Slow-release caffeine as a countermeasure to driver sleepiness induced by partial sleep deprivation

Sleepless on the road: Are mothers of infants with insomnia at risk for impaired driving?

Infant sleep problems have been associated with a myriad of adverse child and parent outcomes, yet whether these problems may pose a risk for parents on the road has received little research attention. This study sought to test whether mothers of infants with insomnia are at an elevated risk for vehicular crashes, by comparing their objectively measured driving performance with that of mothers of well-sleeping infants and with that of women without children. Fifty-four women from these three groups completed a simulated driving task. Outcome measures included standard deviation of lateral position, number of lane crossings, standard deviation of speed, average speed and maximum speed. Women additionally reported on their driving behaviour using the Driving Behaviour Questionnaire, and on sleep, sleepiness and insomnia symptoms using 7-day sleep diaries and questionnaires. Mothers of infants with insomnia demonstrated greater lane deviation (Wald = 9.53, p = 0.009), higher maximum speed (Wald = 6.10, p = 0.04) and poorer self-rated driving behaviour (Wald = 7.44, p = 0.02) compared with control groups. Analyses also indicated that driving performance in mothers of infants with insomnia tended to be poorer relative to control groups with the progression of time on task. While further research is needed to assess the scope of these effects, our findings suggest that parents, healthcare providers and policymakers should be aware of the potential consequences of infant sleep problems on road safety, and collaborate to establish strategies to mitigate these risks.

Optimization of colored pavement considering driving behavior and psychological characteristics under dynamic low-visibility conditions related to fog-a driving simulator study

OBJECTIVE

Colored pavement is commonly used to reduce the road traffic risk and promote road traffic safety, but its performance in foggy environments has not been fully assessed. The goal of this research is to explore the effectiveness and optimization of colored pavement in a dynamic low-visibility environment.

METHODS

A driving simulation experiment is conducted. Three road risk sections in which collisions are common, including a long straight section, a sharp bend section, and a long downslope section, are considered, and three forms of colored pavement are used in five different visibility environments. The effectiveness of the colored pavement is explored by collecting and analyzing driving behavior and physiological characteristic data for 30 drivers in the established driving environment, and information is obtained through a subjective colored evaluation questionnaire. Eight evaluation indexes are selected from the perspectives of driving behavior and physiological characteristics, and the gray premium evaluation method is applied to evaluate the effectiveness of different forms of colored pavement considering the influence of visibility. Finally, the optimal colored pavement under various visibility and road alignment conditions is proposed.

RESULTS

The results show that reasonably selecting colored pavement can effectively improve drivers' behaviors and physiological characteristics under foggy conditions. For different road alignments and visibility conditions, different forms of colored pavement should be used to ensure road traffic safety.

CONCLUSIONS

The findings provide a theoretical reference for the optimization of colored pavement in foggy conditions.

In-vehicle fragrance administration as a countermeasure for driver fatigue

Driver fatigue is a contributing factor in about 10-30% of all fatal crashes. Prevention of fatigue-related crashes relies on robust detection of driver fatigue and application of effective countermeasures. A potential countermeasure is fragrance administration since odors can have alerting effects on humans. The aim here was to investigate if a fragrance incorporating trigeminal components could be used as an in-vehicle countermeasure for driver fatigue. The fragrance was tested in a driving simulator with 21 healthy but sleep-deprived participants. Each participant performed a monotonous driving task twice, once with active fragrance containing a trigeminal component and once with olfactory fragrance, in a cross-over single-blind design. The order of trigeminal/olfactory fragrance was randomized and blinded to the participants. Both fragrances (trigeminal/olfactory) were administered either when the participant fell asleep (defined as eye closure > 3 s) or after approximately 45 min if the participant did not fall asleep. Self-reported sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) every 5 min during driving. Variability in speed and lateral position and line crossing frequency were logged for each drive to measure driving performance. Heart rate measurements (ECG) and eye blinks (EOG) were collected to investigate potential arousing effects of the fragrance and to track objective signs of sleepiness. Mean blink duration, which was used as an objective measure of sleepiness, decreased significantly, after fragrance exposure, as did the frequency of line crossings, but there were no statistically significant differences between the fragrance with trigeminal stimulus and the pure olfactory fragrance. The results are in line with the effects found for other commonly used fatigue countermeasures, like playing loud music. These countermeasures can restore alertness and driving performance for a short while. Whether this is sufficient to support driving performance until the driver can make a safe stop in real traffic remains a topic for future studies.

Effects of caffeine and blue-enriched light on spare visual attention during simulated space teleoperation

Safe and successful operation of the International Space Station robotic arm is a complex task requiring difficult bimanual hand coordination and spatial reasoning skills, adherence to operating procedures and rules, and systems knowledge. These task attributes are all potentially affected by chronic sleep loss and circadian misalignment. In a randomized, placebo-controlled, cross-over trial examining the impact of regularly timed low-dose caffeine (0.3 mg kg-1 h-1) and moderate illuminance blue-enriched white light (~90 lux, ~88 melEDI lux, 6300 K), 16 participants performed 3 types of realistic robotic arm tasks using a high-fidelity desktop simulator overnight. Our goal was to determine how these countermeasures, separately and combined, impacted telerobotic task performance and the ability to allocate attention to an unrelated secondary visual task. We found that all participants maintained a similar level of robotic task performance throughout the primary task but the application of caffeine separately and with blue-enriched light significantly decreased response time to a secondary visual task by -9% to -13%, whereas blue-enriched light alone changed average response times between -4% and +2%. We conclude that, for sleep-restricted individuals, caffeine improved their ability to divide their visual attention, while the effect of blue-enriched light alone was limited. Light and caffeine together was most effective. Use of these countermeasures should improve the margin of safety if astronauts perform familiar tasks under degraded conditions or novel tasks where task workload is increased.

