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Heaton K, Kham-Ai P, Shattell M. Sleep, mental health, and access to health care of women truck drivers. J Am Assoc Nurse Pract 2024; 36:38-45. [PMID: 38038951 DOI: 10.1097/jxx.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The numbers of women in trucking are growing steadily, yet because they represent a minority group, little is known about their health issues. Most studies of truck drivers have focused on the mental and physical health, sleep, and health care access of male truck drivers. PURPOSE The purpose of this study was to characterize chronic stress, sleep, and mental health service and overall access to care among women truck drivers. METHODOLOGY Twenty-five female truck drivers were a subsample of participants from a larger parent study of truck drivers. After approval from the institutional review board, participants completed a 59-item Qualtrics survey; data were transferred from Qualtrics to SPSS v. 24 for analysis. RESULTS No acute sleepiness or excess daytime sleepiness was observed, but participants only slept 6 hr per night, and all experienced poor sleep quality. Although 28% of participants met or exceeded the threshold score for posttraumatic stress disorder (PTSD), only 8% sought care for feelings of upset or distress. Also, 80% of the women had health insurance, yet there were those who did not seek care because of job-related conflicts. CONCLUSION/IMPLICATIONS Participants were sleep deprived and experienced poor-quality sleep. Mental health and other health services utilization was low. Implications for practice include consideration of telehealth services to improve health care access and screening and referral as needed to mental health care providers by Department of Transportation medical examiners. Future research should include younger women truck drivers to determine the potential contribution of perimenopause/menopause to some of the health issues experienced by this group of workers.
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Affiliation(s)
- Karen Heaton
- Faculty, Occupational Health Nursing, Deep South Center for Occupational Health and Safety, School of Nursing, Adult/Acute Health, Chronic Care and Foundations, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Prasert Kham-Ai
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Mona Shattell
- Department of Nursing Systems, Hugh F. and Jeannette G. McKean Endowed Chair, College of NursingAcademic Health Sciences Center University of Central Florida, Orlando, Florida
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Orsini F, Giusti G, Zarantonello L, Costa R, Montagnese S, Rossi R. Driving fatigue increases after the Spring transition to Daylight Saving Time in young male drivers: A pilot study. TRANSPORTATION RESEARCH. PART F, TRAFFIC PSYCHOLOGY AND BEHAVIOUR 2023; 99:83-97. [PMID: 38577012 PMCID: PMC10988525 DOI: 10.1016/j.trf.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 04/06/2024]
Abstract
The Spring transition to Daylight Saving Time (DST) has been associated with several health and road safety issues. Previous literature has focused primarily on the analysis of historical crash and hospitalization data, without investigating specific crash contributing factors, such as driving fatigue. The present study aims to uncover the effects of DST-related circadian desynchrony and sleep deprivation on driving fatigue, by means of a driving simulator experiment. Eighteen participants (all males, age range 21-30 years, mean = 24.2, SD = 2.9) completed two 50-minute trials (at one week distance, same time and same day of the week) on a monotonous highway environment, the second one taking place in the week after the Spring transition to DST. Driving fatigue was evaluated by analysing several different variables (including driving-based, physiological and subjective indices) and by comparison with a historical cohort of pertinent, matched controls who had also undergone two trials, but in the absence of any time change in between. Results showed a considerable rise in fatigue levels throughout the driving task in both trials, but with significantly poorer performance in the post-DST trial, documented by a worsening in vehicle lateral control and an increase in eyelid closure. However, participants seemed unable to perceive this decrease in their alertness, which most likely prevented them from implementing fatigue-coping strategies. These findings indicate that DST has a detrimental effect on driving fatigue in young male drivers in the week after the Spring transition, and provide valuable insights into the complex relationship between DST and road safety.
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Affiliation(s)
- Federico Orsini
- Department of Civil, Environmental and Architectural Engineering, University of Padua, Padua, Italy
- Mobility and Behavior Research Center – MoBe, University of Padua, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Gianluca Giusti
- Department of Medicine, University of Padua, Padua, Italy
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | | | - Rodolfo Costa
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
- Department of Biology, University of Padua, Padua, Italy
| | - Sara Montagnese
- Department of Medicine, University of Padua, Padua, Italy
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Riccardo Rossi
- Department of Civil, Environmental and Architectural Engineering, University of Padua, Padua, Italy
- Mobility and Behavior Research Center – MoBe, University of Padua, Padua, Italy
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Rudisill TM, Innes K(K, Wen S, Haggerty T, Smith GS. The effects of cannabidiol on subjective states, cognition, and psychomotor function in healthy adults: A randomized clinical trial. Fundam Clin Pharmacol 2023; 37:663-672. [PMID: 36625844 PMCID: PMC10175152 DOI: 10.1111/fcp.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
Despite being added to numerous products, little is known about cannabidiol. Drowsiness is a self-reported side effect, which could impact cognitive functioning. To determine whether cannabidiol impacts cognition and psychomotor function, a volunteer sample of healthy, college students were recruited for this randomized, parallel-group, double-blind, feasibility trial from April-November 2021. Participants completed a baseline survey, the Stanford Sleepiness Scale, Visual Analog Mood Scale, Digit Symbol Substitution Test, Trail Making Test, Psychomotor Vigilance Test, and Simple Reaction Time Tests. Participants were then randomized and allocated to receive 300 mg cannabidiol oil (N = 21) or placebo (N = 19). After 120 min, participants retook the tests. Performance between groups was compared using Analysis of Covariance and multi-level Negative Binomial regression. Participants averaged 21 ± 3 years of age, and 52% were female. Self-reported anxiety did not change posttreatment. Performances on the Stanford Sleepiness Scale, Visual Analog Mood Scale, and Psychomotor Vigilance Test increased for both groups. After accounting for baseline scores, attention lapse duration significantly increased for those receiving cannabidiol compared to placebo in the Psychomotor Vigilance Test (76 vs. 66 ms; p = 0.02). Auditory reaction time improved in the cannabidiol group versus placebo for one sound emitted during the Simple Reaction Time Test (241 vs. 245 ms; p = 0.02), but the number of early responses increased from 0.3 to 0.8 for those receiving cannabidiol. While performance on most tests was similar between those receiving cannabidiol and placebo, cannabidiol might affect certain aspects of vigilance. More research and larger trials are needed.
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Affiliation(s)
- Toni Marie Rudisill
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Karen (Kim) Innes
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Sijin Wen
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Gordon S. Smith
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA
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Koopmans I, Doll RJ, van der Wall H, de Kam M, Groeneveld GJ, Cohen A, Zuiker R. Fit for purpose of on-the-road driving and simulated driving: A randomised crossover study using the effect of sleep deprivation. PLoS One 2023; 18:e0278300. [PMID: 36730178 PMCID: PMC9894419 DOI: 10.1371/journal.pone.0278300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Drivers should be aware of possible impairing effects of alcohol, medicinal substance, or fatigue on driving performance. Such effects are assessed in clinical trials, including a driving task or related psychomotor tasks. However, a choice between predicting tasks must be made. Here, we compare driving performance with on-the-road driving, simulator driving, and psychomotor tasks using the effect of sleep deprivation. METHOD This two-way cross over study included 24 healthy men with a minimum driving experience of 3000km per year. Psychomotor tasks, simulated driving, and on-the-road driving were assessed in the morning and the afternoon after a well-rested night and in the morning after a sleep-deprived night. Driving behaviour was examined by calculating the Standard Deviation of Lateral Position (SDLP). RESULTS SDLP increased after sleep deprivation for simulated (10cm, 95%CI:6.7-13.3) and on-the-road driving (2.8cm, 95%CI:1.9-3.7). The psychomotor test battery detected effects of sleep deprivation in almost all tasks. Correlation between on-the-road tests and simulator SDLP after a well-rested night (0.63, p < .001) was not present after a night of sleep deprivation (0.31, p = .18). Regarding the effect of sleep deprivation on the psychomotor test battery, only adaptive tracking correlated with the SDLP of the driving simulator (-0.50, p = .02). Other significant correlations were related to subjective VAS scores. DISCUSSION The lack of apparent correlations and difference in sensitivity of performance of the psychomotor tasks, simulated driving and, on-the-road driving indicates that the tasks may not be interchangeable and may assess different aspects of driving behaviour.
