Thorax 2000;55:224-231 ( March )

Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea

Melissa Hack^a, Robert J O Davies^a, Rebecca Mullins^a, Soo Jeon Choi^a, Sharron Ramdassingh-Dow^a, Crispin Jenkinson^b, John R Stradling^a

^a Osler Chest Unit, Churchill Campus, Oxford Radcliffe Trust, Oxford OX3 7LJ, UK, ^b Health Services Research Unit, Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford, OX3 7LF, UK

Correspondence to: Dr J R Stradling

Received 5 August 1999; Returned to authors 15 October 1999; Revised version received 27 October 1999; Accepted for publication 10 December 1999

BACKGROUNDObstructive sleep apnoea (OSA) impairs vigilance and may lead to an increased rate of driving accidents. In uncontrolled studies accident rates and simulated steering performance improve following treatment with nasal continuous positive airway pressure (NCPAP). This study seeks to confirm the improvement in steering performance in a randomised controlled trial using subtherapeutic NCPAP as a control treatment.
METHODSFifty nine men with OSA (Epworth Sleepiness Score (ESS) of 10, and 10/h dips in SaO₂ of >4% due to OSA) received therapeutic or subtherapeutic NCPAP (1 cm H₂O) for one month. Simulated steering performance over three 30-minute "drives" was quantified as: standard deviation (SD) of road position, deterioration in SD across the drive, length of drive before "crashing", and number of off-road events. The reaction times to peripheral target stimuli during the drive were also measured.
RESULTSSubtherapeutic NCPAP did not improve overnight >4% SaO₂ dips/h compared with baseline values, thus acting as a control. The SD of the steering position improved from 0.36 to 0.21 on therapeutic NCPAP, and from 0.35 to 0.30 on subtherapeutic NCPAP (p = 0.03). Deterioration in SD of the steering position improved from 0.18 to 0.06 SD/h with therapeutic NCPAP and worsened from 0.18 to 0.24 with subtherapeutic NCPAP (p = 0.04). The reaction time to target stimuli was quicker after therapeutic than after subtherapeutic NCPAP (2.3 versus 2.7 seconds, p = 0.04).
CONCLUSIONSTherapeutic NCPAP improves steering performance and reaction time to target stimuli in patients with OSA, lending further support to the hypothesis that OSA impairs driving, increases driving accident rates, and that these improve following treatment with NCPAP.


Keywords: sleep apnoea; driving; sleepiness

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© 2000 by Thorax
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