Comparative Bioavailability and Benefits on Mental Functions of Novel Extended-Release Caffeine Capsules against Immediate-Release Caffeine Capsules: An Open-Label, Randomized, Cross-over, Single-Dose Two-Way Crossover Study

Present study aimed compared pharmacokinetic profile of sustained-release CaffXtend® capsules (SR-Caffeine) with immediate-release caffeine capsules (IR-Caffeine), and the effect of SR-caffeine on memory, motivation, concentration, and attention. This open-label, randomized, single-dose, two-treatment, two-sequence, two-period, two-way crossover oral bioavailability study block randomized (1:1) healthy subjects (N = 15) to receive SR-Caffeine (200 mg) and IR-Caffeine (200 mg). Blood samples were collected at 0.25, 0.50, 0.75, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 24, 36 and 48 h in each period. Primary study outcome included comparing relative bioavailability of SR-Caffeine 200 mg and IR-Caffeine 200 mg under fasting conditions, and changes in caffeine research visual analogue scale (Caff-VAS) scores ('relaxed', 'alert', 'jittery', 'tired', 'tense', 'headache', 'overall mood' and 'mentally fatigued') were also evaluated. Fifteen subjects completed the study. Mean tmax was 4.08 ± 2.13h for SR-Caffeine compared to 0.83 ± 0.39h for IR-Caffeine, (p < 0.0001). Similarly, mean t½ was 7.07 ± 3.48h for SR-Caffeine compared to 5.78 ± 2.11h for IR-Caffeine (p = 0.04189). However, total exposure was similar for SR-Caffeine and IR-Caffeine (90% CI: 89.89-120.50% to 94.49-123.82% for geometric least square mean of ln-transformed AUC0-t and AUC0-∞). In the Caff-VAS evaluation, the SR-Caffeine group showed significantly better scores for 'jitteriness', 'tiredness', 'alertness' and 'overall mood' for 8-12 h than the IR-Caffeine group. No adverse events were reported. Results demonstrated sustained release of caffeine over 24 h from SR-Caffeine as compared to IR-Caffeine, which showed significant improvements in the scores for 'relaxed', 'alertness' and 'overall mood' and significantly lower scores for the parameters-'jittery' and 'tired' for extended period.Clinical trial registration: CTRI/2021/06/034185.

How Tired is Too Tired to Drive? A Systematic Review Assessing the Use of Prior Sleep Duration to Detect Driving Impairment

Driver fatigue is a contributory factor in approximately 20% of vehicle crashes. While other causal factors (eg, drink-driving) have decreased in recent decades due to increased public education strategies and punitive measures, similar decreases have not been seen in fatigue-related crashes. Fatigued driving could be managed in a similar way to drink-driving, with an established point (ie, amount of prior sleep) after which drivers are "deemed impaired". This systematic review aimed to provide an evidence-base for the concept of deemed impairment and to identify how much prior sleep may be required to drive safely. Four online databases were searched (PubMed, Web of Science, Scopus, Embase). Eligibility requirements included a) measurement of prior sleep duration and b) driving performance indicators (eg, lane deviation) and/or outcomes (eg, crash likelihood). After screening 1940 unique records, a total of 61 studies were included. Included studies were categorised as having experimental/quasi-experimental (n = 21), naturalistic (n = 3), longitudinal (n = 1), case-control (n = 11), or cross-sectional (n = 25) designs. Findings suggest that after either 6 or 7 hours of prior sleep, a modest level of impairment is generally seen compared with after ≥ 8 hours of prior sleep (ie, well rested), depending on the test used. Crash likelihood appears to be ~30% greater after 6 or 7 hours of prior sleep, as compared to individuals who are well rested. After one night of either 4 or 5 hours of sleep, there are large decrements to driving performance and approximately double the likelihood of a crash when compared with well-rested individuals. When considering the scientific evidence, it appears that there is a notable decrease in driving performance (and associated increase in crash likelihood) when less than 5h prior sleep is obtained. This is a critical first step in establishing community standards regarding the amount of sleep required to drive safely.

Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study

Background

Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant.

Objective

In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic.

Methods

College student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day.

Results

Participants with a higher sleep onset latency (b=−1.09, SE 0.36; P=.006) and TST (b=−0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=−0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04).

Conclusions

Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health.

Adenosine, caffeine, and sleep-wake regulation: state of the science and perspectives

For hundreds of years, mankind has been influencing its sleep and waking state through the adenosinergic system. For ~100 years now, systematic research has been performed, first started by testing the effects of different dosages of caffeine on sleep and waking behaviour. About 70 years ago, adenosine itself entered the picture as a possible ligand of the receptors where caffeine hooks on as an antagonist to reduce sleepiness. Since the scientific demonstration that this is indeed the case, progress has been fast. Today, adenosine is widely accepted as an endogenous sleep‐regulatory substance. In this review, we discuss the current state of the science in model organisms and humans on the working mechanisms of adenosine and caffeine on sleep. We critically investigate the evidence for a direct involvement in sleep homeostatic mechanisms and whether the effects of caffeine on sleep differ between acute intake and chronic consumption. In addition, we review the more recent evidence that adenosine levels may also influence the functioning of the circadian clock and address the question of whether sleep homeostasis and the circadian clock may interact through adenosinergic signalling. In the final section, we discuss the perspectives of possible clinical applications of the accumulated knowledge over the last century that may improve sleep‐related disorders. We conclude our review by highlighting some open questions that need to be answered, to better understand how adenosine and caffeine exactly regulate and influence sleep.

