obstructive sleep apnea (OSA) is one of the most common sleep disorders leading to sleepiness at the wheel. The aim of this study was to compare the psychomotor vigilance test reaction time (PVT RT) in OSA patients and controls (morning and afternoon) with the results of a divided attention steering simulator (DASS). A second purpose was to compare these results with the mean sleep latencies in the multiple sleep latency test (MSLT), the Epworth Sleepiness Scale (ESS) values and a neurocognitive test (test of attentional performance, TAP).

Patients and Methods

Thirty eight OSA patients and 16 age and sex matched healthy controls were investigated by ESS, PVT, TAP, MSLT, and DASS (response time, failed responses, lane deviation, and off-road-events).

Results

With increasing age, the performance in the DASS decreased. There was no correlation between the DASS and the results of the MSLT and ESS. The controls showed a significantly faster DASS response time in the morning compared to OSA patients (median 2.1 versus 3.0; p=0.044) and fewer off-road events (9 versus 37; p=0.042). We found a moderate correlation between the PVT RT and all parameters of the DASS, as well as the TAP “alertness” subtest.

Conclusion

The increase of PVT RT as well as the decreased tonic alertness in the TAP in untreated OSA patients correlated with an impairment of simulated driving performance. The PVT and the TAP are both suitable diagnostic tools for measuring impaired driving ability in OSA patients. The MSLT did not correlate with the simulated driving performance. We recommend investigation of a longer version of the PVT in order to increase its sensitivity.

Keywords:

• polysomnography
• sustained attention
• tonic alertness
• vigilance
• MSLT
• simulated driving performance

Acknowledgments

The authors thank Dr. Gosia Sullivan for reviewing the paper and acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité – Universitätsmedizin Berlin.

Disclosure

Prof. Dr. Thomas Penzel reports grants from the German-Israeli Foundation (GIF), no: I-1372-303.7/2016 and support from Russian Federation Government, grant No: 075-15-2019-1885; holds shares of The Siestagroup GmbH, Advanced Sleep Research GmbH, and Somnico GmbH; is a consultant to Bayer, Heel, Jazz, and Vidimetrics; and received unrestricted grants from Itamar, Löwenstein Medical, Resmed, and Philips. Dr Christian Veauthier reports grants from German Federal Ministry of Education and Research (BMBF) and personal fees from Bioprojet, outside the submitted work. The authors report no other possible conflicts of interest in this work.