title: Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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: http://www.anzctr.org.au/trial_view.aspx?ID=334979.
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, Australia ; Sleep and Circadian Research Group and NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, Australia ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, Australia ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Catcheside
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, Australia ; The Appleton Institute, Central Queensland University, Adelaide, Australia.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Baulk
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, Australia ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Centre for Sleep Research, University of South Australia, City East Campus, Adelaide, Australia.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Banks
authors.affiliation: Centre for Sleep Research, University of South Australia, City East Campus, Adelaide, Australia.
authors.forename: Jillian
authors.initials: J
authors.lastname: Dorrian
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, Australia ; Department of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
mesh_terms: D001334:Automobile Driving / Q000523:psychology*; D005072:Evoked Potentials, Auditory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D020181:Sleep Apnea, Obstructive / Q000523:psychology*; D012892:Sleep Deprivation / Q000523:psychology; D057190:Stroop Test
keywords: driving performance; neurobehavioral function; obstructive sleep apnea