Effects of a seat-integrated mobilization system during passive driver fatigue

OBJECTIVE

The aim of this study is to evaluate the effectiveness of a seat-integrated mobilization system for maintaining vigilance under monotonous driving situations.

METHOD

For this purpose, vigilance indicators were compared intra-individually in a test condition with mobilization (seat-integrated stimulation) and a placebo condition under standardized conditions in a real driving study (N = 31). During a monotonous two-hour ride, physiological (brain activity by the EEG alpha spindle rate), performance-based (reaction times) and subjective indicators were recorded.

RESULTS

The necessary precondition for the paradigm of inducing fatigue through monotony was confirmed by a significant increase in the EEG alpha spindle rate and the subjective vigilance indices. The mobilization system had a significant impact on the most fatigue-sensitive parameter of the alpha spindle rate, whereas the other parameters of vigilance did not reflect a significant effect of mobilization.

CONCLUSION

The Mobilization Seat is an effective measure to prevent drivers' fatigue during monotonous situations.

A qualitative study exploring how city bus drivers manage sleepiness and fatigue

Sleepiness is an important consideration for workplace safety, especially in relation to shift work. There is limited understanding of how practical applications of countermeasures are used to manage sleepiness in a professional setting. One under-researched group is city bus drivers. This qualitative study investigated the use of individual sleepiness countermeasures within a sample of city bus drivers. Nine semi-structured focus groups were convened to explore the broader experience and management of sleepiness (n = 62, largest proportion aged 45-54 y, mean bus driving experience 13.3 y). The conversations of the focus groups were audio-recorded (total: 682 min) and transcribed anonymously verbatim. Discussions specifically relating to personal countermeasure use were isolated from the original transcripts, creating nine new transcripts for a targeted analysis on the topic of individual countermeasure use. Thematic analysis identified two main themes: (1) strategies used to counteract sleepiness and (2) barriers to individual countermeasure use, each with several subthemes. A variety of countermeasures were used, including strategies with limited potential for counteracting sleepiness, such as opening a window, drinking water, talking, stretching, and consuming forms of sugar. Workplace restrictions, such as access to facilities, limitations of food/drink consumption, and tight schedules, were the strongest influences on countermeasure choice. It is important that bus drivers have access to, and are aware of the effectiveness of, countermeasures to manage sleepiness during shift work. It is vital that the actions of drivers and shift workers are better understood in the planning of organizational countermeasures.

Diet and sleep health: a scoping review of intervention studies in adults

BACKGROUND

Recent research has demonstrated an association between dietary intake and sleep health that can influence chronic disease risk factors. A scoping review of research studies investigating dietary intake and sleep was undertaken to determine the extent and scope of research in laboratory-based, free-living and mixed settings. Additionally, this review determines how well subpopulations and geographical locations are represented and the methodologies used to assess outcome measures.

METHODS

Five online databases were used to identify papers published between 1970 and 2017. Included studies were those conducted in adults and reported both outcomes of interest: (i) sleep health, including sleep restriction and sleep hygiene and (ii) dietary outcomes, including altered nutrients, dietary patterns and supplements.

RESULTS

In total, 129 publications were included with the majority being dietary interventions investigating sleep outcomes (n = 109) with fewer being sleep interventions investigating and reporting dietary outcomes (n = 20). Dietary interventions were most often carried out in free-living environments, in contrast to sleep interventions that were most often carried out in laboratory-based environments. The majority of dietary interventions investigated use of a supplement (n = 66 studies), which was predominantly caffeine (n = 49). Sleep interventions investigated sleep duration only, with the majority (n = 17) investigating the effect of partial sleep restriction under 5.5 h per night on dietary intake, while three studies investigating total sleep deprivation.

CONCLUSIONS

Investigating broader aspects of dietary such as overall diet quality and dietary patterns and other components of sleep health such as quality,  timing and sleep hygiene are important aspects for future research.

Nasal skin temperature reveals changes in arousal levels due to time on task: An experimental thermal infrared imaging study

Infrared thermography, thanks to technological developments and lowering prices, is now getting considerable attention as a potential arousal monitor in the safety industry. Nasal skin temperature might be a valid index to track physiological variations due to reduced arousal levels, and its use could prevent a drowsiness-related deterioration of performance. However, the few studies that have investigated nasal skin temperature in applied settings have had inconsistent results. Here, we assessed the validity of nasal skin temperature to monitor changes in arousal levels (from alertness to drowsiness). The participants performed a 2-h simulated driving task while we simultaneously recorded their nasal skin temperature, brain activity (we used frontal delta electroencephalographic [EEG] activity as the reference index of alertness), and driving performance (speeding time). For those variables, we calculated growth curve models. We also collected subjective ratings of alertness and fatigue before and after the driving session. We found that the nasal skin temperature showed a cubic trajectory (it increased for the first 75 min, and then it began to decrease, but such deceleration gradually diminished over time). As expected, frontal delta EEG activity showed an inverted U-shaped quadratic trend (EEG power increased for the first hour and half, and gradually decreased during the last thirty minutes). The speeding time exhibited a similar pattern of change. Subjective sleepiness and fatigue increased after the task. Overall, our results suggest that nasal skin temperature seems to be a valid measure of arousal variations while performing a complex and dynamic everyday task.