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Affiliation(s)
- Ingrid Koopmans
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Adam Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rob Zuiker
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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Psychomotor Vigilance Performance in Participants with Excessive Daytime Sleepiness in Obstructive Sleep Apnea or Narcolepsy Compared with SAFTE-FAST Model Predictions. Neurol Ther 2023; 12:249-265. [PMID: 36494591 PMCID: PMC9837359 DOI: 10.1007/s40120-022-00425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Excessive daytime sleepiness (EDS) associated with narcolepsy or obstructive sleep apnea (OSA) can impair vigilance/attention. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved to treat EDS associated with narcolepsy (75-150 mg/day) or OSA (37.5-150 mg/day). The analysis reported here explored the use of the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model (used in transport industries to model performance based on accumulated sleep and circadian variability) as a substitute for healthy controls using psychomotor vigilance task (PVT) data collected during clinical studies. METHODS Data were analyzed from two phase 2 studies of solriamfetol in adults with OSA (NCT02806895, EudraCT 2015-003930-28) or narcolepsy (NCT02806908, EudraCT 2015-003931-36). Participants were randomly assigned 1:1 to solriamfetol 150 mg/day (3 days) followed by 300 mg/day (4 days), or placebo (7 days), then crossed over to the other treatment. Actual task effectiveness scores were calculated from average PVT inverse reaction time (pre-dose; 2 h post-dose; 6 h post-dose). Actigraphy-derived sleep intervals were used in SAFTE to determine modeled healthy control task effectiveness scores. RESULTS In participants with OSA (N = 31) on placebo or solriamfetol, actual and modeled healthy control task effectiveness did not differ at any time point. In participants with narcolepsy (N = 20) on placebo, actual task effectiveness at 2 h post-dose was lower than modeled healthy control task effectiveness (nominal P = 0.03), a difference not present with solriamfetol. There was no main effect of solriamfetol on actual or modeled healthy control task effectiveness across time points. CONCLUSION This study represents a novel application of the SAFTE biomathematical model to approximate healthy controls in sleep disorder research and provides valuable lessons that may optimize future research. Future studies should perform a priori power analyses for model-tested outcomes and use sleep measures that capture sleep fragmentation characteristic of sleep disorders for sleep input (e.g., total sleep time rather than time in bed). TRIAL REGISTRATION NCT02806895, EudraCT 2015-003930-28: A Randomized, Double-Blind, Placebo-Controlled, Crossover On-Road Driving Study Assessing the Effect of JZP-110 on Driving Performance in Subjects With Excessive Sleepiness Due to Obstructive Sleep Apnea. NCT02806908, EudraCT 2015-003931-36: A Randomized, Double-Blind, Placebo-Controlled, Crossover On-Road Driving Study Assessing the Effect of JZP-110 on Driving Performance in Subjects With Excessive Sleepiness Due to Narcolepsy.
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Sprajcer M, Dawson D, Kosmadopoulos A, Sach EJ, Crowther ME, Sargent C, Roach GD. How Tired is Too Tired to Drive? A Systematic Review Assessing the Use of Prior Sleep Duration to Detect Driving Impairment. Nat Sci Sleep 2023; 15:175-206. [PMID: 37038440 PMCID: PMC10082604 DOI: 10.2147/nss.s392441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/03/2023] [Indexed: 04/12/2023] Open
Abstract
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.
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Affiliation(s)
- Madeline Sprajcer
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
- Correspondence: Madeline Sprajcer, Central Queensland University, Appleton Institute, 44 Greenhill Road, Wayville, SA, 5034, Australia, Email
| | - Drew Dawson
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
| | - Anastasi Kosmadopoulos
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
| | - Edward J Sach
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
| | - Meagan E Crowther
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
| | - Charli Sargent
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
| | - Gregory D Roach
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, SA, Australia
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Gibbings A, Ray LB, Gagnon S, Collin CA, Robillard R, Fogel SM. The EEG correlates and dangerous behavioral consequences of drowsy driving after a single night of mild sleep deprivation. Physiol Behav 2022; 252:113822. [PMID: 35469778 DOI: 10.1016/j.physbeh.2022.113822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Here, we investigated the behavioral, cognitive, and electrophysiological impact of mild, acute sleep loss via simultaneously recorded behavioral and electrophysiological measures of vigilance during a "real-world", simulated driving task. METHODS Participants (N = 34) visited the lab for two testing days where their brain activity and vigilance were simultaneously recorded during a driving simulator task. The driving task lasted approximately 70 mins and consisted of tailgating the lead car at high speed, which braked randomly, requiring participants to react quickly to avoid crashing. The night before testing, participants either slept from 12am-9am (Normally Rested), or 1am-6am (Sleep Restriction). RESULTS After a single night of mild sleep restriction, sleepiness was increased, participants took longer to brake, missed more braking events, and crashed more often. Brain activity showed more intense alpha burst activity and significant changes in EEG spectral power frequencies related to arousal (e.g., delta, theta, alpha). Importantly, increases in amplitude and number of alpha bursts predicted delays in reaction time when braking. CONCLUSIONS The findings of this study suggest that a single night of mild sleep loss has significant, negative consequences on driving performance and vigilance, and a clear impact on the physiology of the brain in ways that reflect reduced arousal. SIGNIFICANCE Understanding neural and cognitive changes associated with sleep loss may lead to important advancements in identifying and preventing potentially dangerous sleep-related lapses in vigilance.
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Affiliation(s)
- A Gibbings
- Sleep Research Unit, The University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - L B Ray
- Sleep Research Unit, The University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, K1Z 7K4, Canada
| | - S Gagnon
- School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - C A Collin
- School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - R Robillard
- Sleep Research Unit, The University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - S M Fogel
- Sleep Research Unit, The University of Ottawa's Institute of Mental Health Research at The Royal, Ottawa, K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada; University of Ottawa Brain & Mind Research Institute, Ottawa, K1H 8M5, Canada.
