Effects of Fatigue on Real-World Driving in Diseased and Control Participants

This study evaluated real world driver errors and sleepiness in 66 drivers with Obstructive Sleep Apnea (OSA) and 34 matched controls (24 younger and 22 older). Driving errors and driver state were derived from analyses of video data from "black-box" event recorders. Sleep fragmentation data in OSA was derived from actigraphy for 15 days prior to beginning standard treatment (positive airway pressure, PAP) and 15 days after beginning PAP treatment. Prior to starting PAP, OSAs appeared sleepier than controls in general and particularly at intersections, while making safety errors following nights with high levels of fragmented sleep compared to matched controls. Adverse effects of sleep fragmentation during the pre-PAP phase were reduced post-PAP. Greater hours of PAP-use were associated with lower sleepiness and errors on the road. PAP-use was associated with a decrease in high sleep fragmented nights. Findings suggest reduction in acute sleepiness is unlikely to be the only mediating factor that explains the driving safety benefits of PAP in OSA.