Irregular work schedule and sleep disturbance in occupational drivers-A nationwide cross-sectional study

BACKGROUND

The objective of this study was to investigate the relationship between irregular work schedules and sleep disturbance and compare the impacts of work schedule on sleep disturbance between occupational drivers and office workers.

METHODS

Using data from the 3rd and 4th Korean Working Conditions Survey, 3,070 occupational drivers and 9,898 office workers were included in this study. The subjects' days of night work, evening work, and subjective complaints of sleep disturbance were investigated along with other covariates.

RESULTS

In the multivariate logistic regression analyses, occupational drivers (odds ratio [OR], 95% confidence interval [CI]: 1.51, 1.11-2.05), workers who were engaged in more night work (2.49, 1.84-3.38 for 1-15 days, and 3.80, 2.67-5.41 for 16-30 days) and evening work (2.22, 1.66-2.97 for 1-15 days, and 1.76, 1.26-2.45) were more likely to report sleep disturbance. Moreover, occupational driving showed significant interaction effects with both night and evening work on sleep disturbance, and therefore, showed higher ORs for sleep disturbance in the 16-30 days night (5.38, 3.40-8.52) and evening (3.13, 1.97-4.98) compared to no night and evening working office workers.

CONCLUSIONS

Occupational drivers who are exposed to night work and evening work are at higher risks for sleep disturbance. Therefore, for the public and drivers' safety, optimal work schedules for minimising sleep disturbance should be developed.

Effect of single caffeine intake on neuropsychological functions in healthy volunteers: A double-blind placebo-controlled study

Objective

We investigated the effects of a single instance of caffeine intake on neurocognitive functions and driving performance in healthy subjects using an established cognitive battery and a driving simulator system.

Methods

This study was conducted in a double-blind, randomized, placebo-controlled manner from February 19, 2016 to August 6, 2016. Caffeine intake was discontinued 3 days prior to the study. Participants were randomly assigned to receive 200-mg doses of caffeine or a placebo. Thirty minutes after administration, cognitive functions were evaluated via the Symbol Digit Coding Test (SDC), the Stroop Test (ST), the Shifting Attention Test (SAT) and the Four Part Continuous Performance Test (FPCPT). After the cognitive function tests were conducted, driving performance was evaluated using a driving simulator. We measured the brake reaction time (BRT) in the Harsh-braking test and the standard deviation of the lateral position (SDLP) in the Road-tracking test.

Results

Of 100 randomized subjects, 50 (50%) of 100 in the caffeine group and 50 (50%) of 100 in the placebo group completed the study. Participants in the caffeine group had more correct responses than participants in the placebo group on the SAT (P = 0.03) and made fewer errors (P = 0.02). Participants in the caffeine group exhibited shorter times in the Harsh-braking test than participants in the placebo group (P = 0.048).

Conclusions

A single instance of caffeine intake changed some neurocognitive functions and driving performance in healthy volunteers.

Trial registration

UMIN000023576.

Preemptive Caffeine Administration Blocks the Increase in Postoperative Pain Caused by Previous Sleep Loss in the Rat: A Potential Role for Preoptic Adenosine A2A Receptors in Sleep-Pain Interactions

Sleep and pain are reciprocally related, but the precise mechanisms underlying this relationship are poorly understood. This study used a rat model of surgical pain to examine the effect of previous sleep loss on postoperative pain and tested the hypothesis that preoptic adenosinergic mechanisms regulate sleep-pain interactions. Relative to ad libitum sleep, 6 hours of total sleep deprivation prior to a surgical incision significantly enhanced postoperative mechanical hypersensitivity in the affected paw and prolonged the time to recovery from surgery. There were no sex-specific differences in these measures. There were also no changes in adrenocorticotropic hormone and corticosterone levels after sleep deprivation, suggesting that this effect was not mediated by the stress associated with the sleep perturbation. Systemic administration of the nonselective adenosine receptor antagonist caffeine at the onset of sleep deprivation prevented the sleep deprivation-induced increase in postoperative hypersensitivity. Microinjection of the adenosine A2A receptor antagonist ZM 241385 into the median preoptic nucleus (MnPO) blocked the increase in surgical pain levels and duration caused by prior sleep deprivation and eliminated the thermal hyperalgesia induced by sleep deprivation in a group of nonoperated (i.e., without surgical incision) rats. These data show that even a brief sleep disturbance prior to surgery worsens postoperative pain and are consistent with our hypothesis that adenosine A2A receptors in the MnPO contribute to regulate these sleep-pain interactions.

Name that tune: Mitigation of driver fatigue via a song naming game

Fatigued driving contributes to a substantial number of motor vehicle accidents each year. Music listening is often employed as a countermeasure during driving in order to mitigate the effects of fatigue. Though music listening has been established as a distractor in the sense that it increases cognitive load during driving, it is possible that increased cognitive load is desirable under particular circumstances. For instance, during situations that typically result in cognitive underload, such as driving in a low-traffic monotonous stretch of highway, it may be beneficial for cognitive load to increase, thereby necessitating allocation of greater cognitive resources to the task of driving and attenuating fatigue. In the current study, we employed a song-naming game as a countermeasure to fatigued driving in a simulated monotonous environment. During the first driving session, we established that driving performance deteriorates in the absence of an intervention following 30min of simulated driving. During the second session, we found that a song-naming game employed at the point of fatigue onset was an effective countermeasure, as reflected by simulated driving performance that met or exceeded fresh driving behavior and was significantly better relative to fatigued performance during the first driving session.