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Riontino L, Cavallero C. Impact of sleep deprivation on attentional networks: disentangling orienting components. Brain Cogn 2022; 159:105863. [DOI: 10.1016/j.bandc.2022.105863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
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Maghsoudipour M, Moradi R, Moghimi S, Ancoli-Israel S, DeYoung PN, Malhotra A. Time of day, time of sleep, and time on task effects on sleepiness and cognitive performance of bus drivers. Sleep Breath 2022; 26:1759-1769. [DOI: 10.1007/s11325-021-02526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
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McCormick CR. Lifestyle factors and their impact on the networks of attention. APPLIED COGNITIVE PSYCHOLOGY 2021. [DOI: 10.1002/acp.3904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Reassessing Fitness-to-Drive in Drinker Drivers: The Role of Cognition and Personality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312828. [PMID: 34886553 PMCID: PMC8657624 DOI: 10.3390/ijerph182312828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/04/2023]
Abstract
Drunken driving is among the main challenges for road safety by causing worldwide motor-vehicle crashes with severe injuries and deaths. The reassessment of fitness-to-drive in drivers stopped for drunken driving includes mainly psychological examinations. The present study aimed to investigate the effectiveness and the consistency of selected variables of different psychological driving-related dimensions (i.e., cognitive skills and personality) in discriminating 90 male drinker drivers (DD) from matched non-drinkers controls. The Montreal Cognitive Assessment (MoCA), the Mental Rotation Test (MRT), and the Perspective-Taking Test (PT) were administered to assess overall cognitive functioning, and object- and self-based spatial transformation abilities, respectively. Participants completed a computerized test measuring resilience of attention (DT), reaction times (RT), and perceptual speed (ATAVT). The Personality Psychopathology Five scales (i.e., PSY-5: Aggressiveness-AGGR, Psychoticism-PSYC, Disconstraint-DISC, Negative-Emotionality-NEGE, and Introversion-INTR) the validity scale (L) and the dissimulation index (F-K) were scored from the Minnesota Multiphasic Personality Inventory (MMPI-2). A logistic binomial regression analysis (backward subtraction method) was used to identify discriminant predictors. A prediction analysis (ROC curve method) was performed on the final model. Results showed that the scores obtained in MRT, DT, and the personality measures of PSYC, DISC, NEGE, and INTR significantly discriminated DD from their matched controls with moderate-to-good values of accuracy (0.79), sensitivity (0.80), and specificity (0.79), as well as a good AUC value (0.89). In some cases, the personality dimensions provided—reliable—unexpected results. Low scores of PSYC, NEGE, and INTR were found to predict the membership to the DD group; results are discussed with reference to response management. Personality measures should be assessed with particular attention in a forensic context because they are more prone to be feigned than cognitive ones. Overall, the present study confirmed the relevance of integrating different driving-related psychological dimensions in the evaluation of fitness-to-drive showing the usefulness of standardized tools for the reassessment of drinker drivers.
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Walsh MT. Discharging select patients without an escort after ambulatory anesthesia: identifying return to baseline function. Curr Opin Anaesthesiol 2021; 34:703-708. [PMID: 34369407 DOI: 10.1097/aco.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current standard of care requires ambulatory surgical patients to have an escort for discharge. Recent studies have started to challenge this dogma. Modern ultrashort acting anesthetics have minimal psychomotor effects after a couple of hours. Driving simulator performance and psychomotor testing return to baseline as soon as 1 h following propofol sedation. RECENT FINDINGS Two recent reports of actual experience with thousands of patients found no increase in complications in patients who were discharged without escort or drove themselves from a sedation center. These studies suggest discharge without escort may be safe in select patients but a method to identify appropriate patients remains undefined. SUMMARY A reliable test to document return of function might allow safe discharge without an escort. Currently, there is intense interest in developing reliable, inexpensive, easy to administer psychomotor function testing to improve workplace safety and legally define the effects of drugs on driving impairment. Future studies may be able to adapt this technology and develop a validated test for residual anesthetic impairment.
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Affiliation(s)
- Michael T Walsh
- Mayo Clinic, Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
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Bijlenga D, Urbanus B, van der Sluiszen NNJJM, Overeem S, Ramaekers JG, Vermeeren A, Lammers GJ. Comparing objective wakefulness and vigilance tests to on-the-road driving performance in narcolepsy and idiopathic hypersomnia. J Sleep Res 2021; 31:e13518. [PMID: 34755413 PMCID: PMC9286536 DOI: 10.1111/jsr.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
Patients with narcolepsy or idiopathic hypersomnia (IH) are at increased risk of driving accidents. Both excessive daytime sleepiness, i.e. unwanted sleep episodes during the day, and disturbed vigilance are core features of these disorders. We tested on‐the‐road driving performance of patients with narcolepsy or IH coming in for a routine driving fitness evaluation and examined: (1) correlations between driving performance and the Maintenance of Wakefulness Test (MWT), Sustained Attention to Response Task (SART) and Psychomotor Vigilance Test (PVT) as objective tests; (2) the predictive power of the MWT and SART for increased risk of impaired driving; (3) the best set of objective predictors for increased risk of impaired driving. Participants were 44 patients (aged 18–75 years) with narcolepsy type 1 (NT1), type 2 (NT2) or IH. They completed the MWT, SART, PVT, a subjective sleepiness questionnaire, and a standardised on‐the‐road driving test. The standard deviation of the lateral position (SDLP) was used as outcome measure of driving performance. The MWT had low correlation with the SDLP (ρ = −0.41 to −0.49, p < 0.01). The SART and PVT had low correlations with SDLP (ρ = 0.30 and ρ = 0.39, respectively, both p < 0.05). The predictive power of MWT for an increased risk of impaired driving was significant, but low (area under the curve = 0.273, p = 0.012), and non‐significant for SART. We conclude that in our present group, none of the tests had adequate ability to predict impaired driving, questioning their use for clinical driving fitness evaluation in narcolepsy and IH. Real‐time monitoring of sleepiness while driving seems more promising in these patients.
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Affiliation(s)
- Denise Bijlenga
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bram Urbanus
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Nick N J J M van der Sluiszen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sebastiaan Overeem
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jan G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Gert Jan Lammers
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
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Summers SJ, Keegan RJ, Flood A, Martin K, McKune A, Rattray B. The Acute Readiness Monitoring Scale: Assessing Predictive and Concurrent Validation. Front Psychol 2021; 12:738519. [PMID: 34630249 PMCID: PMC8498198 DOI: 10.3389/fpsyg.2021.738519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
To complement and enhance readiness-monitoring capability, the Acute Readiness Monitoring Scale (ARMS) was developed: a widely applicable, simple psychometric measure of perceived readiness. While this tool may have widespread utility in sport and military settings, it remains unknown if the ARMS demonstrates predictive and concurrent validity. Here, we investigated whether the ARMS is: (1) responsive to an acute manipulation of readiness using sleep deprivation, (2) relates to biological markers of readiness [cortisol/heart-rate variability (HRV)], and (3) predicts performance on a cognitive task. Thirty young adults (aged 23 ± 4 years; 18 females) participated. All participants engaged in a 24-h sleep deprivation protocol. Participants completed the ARMS, biological measures of readiness (salivary cortisol, HRV), and cognitive performance measures (psychomotor vigilance task) before, immediately after, 24-, and 48-h post-sleep deprivation. All six of the ARMS subscales changed in response to sleep deprivation: scores on each subscale worsened (indicating reductions in perceived readiness) immediately after sleep deprivation, returning to baseline 24/48 h post. Lower perceived readiness was associated with reduced awakening responses in cortisol and predicted worse cognitive performance (slower reaction time). No relationship was observed between the ARMS and HRV, nor between any biological markers of readiness (cortisol/HRV) and cognitive performance. These data suggest that the ARMS may hold practical utility in detecting, or screening for, the wide range of deleterious effects caused by sleep deprivation; may constitute a quick, cheap, and easily interpreted alternative to biological measures of readiness; and may be used to monitor or mitigate potential underperformance on tasks requiring attention and vigilance.
