Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea

No Thumbnail Available
Vakulin, Andrew
Catcheside, Peter G
Baulk, Stuart D
Antic, Nicholas Alexander
Banks, Siobhan
Dorrian, Jill
McEvoy, Ronald Douglas
Journal Title
Journal ISSN
Volume Title
American Academy of Sleep Medicine
Copyright © 2015 Associated Professional Sleep Societies, LLC. Published by American Academy of Sleep Medicine.
Rights Holder
Associated Professional Sleep Societies, LLC.
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with driving impairment and road crashes. However, daytime function varies widely between patients presenting a clinical challenge when assessing crash risk. This study aimed to determine the proportion of patients showing "normal" versus "abnormal" driving simulator performance and examine whether anthropometric, clinical, and neurobehavioral measures predict abnormal driving. METHODS: Thirty-eight OSA patients performed a 90-min simulated driving task under 3 conditions: normal sleep, restricted sleep (4 h in bed), and normal sleep + alcohol (BAC∼0.05 g/dL). Patients were classified as "resilient" drivers if, under all 3 experimental conditions their mean steering deviation fell within 2 standard deviations of the mean steering deviation of 20 controls driving under baseline normal sleep conditions, or a "vulnerable" driver if mean steering deviation was outside this range in at least one experimental condition. Potentially predictive baseline anthropometric, clinical, neurocognitive, and cortical activation measures were examined. RESULTS: Of the 38 OSA patients examined, 23 (61%) and 15 (39%) were classified as resilient and vulnerable drivers, respectively. There were no differences in baseline measures between the groups, although the proportion of females was greater and self-reported weekly driving exposure was less among vulnerable drivers (p < 0.05). On univariate analysis gender, weekly driving hours, and auditory event related potential P2 amplitude were weakly associated with group status. Multivariate analysis showed weekly driving hours (OR 0.69, 95%CI, 0.51-0.94, p = 0.02) and P2 amplitude (OR 1.34, 95%CI 1.02-1.76, p = 0.035) independently predicted vulnerable drivers. CONCLUSIONS: Most OSA patients demonstrated normal simulated driving performance despite exposure to further sleep loss or alcohol. Most baseline measures did not differentiate between resilient and vulnerable drivers, although prior driving experience and cortical function were predictive. Novel measures to assist identification of OSA patients at risk of driving impairment and possibly accidents are needed. TRIAL REGISTRATION: Data presented in this manuscript was collected as part of a clinical trial "Experimental Investigations of Driving Impairment in Obstructive Sleep Apnea." Trial ID: ACTRN12610000009011, URL:
Full text freely available online at PubMed Central <>
Sleep apnea, Sleep study, Driving impairment
Vakulin, A., Catcheside, P., Baulk, S., Antic, N.A., Banks, S., Dorrian, J., et al. (2014). Individual Variability and Predictors of Driving Simulator Impairment in Patients with Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 10(6) pp. 647-655.