Examining signs of driver sleepiness, usage of sleepiness countermeasures and the associations with sleepy driving behaviours and individual factors

The impairing effect from sleepiness is a major contributor to road crashes. The ability of a sleepy driver to perceive their level of sleepiness is an important consideration for road safety as well as the type of sleepiness countermeasure used by drivers as some sleepiness countermeasures are more effective than others. The aims of the current study were to determine the extent that the signs of driver sleepiness were associated with sleepy driving behaviours, as well as determining which individual factors (demographic, work, driving, and sleep-related factors) were associated with using a roadside or in-vehicle sleepiness countermeasure. A sample of 1518 Australian drivers from the Australian State of New South Wales and the neighbouring Australian Capital Territory took part in the study. The participants' experiences with the signs of sleepiness were reasonably extensive. A number of the early signs of sleepiness (e.g., yawning, frequent eye blinks) were related with continuing to drive while sleepy, with the more advanced signs of sleepiness (e.g., difficulty keeping eyes open, dreamlike state of consciousness) associated with having a sleep-related close call. The individual factors associated with using a roadside sleepiness countermeasure included age (being older), education (tertiary level), difficulties getting to sleep, not continuing to drive while sleepy, and having experienced many signs of sleepiness. The results suggest that these participants have a reasonable awareness and experience with the signs of driver sleepiness. Factors related to previous experiences with sleepiness were associated with implementing a roadside countermeasure. Nonetheless, the high proportions of drivers performing sleepy driving behaviours suggest that concerted efforts are needed with road safety campaigns regarding the dangers of driving while sleepy.

The Effects of Caffeine Use on Driving Safety Among Truck Drivers Who Are Habitual Caffeine Users

The purpose of this study was to describe caffeine use among a group of habitual caffeine users, truck drivers, and to explore the associations between caffeine use and critical safety events by age in the naturalistic work setting. A secondary analysis of existing data from the Naturalistic Truck Driving Study was conducted. Analyses focused on the association between sleep and caffeine consumption by duty status, comparisons of sleep and caffeine use by age, and the associations between caffeine use and safety-critical events (SCEs). Findings indicated differences in caffeine use by duty status. However, no difference in sleep time by duty status, or between sleep time and caffeine use was found regardless of when the caffeine was consumed during the 5 hours prior to sleep. Sleep time did not vary significantly by age, although increasing age was associated with decreased caffeine use. Overall, a 6% reduction in the rate of SCEs per eight ounces of caffeinated beverage consumed was found. This study makes a unique scientific contribution because it uses real-time observations of truckers in the naturalistic work setting. It also does not involve caffeine withdrawal but rather an investigation of the effects of the naturalistic consumption of caffeine on sleep and driving performance. Findings suggest that caffeine use among habitual users offers a protective effect for safety-critical driving events. Occupational health nurses may use this information to counsel workers in the use of caffeine to enhance driving safety.

The effect of partial sleep deprivation on computer-based measures of fitness to drive

PURPOSE

Using a partial sleep deprivation paradigm, the aim of the study was to investigate the sensitivity of a computer-based test battery of fitness to drive to detect impairments related to sleepiness.

METHODS

Forty-seven healthy subjects (34 females, mean age 26.0 ± 6.8 years) participated in a counterbalanced within-subject design of two conditions: (i) normal night sleep and (ii) partial sleep deprivation (PSD) with 4 h time in bed. For the assessment of fitness to drive, we used a validated traffic psychological test battery. Moreover, well-established measures of sleepiness highly responsive to sleep deprivation were applied: the Karolinska Sleepiness Scale (KSS), pupillography (Pupil Unrest Index (PUI) as physiological sleepiness indicator) and two sustained attention tasks (psychomotor Vigilance Task and Mackworth Clock Test).

RESULTS

Subjective and physiological sleepiness were significantly increased after PSD, accompanied by large (d > 1.50 for KSS) and medium (d = 0.55 for PUI) effect sizes. Sleepiness-related performance decrements were found in both sustained attention tasks (d = 0.59-0.77). Assessing driving-related ability, PSD induced decrements only in the test domain Reaction Test (reaction time d = 0.54 and motor time d = 0.45). All other subtests-as well as the overall judgement of fitness to drive-were not significantly affected by PSD.

CONCLUSION

In contrast to established tests of sustained attention and subjective sleepiness, computer-based test batteries of fitness to drive might lack sensitivity to core aspects of sleepiness as they mainly consist of short and stimulating subtests. Therefore, tasks that require sustained attention should be an essential part of traffic psychological test batteries when sleepiness is a potential issue.

The Case for Addressing Operator Fatigue

Sleep deficiency, which can be caused by acute sleep deprivation, chronic insufficient sleep, untreated sleep disorders, disruption of circadian timing, and other factors, is endemic in the U.S., including among professional and non-professional drivers and operators. Vigilance and attention are critical for safe transportation operations, but fatigue and sleepiness compromise vigilance and attention by slowing reaction times and impairing judgment and decision-making abilities. Research studies, polls, and accident investigations indicate that many Americans drive a motor vehicle or operate an aircraft, train or marine vessel while drowsy, putting themselves and others at risk for error and accident. In this chapter, we will outline some of the factors that contribute to sleepiness, present evidence from laboratory and field studies demonstrating how sleepiness impacts transportation safety, review how sleepiness is measured in laboratory and field settings, describe what is known about interventions for sleepiness in transportation settings, and summarize what we believe are important gaps in our knowledge of sleepiness and transportation safety.

Effects of fatigue on driving performance under different roadway geometries: a simulator study

OBJECTIVE

This article examines the effects of fatigue on driving performance under different roadway geometries using a driving simulator.