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Affiliation(s)
- Simon J Summers
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Penrith, NSW, Australia.,Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - Richard J Keegan
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Andrew Flood
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.,Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kristy Martin
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Andrew McKune
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ben Rattray
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
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Spindle TR, Martin EL, Grabenauer M, Woodward T, Milburn MA, Vandrey R. Assessment of cognitive and psychomotor impairment, subjective effects, and blood THC concentrations following acute administration of oral and vaporized cannabis. J Psychopharmacol 2021; 35:786-803. [PMID: 34049452 PMCID: PMC9361180 DOI: 10.1177/02698811211021583] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cannabis legalization is expanding, but there are no established methods for detecting cannabis impairment. AIM Characterize the acute impairing effects of oral and vaporized cannabis using various performance tests. METHODS Participants (N = 20, 10 men/10 women) who were infrequent cannabis users ingested cannabis brownies (0, 10, and 25 mg Δ-9-tetrahydrocannabinol, THC) and inhaled vaporized cannabis (0, 5, and 20 mg THC) in six double-blind outpatient sessions. Cognitive/psychomotor impairment was assessed with a battery of computerized tasks sensitive to cannabis effects, a novel test (the DRiving Under the Influence of Drugs, DRUID®), and field sobriety tests. Blood THC concentrations and subjective drug effects were evaluated. RESULTS Low oral/vaporized doses did not impair cognitive/psychomotor performance relative to placebo but produced positive subjective effects. High oral/vaporized doses impaired cognitive/psychomotor performance and increased positive and negative subjective effects. The DRUID® was the most sensitive test to cannabis impairment, as it detected significant differences between placebo and active doses within both routes of administration. Women displayed more impairment on the DRUID® than men at the high vaporized dose only. Field sobriety tests showed little sensitivity to cannabis-induced impairment. Blood THC concentrations were far lower after cannabis ingestion versus inhalation. After inhalation, blood THC concentrations typically returned to baseline well before pharmacodynamic effects subsided. CONCLUSIONS Standard approaches for identifying impairment due to cannabis exposure (i.e. blood THC and field sobriety tests) have severe limitations. There is a need to identify novel biomarkers of cannabis exposure and/or behavioral tests like the DRUID® that can reliably and accurately detect cannabis impairment at the roadside and in the workplace.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin L Martin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Benderoth S, Hörmann HJ, Schießl C, Elmenhorst EM. Reliability and Validity of a 3-minute Psychomotor Vigilance Task (PVT) in Assessing Sensitivity to Sleep Loss and Alcohol: Fitness for Duty in Aviation and Transportation. Sleep 2021; 44:6301496. [PMID: 34137863 DOI: 10.1093/sleep/zsab151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES The psychomotor vigilance task (PVT) is a widely used objective method to measure sustained attention, but the standard 10-min version is often impractical in operational settings. We investigated the reliability and validity of a 3-min PVT administered on a portable handheld device assessing sensitivity to sleep loss and alcohol in relation to a 10-min PVT and to applied tasks. METHODS Forty-seven healthy volunteers underwent a 12 consecutive days sleep lab protocol. A cross-over design was adopted including total sleep deprivation (TSD, 38 hours awake), sleep restriction (SR, 4 h sleep opportunity), acute alcohol consumption, and SR after alcohol intake (SR/Alc 4 h sleep opportunity). Participants performed a 10-min and 3-min PVT and operationally-relevant tasks related to demands in aviation and transportation. RESULTS Sleep loss resulted in significant performance impairments compared to baseline measurements detected by both PVT versions - particularly for mean speed (both p < .001) - and the operationally-relevant tasks. Similar effects were observed due to alcohol intake (speed: both p < .001). The 3-min and 10-min PVT results were highly correlated (speed: between r = .72 and r = .89). Three of four aviation related tasks showed robust correlations with the 3-min PVT. Correlations with the parameters of the task related to transportation were lower, but mainly significant. CONCLUSION The 3-min PVT showed a high reliability and validity in assessing sleep loss and alcohol induced impairments in cognitive performance. Thus, our results underline its usefulness as potential fitness for duty self-monitoring tool in applied settings.
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Affiliation(s)
- Sibylle Benderoth
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Hans-Jürgen Hörmann
- Department of Aviation and Space Psychology, Institute of Aerospace Medicine, German Aerospace Center (DLR), Hamburg, Germany
| | - Caroline Schießl
- Department of Information Flow Modelling in Mobility Systems, Institute of Transportation Systems, German Aerospace Center (DLR), Braunschweig, Germany
| | - Eva-Maria Elmenhorst
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Institute for Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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17
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Lal C, Weaver TE, Bae CJ, Strohl KP. Excessive Daytime Sleepiness in Obstructive Sleep Apnea. Mechanisms and Clinical Management. Ann Am Thorac Soc 2021; 18:757-768. [PMID: 33621163 PMCID: PMC8086534 DOI: 10.1513/annalsats.202006-696fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Many patients with obstructive sleep apnea (OSA) experience excessive daytime sleepiness (EDS), which can negatively affect daily functioning, cognition, mood, and other aspects of well-being. Although EDS can be reduced with primary OSA treatment, such as continuous positive airway pressure (CPAP) therapy, a significant proportion of patients continue to experience EDS despite receiving optimized therapy for OSA. This article reviews the pathophysiology and clinical evaluation and management of EDS in patients with OSA. The mechanisms underlying EDS in CPAP-treated patients remain unclear. Experimental risk factors include chronic intermittent hypoxia and sleep fragmentation, which lead to oxidative injury and changes in neurons and brain circuit connectedness involving noradrenergic and dopaminergic neurotransmission in wake-promoting regions of the brain. In addition, neuroimaging studies have shown alterations in the brain's white matter and gray matter in patients with OSA and EDS. Clinical management of EDS begins with ruling out other potential causes of EDS and evaluating its severity. Tools to evaluate EDS include objective and self-reported assessments of sleepiness, as well as cognitive assessments. Patients who experience residual EDS despite primary OSA therapy may benefit from wake-promoting pharmacotherapy. Agents that inhibit reuptake of dopamine or of dopamine and norepinephrine (modafinil/armodafinil and solriamfetol, respectively) have demonstrated efficacy in reducing EDS and improving quality of life in patients with OSA. Additional research is needed on the effects of wake-promoting treatments on cognition in these patients and to identify individual or disorder-specific responses.
