title: Specific sleepiness symptoms are indicators of performance impairment during sleep deprivation.
abstract: Drivers are not always aware that they are becoming impaired as a result of sleepiness. Using specific symptoms of sleepiness might assist with recognition of drowsiness related impairment and help drivers judge whether they are safe to drive a vehicle, however this has not been evaluated. In this study, 20 healthy volunteer professional drivers completed two randomized sessions in the laboratory - one under 24h of acute sleep deprivation, and one with alcohol. The Psychomotor Vigilance Task (PVT) and a 30min simulated driving task (AusEdTM) were performed every 3-4h in the sleep deprivation session, and at a BAC of 0.00% and 0.05% in the alcohol session, while electroencephalography (EEG) and eye movements were recorded. After each test session, drivers completed the Karolinska Sleepiness Scale (KSS) and the Sleepiness Symptoms Questionnaire (SSQ), which includes eight specific sleepiness and driving performance symptoms. A second baseline session was completed on a separate day by the professional drivers and in an additional 20 non-professional drivers for test-retest reliability. There was moderate test-retest agreement on the SSQ (r=0.59). Significant correlations were identified between individual sleepiness symptoms and the KSS score (r values 0.50-0.74, p<0.01 for all symptoms). The frequency of all SSQ items increased during sleep deprivation (χ(2) values of 28.4-80.2, p<0.01 for all symptoms) and symptoms were related to increased subjective sleepiness and performance deterioration. The symptoms "struggling to keep your eyes open", "difficulty maintaining correct speed", "reactions were slow" and "head dropping down" were most closely related to increased alpha and theta activity on EEG (r values 0.49-0.59, p<0.001) and "nodding off to sleep" and "struggling to keep your eyes open" were related to slow eye movements (r values 0.67 and 0.64, p<0.001). Symptoms related to visual disturbance and impaired driving performance were most accurate at detecting severely impaired driving performance (AUC on ROC curve of 0.86-0.91 for detecting change in lateral lane position greater than the change at a BAC of 0.05%). Individual sleepiness symptoms are related to impairment during acute sleep deprivation and might be able to assist drivers in recognizing their own sleepiness and ability to drive safely.
authors.affiliation: Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg 3084, Victoria, Australia; The University of Melbourne, Department of Medicine, Austin Hospital, Heidelberg 3084, Victoria, Australia. Electronic address: mark.howard@austin.org.au.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Howard
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Jackson
authors.forename: David
authors.initials: D
authors.lastname: Berlowitz
authors.forename: Fergal
authors.initials: F
authors.lastname: O'Donoghue
authors.forename: Philip
authors.initials: P
authors.lastname: Swann
authors.forename: Justine
authors.initials: J
authors.lastname: Westlake
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wilkinson
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Pierce
mesh_terms: D000328:Adult; D000434:Alcoholic Beverages; D001288:Attention; D001334:Automobile Driving; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D002492:Central Nervous System Depressants / Q000494:pharmacology; D003198:Computer Simulation; D004569:Electroencephalography; D000431:Ethanol / Q000494:pharmacology; D053483:Eye Movement Measurements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology*; D012892:Sleep Deprivation / Q000175:diagnosis / Q000503:physiopathology*; D012894:Sleep Stages / Q000502:physiology*; D011795:Surveys and Questionnaires
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol
keywords: Driving; Perception; Psychomotor performance; Sleep; Sleep deprivation; Subjective sleepiness