METHODS

Twenty-four participants each completed a driving scenario twice: while alert and while experiencing fatigue. The driving scenario was composed of straight road segments and curves; there were 6 curves with 3 radius values (i.e., 200, 500, and 800 m) and 2 turning directions (i.e., left and right). Analysis was conducted on driving performance measures such as longitudinal speed, steering wheel movements, and lateral position.

RESULTS

RESULTS confirmed that decremental changes in driving performance due to fatigue varied among road conditions. On straight segments, drivers' abilities to steer and maintain lane position were impaired, whereas on curves we found decremental changes in the quality of longitudinal speed as well as steering control and keeping the vehicle in the lane. Moreover, the effects of fatigue on driving performance were relative to the radius and direction of the curve. Fatigue impaired drivers' abilities to control the steering wheel, and the impairment proved more obvious on curves. The degree varied significantly as the curve radius changed. Drivers tended to drive closer to the right side due to fatigue, and the impairment in maintaining lane position became more obvious as the right-turn curve radius decreased.

CONCLUSIONS

Driver fatigue has detrimental effects on driving performance, and the effects differ under different roadway geometries.

Effects of 28-days ingestion of a slow-release energy supplement versus placebo on hematological and cardiovascular measures of health

Background

Recently, slow release tablets have been developed to prolong energy release throughout the day. The efficacy of the delivery of slow-release caffeine alone is fairly well documented; however, an assessment of safety and tolerability of prolonged use of slow-release energy supplements is lacking. Therefore the objective of this study was to investigate the effect of daily ingestion of a slow-release energy supplement for 28 days on blood chemistry and resting cardiovascular measures in healthy men and women.

Methods

Forty healthy individuals (20 males, 20 females; age: 22.73 ± 3.06 years; height: 171.68 ± 10.45 cm; mass: 74.49 ± 15.51 kg; BMI: 25.08 ± 3.66 (kg • m²) ^-1) participated in this randomized, double-blind, placebo controlled study. Following a 12-hour fast, participants reported for pre-testing. Testing consisted of resting heart rate (RHR) and blood pressure (BP) measures, followed by assessment of metabolic blood chemistry, blood lipids and complete cell counts. Participants then supplemented with either Energize™ (SUPP) or placebo (PL) for 28 days. Post-testing occurred 24-hours after ingestion of the final dose and consisted of the same protocol at the same time of day as pre-testing.

Results

No significant changes in outcome measures were observed. A significant difference between groups was observed for plasma glucose concentrations; however, follow-up testing revealed that pre- to post-supplementation changes were not significant for either SUPP or PL. All variables remained within normal adult reference ranges. No adverse events were reported.

Conclusions

These findings indicate that 28 consecutive days ingestion of a slow release energy supplement containing caffeine in caffeine users is both safe and tolerable.

Continuing to drive while sleepy: the influence of sleepiness countermeasures, motivation for driving sleepy, and risk perception

Driver sleepiness is a major contributor to road crashes. The current study sought to examine the association between perceptions of effectiveness of six sleepiness countermeasures and their relationship with self-reports of continuing to drive while sleepy among 309 drivers after controlling for the influence of age, sex, motivation for driving sleepy, and risk perception of sleepy driving. The results demonstrate that the variables of age, sex, motivation, and risk perception were significantly associated with self-reports of continuing to drive while sleepy and only one countermeasure was associated with self-reports of continuing to drive while sleepy. Further, it was found that age differences in self-reports of continuing to drive while sleepy was mediated by participants' motivation and risk perception. These findings highlight modifiable factors that could be focused on with interventions that seek to modify drivers' attitudes and behaviours of driving while sleepy.

A visual ERP study of impulse inhibition following a zaleplon-induced nap after sleep deprivation

The side effects of a zaleplon-induced nap as a countermeasure in the reduction of impulse inhibition function decline following 30 h of sleep deprivation (SD) were examined by event-related brain potentials. Sixteen adult participants performed a Go/NoGo task at five time points: (1) baseline; (2) after 30 h of SD; (3) upon sudden awakening, also called 2 h post-drug; (4) 4 h post-drug; and (5) 6 h post-drug. Behavior results show an increase in both reaction time and false alarm rates after SD and sudden awakening, and a marked decrease at 4 h and 6 h post-drug in zaleplon and placebo conditions. However, no difference was observed between the zaleplon condition and the placebo condition. In event-related potential (ERP) reults compared with results obtained under control conditions, NoGo-P3 latencies significantly increased, whereas the Nogo-P3 amplitude decreased after 30 h of SD and sudden awakening in both the zaleplon condition and the placebo condition. These results indicate that SD attenuates resource allocation and error monitoring for NoGo stimuli. In addition, NoGo-P3 latencies were longer in the zaleplon condition compared with the placebo condition at sudden awakening. Additionally, the NoGo-P3 latencies were shorter in the zaleplon condition than in the placebo condition at 4 h and 6 h post-drug. These results indicate that zaleplon at a dose of 10 mg/day may help subjects achieve a better recovery or maintain better impulse inhibition function, although the side effects of zaleplon last at least 2 h post-drug.