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Affiliation(s)
- Chitra Lal
- Medical University of South Carolina, Charleston, South Carolina
| | - Terri E. Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Charles J. Bae
- Penn Sleep Center, University of Pennsylvania, Philadelphia, Pennsylvania; and
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18
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van der Sluiszen NNJJM, Urbanus B, Lammers GJ, Overeem S, Ramaekers JG, Vermeeren A. On-the-road driving performance of patients with central disorders of hypersomnolence. TRAFFIC INJURY PREVENTION 2021; 22:120-126. [PMID: 33543997 DOI: 10.1080/15389588.2020.1862804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 11/03/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Excessive Daytime Sleepiness is a core symptom of narcolepsy and idiopathic hypersomnia, which impairs driving performance. Adequate treatment improves daytime alertness, but it is unclear whether driving performance completely normalizes. This study compares driving performance of patients with narcolepsy and idiopathic hypersomnia receiving treatment to that of healthy controls. METHODS Patients diagnosed with narcolepsy type 1 (NT1, n = 33), narcolepsy type 2 (NT2, n = 7), or idiopathic hypersomnia (IH, n = 6) performed a standardized one-hour on-the-road driving test, measuring standard deviation of lateral position (SDLP). RESULTS Results showed that mean SDLP in patients did not differ significantly from controls, but the 95%CI of the mean difference (+1.02 cm) was wide (-0.72 to +2.76 cm). Analysis of subgroups, however, showed that mean SDLP in NT1 patients was significantly increased by 1.90 cm as compared to controls, indicating impairment. Moreover, four NT1 patients requested to stop the test prematurely due to self-reported somnolence, and two NT1 patients were stopped by the driving instructor for similar complaints. CONCLUSION Driving performance of NT1 patients may still be impaired, despite receiving treatment. No conclusions can be drawn for NT2 and IH patients due to the low sample sizes of these subgroups. In clinical practice, determination of fitness to drive for these patients should be based on an individual assessment in which also coping strategies are taken into account.
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Affiliation(s)
- N N J J M van der Sluiszen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B Urbanus
- Stichting Epilepsie Instelling Nederland (SEIN), Heemstede, The Netherlands
| | - G J Lammers
- Stichting Epilepsie Instelling Nederland (SEIN), Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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19
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Gibbings A, Ray LB, Berberian N, Nguyen T, Shahidi Zandi A, Owen AM, Comeau FJE, Fogel SM. EEG and behavioural correlates of mild sleep deprivation and vigilance. Clin Neurophysiol 2020; 132:45-55. [PMID: 33248433 DOI: 10.1016/j.clinph.2020.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The current study investigated the behavioral, cognitive, and electrophysiological impact of mild (only a few hours) and acute (one night) sleep loss via simultaneously recorded behavioural and physiological measures of vigilance. METHODS Participants (N = 23) came into the lab for two testing days where their brain activity and vigilance were recorded and assessed. The night before the testing session, participants either slept from 12am to 9am (Normally Rested), or from 1am to 6am (Sleep Restriction). RESULTS Vigilance was reduced and sleepiness was increased in the Sleep Restricted vs. Normally Rested condition, and this was exacerbated over the course of performing the vigilance task. As well, sleep restriction resulted in more intense alpha bursts. Lastly, EEG spectral power differed in Sleep Restricted vs. Normally Rested conditions as sleep onset progressed, particularly for frequencies reflecting arousal (e.g., delta, alpha, beta). CONCLUSIONS The findings of this study suggest that only one night of mild sleep loss significantly increases sleepiness and, importantly, reduces vigilance. In addition, this sleep loss has a clear impact on the physiology of the brain in ways that reflect reduced arousal. SIGNIFICANCE Understanding the neural correlates and cognitive processes associated with loss of sleep may lead to important advancements in identifying and preventing deleterious or potentially dangerous, sleep-related lapses in vigilance.
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Affiliation(s)
- A Gibbings
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - L B Ray
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - N Berberian
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - T Nguyen
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - A Shahidi Zandi
- Alcohol Countermeasures Systems Corp (ACS), Toronto M9W 6J2, Canada
| | - A M Owen
- The Brain & Mind Institute, Western University, London N6A 5B7, Canada
| | - F J E Comeau
- Alcohol Countermeasures Systems Corp (ACS), Toronto M9W 6J2, Canada
| | - S M Fogel
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; The Brain & Mind Institute, Western University, London N6A 5B7, Canada; University of Ottawa Brain & Mind Research Institute, Ottawa K1H 8M5, Canada.
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20
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Driving Accidents, Driving Violations, Symptoms of Attention-Deficit-Hyperactivity (ADHD) and Attentional Network Tasks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145238. [PMID: 32698490 PMCID: PMC7400088 DOI: 10.3390/ijerph17145238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/12/2020] [Accepted: 07/16/2020] [Indexed: 01/21/2023]
Abstract
Background: Iran has serious problems with traffic-related injuries and death. A major reason for traffic accidents is cognitive failure due to deficits in attention. In this study, we investigated the associations between traffic violations, traffic accidents, symptoms of attention-deficit/hyperactivity disorder (ADHD), age, and on an attentional network task in a sample of Iranian adults. Methods: A total of 274 participants (mean age: 31.37 years; 80.7% males) completed questionnaires covering demographic information, driving violations, traffic accidents, and symptoms of ADHD. In addition, they underwent an objective attentional network task (ANT), based on Posner’s concept of attentional networks. Results: More frequent traffic violations, correlated with lower age and poorer performance on the attentional network tasks. Higher symptoms of ADHD were associated with more accidents and more traffic violations, but not with the performance of the attentional tasks. Higher ADHD scores, a poorer performance on attentional network tasks, and younger age predicted traffic violations. Only higher symptoms of ADHD predicted more traffic accidents. Conclusions: In a sample of Iranian drivers, self-rated symptoms of ADHD appeared to be associated with traffic violations and accidents, while symptoms of ADHD were unrelated to objectively assessed performance on an attentional network task. Poor attentional network performance was a significant predictor of traffic violations but not of accidents. To increase traffic safety, both symptoms of ADHD and attentional network performance appear to merit particular attention.
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21
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Lowrie J, Brownlow H. The impact of sleep deprivation and alcohol on driving: a comparative study. BMC Public Health 2020; 20:980. [PMID: 32571274 PMCID: PMC7310070 DOI: 10.1186/s12889-020-09095-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is concern about the detrimental effects of shift-workers’ increasing working hours particularly when driving sleep deprived. The approach to measuring the magnitude of driving impairment caused by sleep deprivation was by comparing it to alcohol. The study compared driving performance after 24-h of wakefulness to performance with a BrAC of just over 22 μg/100mls of breath which is equal to 50 mg of alcohol per 100mls of blood (Scottish drink-drive limit). The effectiveness of coffee as a countermeasure for driver fatigue and the association between subjective impairment and actual performance was also investigated. Methods A study of 30 participants (11 male and 19 female; mean age 21) was conducted. Subjects were tested under three conditions: fully rested, sleep deprived, and alcohol intoxicated – BrAC mean [SD] 25.95 μg [2.78]. Under each condition, subjects were tested before and after coffee ingestion. This involved driving simulation (Lane Change Task and Reaction Test) and subjective Likert scales (Karolinska Sleepiness Scale and driver impairment scale). Outcome measures included lane tracking adaptive mean deviation, reaction time, and subjective sleepiness and impairment ratings. Results Compared to alcohol, sleep deprived mean reaction times were slower (2.86 s vs. 2.34 s) and lateral control of the vehicle was reduced (lane tracking adaptive mean deviation: 0.5 vs. 0.3). Coffee did not produce an improvement when sleep deprived, and instead, performance deteriorated. Females were less impaired following sleep deprivation than males. Following prolonged wakefulness, the correlation between subjective impairment and actual performance was significant. Conclusions It was concluded that sleep deprivation has a greater impact on driving performance than a BrAC of 22 μg/100mls of breath, as measured by driving simulation. Coffee is not an effective countermeasure for sleep deprived driving and drivers’ ability to judge this impairment is suggested to be limited.