Drowsiness detection during different times of day using multiple features

Driver drowsiness has been one of the major causes of road accidents that lead to severe trauma, such as physical injury, death, and economic loss, which highlights the need to develop a system that can alert drivers of their drowsy state prior to accidents. Researchers have therefore attempted to develop systems that can determine driver drowsiness using the following four measures: (1) subjective ratings from drivers, (2) vehicle-based measures, (3) behavioral measures and (4) physiological measures. In this study, we analyzed the various factors that contribute towards drowsiness. A total of 15 male subjects were asked to drive for 2 h at three different times of the day (00:00-02:00, 03:00-05:00 and 15:00-17:00 h) when the circadian rhythm is low. The less intrusive physiological signal measurements, ECG and EMG, are analyzed during this driving task. Statistically significant differences in the features of ECG and sEMG signals were observed between the alert and drowsy states of the drivers during different times of day. In the future, these physiological measures can be fused with vision-based measures for the development of an efficient drowsiness detection system.

The effect of three low-cost engineering treatments on driver fatigue: A driving simulator study

Three engineering treatments were implemented in a driving simulator study to assess the effect of road-based measures on alleviating the symptoms of fatigue. Using results from previous research on the effect of circadian rhythms on fatigue-related crashes, two groups of male drivers were recruited for this study: young shift workers under the age of 35, who attended immediately after their night shift, and older drivers over the age of 45, who completed the study during the 'post lunch dip' period, after consuming lunch. Eye tracking (PERCLOS) and lateral driver performance measures were used to assess whether baseline measures of fatigue changed after drivers experienced each of the three treatments, which included variable message signs, chevrons and rumble strips. Results showed a marked difference in these measures between drivers' baseline (not fatigued) and experimental (fatigued) visits. There were also some reductions in lateral deviation and eye closure (as measured by PERCLOS) when the treatments were encountered, but no marked difference between the three treatments. These results suggest that in addition to driver- and vehicle-based methods currently employed to mitigate the effects of fatigue, the inclusion of such engineering measures may help alleviate fatigue-related impairments in driving, particularly if such treatments are implemented during long stretches of straight monotonous roads which are known to be associated with fatigue-related crashes. However, positive effects of the treatments were short lived, prompting the need for further investigations on their optimal frequency of presentation and combination to achieve maximum impact from these low-cost, road-based treatments.

Effects of d-amphetamine on simulated driving performance before and after sleep deprivation

RATIONALE

Stimulant drugs are commonly abused and also used to promote wakefulness, yet their effects on driving performance during sleep deprivation have not been thoroughly researched in experimental studies.

OBJECTIVES

The aims were to assess the effects on fundamental driving parameters during simulated driving of two doses of d-amphetamine and further to assess the interaction between d-amphetamine and sleep deprivation.

METHODS

A double-blind, placebo-controlled experiment including 18 healthy male volunteers was conducted.

RESULTS

The participants felt more alert when taking a dose of d-amphetamine than when taking placebo, and the effect was stronger for the higher dose. However, the data did not show any evidence that taking d-amphetamine prevented the subjects from becoming successively sleepier during the night. A significant main effect of the dose was found for three out of the five primary indicators where the lower dose led to improved driving. These indicators were crossing-car reaction time, and coherence and delay from a car-following event. Regarding sleep deprivation, a main effect was found for four of the primary indicators and three of the secondary indicators. The results showed overall impaired driving with respect to standard deviation of lateral position and delay in reaction time when the sleep-deprived conditions were compared to the alert condition. We found no interactions between dose and sleep deprivation for any of the performance indicators.

CONCLUSIONS

Our results suggest that administration of d-amphetamine does not compensate for impairment of driving due to fatigue. The positive effects of 10 mg were not further improved or even sustained when increasing the dose to 40 mg.

Modafinil improves event related potentials P300 and contingent negative variation after 24 h sleep deprivation

AIMS

The efficacy of modafinil as a countermeasure in the reduction of cognitive decline following 24 h of sleep deprivation (SD) on subjective sleepiness scales, event-related potential (ERP) P300, and contingent negative variation (CNV) was evaluated.

MAIN METHODS

Eleven healthy males, age 25-30 years participated. The experiment was performed in five sessions on different days between 7 and 8a.m. Session 1, baseline recordings; Session 2, after one night's SD; Session 3, 48 h of recovery from SD; Session 4, after 1 week of Session 1, following one night's SD along with modafinil (400mg/day); Session 5, 48 h of recovery after SD+modafinil.

KEY FINDINGS

Subjective sleepiness scores increased significantly after SD as compared to baseline (P<0.01), but remained unaltered after modafinil supplementation. There was an increase in N100 and P300 peak latencies of ERP following SD (P<0.01), which was reduced with modafinil (P<0.05). There was an increase in CNV M100 and P300 peak latencies after SD (P<0.01) which decreased with the use of modafinil (P<0.05). The CNV reaction time increased following SD (P<0.01) and decreased with the use of modafinil (P<0.05). No significant effects on ERP N200, P200 latencies and P200, P300 amplitudes and CNV N100, M200 peak latencies and M100, M200 amplitudes were observed.

SIGNIFICANCE

The results strongly suggest that modafinil in a dose of 400mg/day, reduces the subjective sleepiness and cognitive decline following 24 h of SD.

Effects of coffee on driving performance during prolonged simulated highway driving

RATIONALE

Coffee is often consumed to counteract driver sleepiness. There is limited information on the effects of a single low dose of coffee on prolonged highway driving in non-sleep deprived individuals.

OBJECTIVES

The aim of this study was to examine the effects of a single cup of coffee (80 mg caffeine) on simulated highway driving performance.

METHODS

Non-sleep deprived healthy volunteers (n024) participated in a double-blind, placebo-controlled, crossover study. After 2 h of monotonous highway driving, subjects received caffeinated or decaffeinated coffee during a 15-min break before continuing driving for another 2 h. The primary outcome measure was the standard deviation of lateral position (SDLP), reflecting the weaving of the car. Secondary outcome measures were speed variability, subjective sleepiness, and subjective driving performance.