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Affiliation(s)
- Joanna Lowrie
- University of Dundee, Nethergate, Dundee, DD1 4HN, Scotland.
| | - Helen Brownlow
- The Centre for Forensic & Legal Medicine, 2 Park Pl, Dundee, DD1 4HR, Scotland
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22
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Spindle TR, Cone EJ, Goffi E, Weerts EM, Mitchell JM, Winecker RE, Bigelow GE, Flegel RR, Vandrey R. Pharmacodynamic effects of vaporized and oral cannabidiol (CBD) and vaporized CBD-dominant cannabis in infrequent cannabis users. Drug Alcohol Depend 2020; 211:107937. [PMID: 32247649 PMCID: PMC7414803 DOI: 10.1016/j.drugalcdep.2020.107937] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The use and availability of oral and inhalable products containing cannabidiol (CBD) as the principal constituent has increased with expanded cannabis/hemp legalization. However, few controlled clinical laboratory studies have evaluated the pharmacodynamic effects of oral or vaporized CBD or CBD-dominant cannabis. METHODS Eighteen healthy adults (9 men; 9 women) completed four, double-blind, double-dummy, drug administration sessions. Sessions were separated by ≥1 week and included self-administration of 100 mg oral CBD, 100 mg vaporized CBD, vaporized CBD-dominant cannabis (100 mg CBD; 3.7 mg THC), and placebo. Study outcomes included: subjective drug effects, vital signs, cognitive/psychomotor performance, and whole blood THC and CBD concentrations. RESULTS Vaporized CBD and CBD-dominant cannabis increased ratings on several subjective items (e.g., Like Drug Effect) relative to placebo. Subjective effects did not differ between oral CBD and placebo and were generally higher for CBD-dominant cannabis compared to vaporized CBD. CBD did not increase ratings for several items typically associated with acute cannabis/THC exposure (e.g., Paranoid). Women reported qualitatively higher ratings for Pleasant Drug Effect than men after vaporized CBD and CBD-dominant cannabis use. CBD-dominant cannabis increased heart rate compared to placebo. Cognitive/psychomotor impairment was not observed in any drug condition. CONCLUSIONS Vaporized CBD and CBD-dominant cannabis produced discriminable subjective drug effects, which were sometimes stronger in women, but did not produce cognitive/psychomotor impairment. Subjective effects of oral CBD did not differ from placebo. Future research should further elucidate the subjective effects of various types of CBD products (e.g., inhaled, oral, topical), which appear to be distinct from THC-dominant products.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA.
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Elia Goffi
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Elise M Weerts
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - John M Mitchell
- RTI International, Research Triangle Park, 3040 East Cornwallis Rd., NC, 27709, USA
| | - Ruth E Winecker
- RTI International, Research Triangle Park, 3040 East Cornwallis Rd., NC, 27709, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Ronald R Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600Fishers Lane, Rockville, MD, 20857, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
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Rahman SA, Rood D, Trent N, Solet J, Langer EJ, Lockley SW. Manipulating sleep duration perception changes cognitive performance - An exploratory analysis. J Psychosom Res 2020; 132:109992. [PMID: 32172039 PMCID: PMC7568839 DOI: 10.1016/j.jpsychores.2020.109992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To test the effect of perceived sleep duration on cognitive performance. METHODS Sixteen healthy individuals [8F; mean age (± SD): 24.2 ± 3.0 years)] received an 8-h sleep opportunity followed by a 5-h opportunity on two consecutive nights. Upon waking, they were randomized to being informed that they received either an 8-h or 5-h sleep opportunity, via a clock that ran either fast, slow or normally. Cognitive performance was assessed using 10-min auditory psychomotor vigilance tests and subjective sleepiness ratings. Homeostatic and circadian sleep drive was assessed using waking electroencephalography (EEG). RESULTS Reaction time was significantly quicker when individuals thought that they had slept for 8 h but given a 5-h sleep opportunity. Conversely, reaction times were significantly slower when individuals thought they had 5 h of sleep but given an 8-h sleep opportunity. EEG delta power (1.0-4.5 Hz) during wake increased significantly when sleep was restricted to 5 h, and individuals thought they slept for 5 h, but this increase was attenuated with a perceived sleep duration of 8 h following a 5-h opportunity. EEG delta power did not increase, however, with perceived sleep restriction. EEG high-alpha activity (10.5-11.5 Hz) was consistently higher when participants thought that they had an 8-h sleep opportunity, regardless of the actual duration. CONCLUSIONS These results suggest that perceived sleep duration may modulate psychosomatic responses. Additional studies with predefined outcomes and analyses are necessary to confirm these findings, which may have important implications for understanding how sleep affects cognition and psychosomatic responses.
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Affiliation(s)
- Shadab A. Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, 02115,Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115
| | - Dharmishta Rood
- Department of Psychology, Harvard University, Cambridge, MA, 02139
| | - Natalie Trent
- Department of Psychology, Harvard University, Cambridge, MA, 02139
| | - Jo Solet
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115,Department of Medicine, Cambridge Health Alliance, Cambridge, MA, 02139
| | - Ellen J. Langer
- Department of Psychology, Harvard University, Cambridge, MA, 02139
| | - Steven W. Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, 02115,Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115
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24
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St Hilaire MA, Anderson C, Anwar J, Sullivan JP, Cade BE, Flynn-Evans EE, Czeisler CA, Lockley SW. Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts. Sleep 2020; 42:5362587. [PMID: 30794317 DOI: 10.1093/sleep/zsz041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/15/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) recently reinstated extended-duration (24-28 hr) work shifts (EDWS) for postgraduate year 1 (PGY-1) resident physicians. This study examined the relationship between overnight sleep duration during EDWS and subsequent "post-call" performance in PGY-1 resident physicians. METHODS Thirty-four PGY-1 resident physicians (23 males; 24-32 years) were studied between 2002 and 2004 during 3-week Q3 "on-call" rotation schedules in the Medical and Cardiac Intensive Care Units at Brigham and Women's Hospital in Boston. Daily sleep logs (validated by ambulatory polysomnography) were collected and the 10 min psychomotor vigilance task (PVT) was administered every ~6 hr during each EDWS. Generalized estimating equations were used to examine the relationship between overnight sleep duration and PVT performance "post-call" (0500-1900 hr). Postcall performance during EDWS was compared with sessions matched for time-of-day and weeks-into-schedule in the same resident physician during an intervention schedule that eliminated EDWS. RESULTS Resident physicians obtained an average of 1.6 ± 1.5 hr cumulative sleep overnight during EDWS (<4 hr on 92% of nights). PVT attentional failures were significantly reduced only after >4 hr sleep (p = 0.027 versus no sleep). Despite this apparent improvement, the odds of incurring >1 attentional failure were 2.72 times higher during postcall following >4 hr sleep compared with matched sessions during non-EDWS. CONCLUSIONS Even with >4 hr sleep overnight (8% of EDWS), performance remained significantly impaired. These findings suggest that even "strategic napping," a recommendation recently removed from ACGME guidelines, is insufficient to mitigate severe performance impairment introduced by extending duty beyond 16 hr.