RESULTS

The results showed that caffeinated coffee significantly reduced SDLP as compared to decaffeinated coffee, both in the first (p00.024) and second hour (p00.019) after the break. Similarly, the standard deviation of speed (p0 0.024; p00.001), mental effort (p00.003; p00.023), and subjective sleepiness (p00.001; p00.002) were reduced in both the first and second hour after consuming caffeinated coffee. Subjective driving quality was significantly improved in the first hour after consuming caffeinated coffee (p00.004).

CONCLUSIONS

These findings demonstrate a positive effect of one cup of caffeinated coffee on driving performance and subjective sleepiness during monotonous simulated highway driving.

Positive effects of Red Bull® Energy Drink on driving performance during prolonged driving

BACKGROUND

The purpose of this study was to examine if Red Bull® Energy Drink can counteract sleepiness and driving impairment during prolonged driving.

METHODS

Twenty-four healthy volunteers participated in this double-blind placebo-controlled crossover study. After 2 h of highway driving in the STISIM driving simulator, subjects had a 15-min break and consumed Red Bull® Energy Drink (250 ml) or placebo (Red Bull® Energy Drink without the functional ingredients: caffeine, taurine, glucuronolactone, B vitamins (niacin, pantothenic acid, B6, B12), and inositol) before driving for two additional hours. A third condition comprised 4 h of uninterrupted driving. Primary parameter was the standard deviation of lateral position (SDLP), i.e., the weaving of the car. Secondary parameters included SD speed, subjective driving quality, sleepiness, and mental effort to perform the test.

RESULTS

No significant differences were observed during the first 2 h of driving. Red Bull® Energy Drink significantly improved driving relative to placebo: SDLP was significantly reduced during the 3rd (p < 0.046) and 4th hour of driving (p < 0.011). Red Bull® Energy Drink significantly reduced the standard deviation of speed (p < 0.004), improved subjective driving quality (p < 0.0001), and reduced mental effort to perform the test (p < 0.024) during the 3rd hour of driving. Subjective sleepiness was significantly decreased during both the 3rd and 4th hour of driving after Red Bull® Energy Drink (p < 0.001 and p < 0.009, respectively). Relative to uninterrupted driving, Red Bull® Energy Drink significantly improved each parameter.

CONCLUSION

Red Bull® Energy Drink significantly improves driving performance and reduces driver sleepiness during prolonged highway driving.

Effects of 2 adenosine antagonists, quercetin and caffeine, on vigilance and mood

Quercetin, a phenolic flavonoid found in small quantities in some fruits and vegetables, is an adenosine receptor antagonist in vitro marketed as a dietary supplement for purported caffeine-like effects. A double-blind, placebo-controlled, between-subjects study was conducted to compare the behavioral effects of quercetin to a central adenosine receptor antagonist, caffeine. Fifty-seven volunteers received either 2000 mg of quercetin dihydrate (a dose estimated based on in vitro receptor binding to be equivalent in potency to 200 mg of caffeine), placebo, or 200 mg of caffeine. One hour later, a 45-minute visual vigilance task was administered. The Profile of Mood States questionnaire was completed before treatment and immediately after vigilance testing. On the vigilance task, caffeine increased the number of stimuli detected (P < 0.02) and decreased the reaction time (P = 0.001). Caffeine increased self-reported vigor and reduced fatigue and total mood disturbance Profile of Mood States scores compared with placebo. Quercetin did not significantly alter any parameter, but values were typically intermediate between caffeine and placebo on those tests affected by caffeine. Quercetin is unlikely to have any effects when consumed by humans in quantities present in the diet or in dietary supplements. Caffeine (200 mg) administration resulted in the expected effects on vigilance and mood.

Poor reported sleep quality predicts low positive affect in daily life among healthy and mood-disordered persons

Sleep disturbance is a core symptom of mood disorders. However, surprisingly little is known about the relationship between sleep quality and ambulatory daily mood, especially in mood-disordered populations. We assessed ambulatory positive affect (PA) and negative affect (NA) 10 times daily for three consecutive days with the computerized experience sampling method among persons with major depression (n = 35), minor depression (n = 25) and healthy controls (n = 36). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poorer sleep quality predicted lower ambulatory PA, even after accounting for the effects of diagnostic group and self-reported anxiety. Conversely, sleep quality did not predict ambulatory NA once diagnostic group was accounted for. Analyzes of specific PSQI component scores indicated that poor subjective sleep quality and self-reported daytime dysfunction were the sleep components most strongly tied to reports of low ambulatory PA. Impaired sleep quality may be responsible for reduced pleasurable experience in everyday life.

Predicting driver drowsiness using vehicle measures: recent insights and future challenges

INTRODUCTION

Driver drowsiness is a significant contributing factor to road crashes. One approach to tackling this issue is to develop technological countermeasures for detecting driver drowsiness, so that a driver can be warned before a crash occurs.

METHOD

The goal of this review is to assess, given the current state of knowledge, whether vehicle measures can be used to reliably predict drowsiness in real time.

RESULTS

Several behavioral experiments have shown that drowsiness can have a serious impact on driving performance in controlled, experimental settings. However, most of those studies have investigated simple functions of performance (such as standard deviation of lane position) and results are often reported as averages across drivers, and across time.

CONCLUSIONS

Further research is necessary to examine more complex functions, as well as individual differences between drivers.

IMPACT ON INDUSTRY

A successful countermeasure for predicting driver drowsiness will probably require the setting of multiple criteria, and the use of multiple measures.