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Affiliation(s)
- Melissa A St Hilaire
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Clare Anderson
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Junnat Anwar
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Jason P Sullivan
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Brian E Cade
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Erin E Flynn-Evans
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Steven W Lockley
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Arora S, Lawrence MA, Klein RM. The Attention Network Test Database: ADHD and Cross-Cultural Applications. Front Psychol 2020; 11:388. [PMID: 32292363 PMCID: PMC7119191 DOI: 10.3389/fpsyg.2020.00388] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/19/2020] [Indexed: 12/24/2022] Open
Abstract
Attention is a central component of cognitive and behavioral processes and plays a key role in basic and higher-level functioning. Posner's model of attention describes three components or networks of attention: the alerting, which involves high intensity states of arousal; the orienting, which involves the selective direction of attention; and the executive control, which involves cognitive functions such as conflict resolution and working memory. The Attention Network Test (ANT) is a computerized testing measure that was developed to measure these three networks of attention. This project describes the ANT, its widely used variants, and the recently developed ANT Database, a repository of data extracted from all studies that have used the ANT as of 2019. To illustrate the potential uses of the database, two meta-analyses conducted using the ANT Database are described. One explores task performance in children with and without attention deficit/hyperactivity disorder (ADHD). The other one explores regional differences between studies conducted in China, Europe, and the United States. We are currently in the process of integrating the database into a publicly available web interface. When that work is complete, researchers, clinicians, and the general public will be able to use the database to explore topics of interest related to attention.
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Affiliation(s)
- Swasti Arora
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Raymond M. Klein
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Vinckenbosch FRJ, Vermeeren A, Verster JC, Ramaekers JG, Vuurman EF. Validating lane drifts as a predictive measure of drug or sleepiness induced driving impairment. Psychopharmacology (Berl) 2020; 237:877-886. [PMID: 31897572 PMCID: PMC7036056 DOI: 10.1007/s00213-019-05424-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Standard deviation of lateral position (SDLP) has been accepted as a reliable parameter for measuring driving impairment due to lowered vigilance caused by sleepiness or the use of sedating drugs. Recently, lane drifts were proposed as an additional outcome measure quantifying momentary lapses of attention. The purpose of this study was to validate lane drifts as outcome measure of driver impairment in a large data pool from two independent research centers. METHODS Data from 11 placebo-controlled studies that assessed the impact of alcohol, hypnotics, and sleep deprivation on actual driving performance were pooled. In total, 717 on-the-road tests performed by 315 drivers were subjected to an automated algorithm to detect occurrences of lane drifts. Lane drifts were defined as deviations > 100 cm from the mean (LDmlp) and from the absolute lateral position (LDalp) for 8 s. RESULTS The number of LDmlp was low and did not differ between treatments and baseline, i.e., 14 vs. 3 events, respectively. LDalp were frequent and significantly higher during treatment relative to baseline, i.e., 1646 vs. 470 events. The correlation between LDalp and SDLP in the treatment conditions was very high (rs = 0.77). The frequency of the occurrence of treatment-induced lane drifts however depended on baseline SDLP of drivers, whereas treatment-induced changes in SDLP occurred independent of baseline SDLP. CONCLUSION LDmlp is not useful as an outcome measure of driver impairment due to its rare occurrence, even when treatment-induced increments in SDLP are evident. Treatment effects on LDalp and SDLP are closely related.
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Affiliation(s)
- F. R. J. Vinckenbosch
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - A. Vermeeren
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - J. C. Verster
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands ,Division of Pharmacology, Utrecht University, 3584CG, Utrecht, The Netherlands ,Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
| | - J. G. Ramaekers
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - E. F. Vuurman
- Department of neuropsychology and psychopharmacology, Maastricht University, Maastricht, The Netherlands
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Stojanoski B, Benoit A, Van Den Berg N, Ray LB, Owen AM, Shahidi Zandi A, Quddus A, Comeau FJE, Fogel SM. Sustained vigilance is negatively affected by mild and acute sleep loss reflected by reduced capacity for decision making, motor preparation, and execution. Sleep 2019; 42:5139646. [PMID: 30346590 DOI: 10.1093/sleep/zsy200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
Study Objectives The behavioral and cognitive consequences of severe sleep deprivation are well understood. Surprisingly, relatively little is known about the neural correlates of mild and acute sleep restriction on tasks that require sustained vigilance for prolonged periods of time during the day. Methods and Results Event-related potential (ERP) paradigms can reveal insight into the neural correlates underlying visual processing and behavioral responding that is impaired with reduced alertness, as a consequence of sleep loss. Here, we investigated the impact of reduced vigilance following at-home mild sleep restriction to better understand the associated behavioral consequences and changes in information processing revealed by ERPs. As expected, vigilance was reduced (e.g. increased lapses and response slowing) that increased over the course of the experiment in the "sleep restricted" (5 hr sleep) compared with the "sleep-extension" (9 hr sleep) condition. Corresponding to these lapses, we found decreased positivity of visually evoked potentials in the Sleep Restriction vs. Sleep Extension condition emerging from 316 to 449 ms, maximal over parietal/occipital cortex. We also investigated electrophysiological signs of motor-related processing by comparing lateralized readiness potentials (LRPs) and found reduced positivity of LRPs in the Sleep Restriction vs. Sleep Extension condition at 70-40 ms before, and 115-158 ms after a response was made. Conclusions These results suggest that even a single night of mild sleep restriction can negatively affect vigilance, reflected by reduced processing capacity for decision making, and dulls motor preparation and execution.
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Affiliation(s)
| | - Antoine Benoit
- The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Nicholas Van Den Berg
- The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Laura B Ray
- The Royal's Institute of Mental Health Research, Ottawa, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
| | | | - Azhar Quddus
- Alcohol Countermeasures Systems Corp (ACS), Toronto, Canada
| | | | - Stuart M Fogel
- Brain and Mind Institute, Western University, London, Canada.,The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada.,University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
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28
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van der Sluiszen NN, Vermeeren A, Verster JC, van de Loo AJ, van Dijken JH, Veldstra JL, Brookhuis KA, de Waard D, Ramaekers JG. Driving performance and neurocognitive skills of long-term users of benzodiazepine anxiolytics and hypnotics. Hum Psychopharmacol 2019; 34:e2715. [PMID: 31837049 PMCID: PMC7003498 DOI: 10.1002/hup.2715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/03/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to compare actual driving performance and skills related to driving of patients using benzodiazepine anxiolytics or hypnotics for at least 6 months to that of healthy controls. METHODS Participants were 44 long-term users of benzodiazepine and benzodiazepine-related anxiolytics (n = 12) and hypnotics (n = 32) and 65 matched healthy controls. Performance was assessed using an on-the-road driving test measuring standard deviation of lateral position (SDLP, in cm) and a battery of neurocognitive tasks. Performance differences between groups were compared with a blood alcohol concentration of 0.5 mg/ml to determine clinical relevance. RESULTS Compared with controls, SDLP was significantly increased in hypnotic users (+1.70 cm) but not in anxiolytic users (+1.48 cm). Anxiolytic and hypnotic users showed significant and clinically relevant impairment on neurocognitive task measuring executive functioning, vigilance, and reaction time. For patients using hypnotics for at least 3 years, no significant driving impairment was observed. CONCLUSION Impairing effects of benzodiazepine hypnotics on driving performance may mitigate over time following longer term use (i.e. 3 years or more) although neurocognitive impairments may remain.
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Affiliation(s)
- Nick N.J.J.M. van der Sluiszen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Joris C. Verster
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands,Centre for Human PsychopharmacologySwinburne UniversityMelbourneVictoriaAustralia
| | - Aurora J.A.E. van de Loo
- Division PharmacologyUtrecht UniversityUtrechtThe Netherlands,Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Joke H. van Dijken
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Janet L. Veldstra
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Karel A. Brookhuis
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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Sleep after Heavy Alcohol Consumption and Physical Activity Levels during Alcohol Hangover. J Clin Med 2019; 8:jcm8050752. [PMID: 31137775 PMCID: PMC6572586 DOI: 10.3390/jcm8050752] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/16/2022] Open
Abstract
Alcohol consumption can negatively affect sleep quality. The current study examined the impact of an evening of alcohol consumption on sleep, and next day activity levels and alcohol hangover. n = 25 healthy social drinkers participated in a naturalistic study, consisting of an alcohol and alcohol-free test day. On both days, a GENEactiv watch recorded sleep and wake, and corresponding activity levels. In addition, subjective assessments of sleep duration and quality were made, and hangover severity, and the amount of consumed alcoholic beverages were assessed. Alcohol consumption was also assessed in real-time during the drinking session, using smartphone technology. The results confirmed, by using both objective and subjective assessments, that consuming a large amount of alcohol has a negative impact on sleep, including a significant reduction in objective sleep efficiency and significantly lower self-reported sleep quality. Activity levels during the hangover day were significantly reduced compared to the alcohol-free control day. Of note, next-morning retrospective alcohol consumption assessments underestimated real-time beverage recordings. In conclusion, heavy alcohol consumption impairs sleep quality, which is associated with increased next day hangover severity and reduced activity levels. The outcome of this study underlines that, in addition to retrospectively reported data, real-time objective assessments are needed to fully understand the effects of heavy drinking.
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Colizzi M, Bhattacharyya S. Cannabis use and the development of tolerance: a systematic review of human evidence. Neurosci Biobehav Rev 2018; 93:1-25. [DOI: 10.1016/j.neubiorev.2018.07.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
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Harand C, Mondou A, Chevanne D, Bocca ML, Defer G. Evidence of attentional impairments using virtual driving simulation in multiple sclerosis. Mult Scler Relat Disord 2018; 25:251-257. [PMID: 30144695 DOI: 10.1016/j.msard.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Detection of attentional disorders in complex situation related to daily life activities in multiple sclerosis patients needs better adapted tools than traditional cognitive assessment. OBJECTIVE To investigate the usefulness of virtual reality assessment of attention in multiple sclerosis, especially to evaluate alertness and divided attention using driving simulation. METHODS In this preliminary study, 11 relapsing-remitting patients (median EDSS: 2; mean disease duration of 10.3 years) and 11 healthy matched controls performed a driving simulation under three conditions (monotonous driving, divided attention driving and urban driving) where Standard Deviation of Lateral position (SDLP) was the main evaluated criteria. In comparison, traditional cognitive assessment of attentional functions was administered (SDMT, alertness and divided attention of TAP battery). Statistical non-parametric Mann-Whitney U tests were used to compare performances between groups in the two types of assessments. Exploratory correlational analyses were further conducted. RESULTS No significant difference was observed between groups for traditional attentional assessment except for information processing speed (SDMT; p < 0.01). Considering virtual reality, patients were less efficient than controls on the primary parameter of safe driving (SDLP; p < 0.05). They also committed more errors and omissions (p < 0.01) and speed fluctuations (p < 0.01) during the divided-attention driving condition. Urban driving did not reveal difference between groups. Lack of significant correlations between traditional and virtual reality attentional assessment suggested that they do not evaluate the same cognitive processes. CONCLUSION Patients experienced difficulties in maintaining the trajectory and the speed of the simulated vehicle which may be indicative of attentional difficulties, especially alertness and divided attention. These impairments were not revealed by the traditional cognitive assessment. Results of this preliminary study shed new light about the usefulness of virtual reality techniques and their future interest as a part of cognitive rehabilitation programs. They also highlights the need to develop driving preventive measures in MS.
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Affiliation(s)
- C Harand
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France.
| | - A Mondou
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - D Chevanne
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - M L Bocca
- Normandie University, UNICAEN, INSERM, U1075, COMETE, 14000 Caen, France
| | - G Defer
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France; Réseau Bas-Normand Pour la Prise en Charge de la SEP, 14000 Caen, France
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Bhat S, Gupta D, Akel O, Polos PG, DeBari VA, Akhtar S, McIntyre A, Ming SX, Upadhyay H, Chokroverty S. The relationships between improvements in daytime sleepiness, fatigue and depression and psychomotor vigilance task testing with CPAP use in patients with obstructive sleep apnea. Sleep Med 2018; 49:81-89. [PMID: 30093261 DOI: 10.1016/j.sleep.2018.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if the subjective improvements in daytime sleepiness, fatigue and depression experienced by patients with obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) therapy predict an objective improvement in vigilance, and whether patients with mild-to-moderate OSA differ from patients with severe OSA in this regard. METHODS A total of 182 patients underwent psychomotor vigilance task (PVT) testing and measurements of subjective daytime sleepiness, fatigue and depression at baseline and after a minimum of one month of adherent CPAP use at an adequate pressure. RESULTS Patients with both mild-to-moderate (n = 92) and severe (n = 90) OSA experienced improvements in subjective daytime sleepiness, fatigue and depression, but objective improvement in vigilance was only seen in patients with severe OSA. In patients with severe OSA, while a correlation was found between improvements in daytime sleepiness and some PVT parameters, changes in subjective daytime sleepiness, fatigue and depression scores were not predictive of objective improvement in vigilance while controlling for all these subjective symptoms and for age, gender, body mass index, apnea-hypopnea index/respiratory event index and total sleep time/total recording time with pulse oximetry below 90%. CONCLUSIONS We found no predictive relationship between subjective improvements in daytime sleepiness, fatigue and depression and objective vigilance with CPAP use in patients with OSA. These results suggest that subjective complaints of daytime impairment and objective measures of vigilance in patients with OSA should be assessed separately while evaluating the efficacy of CPAP therapy on daytime functioning.
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Affiliation(s)
- Sushanth Bhat
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA.
| | - Divya Gupta
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
| | - Omar Akel
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
| | - Peter G Polos
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
| | | | - Shaista Akhtar
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
| | - Anna McIntyre
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
| | - Sue X Ming
- Rutgers University-New Jersey Medical School, Newark, NJ, USA
| | | | - Sudhansu Chokroverty
- JFK Neuroscience Institute, Hackensack Meridian Health-JFK Medical Center, Edison, NJ 08818, USA
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Ferreira DH, Boland JW, Phillips JL, Lam L, Currow DC. The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review. Palliat Med 2018; 32:786-803. [PMID: 29299954 DOI: 10.1177/0269216317746583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety. AIM To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness. DESIGN Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909. DATA SOURCES Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools. RESULTS From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance. CONCLUSION This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
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Affiliation(s)
- Diana H Ferreira
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Jason W Boland
- 2 Hull York Medical School, University of Hull, Hull, UK
| | - Jane L Phillips
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Lawrence Lam
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.,2 Hull York Medical School, University of Hull, Hull, UK.,3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,4 Wolfson Centre for Palliative Care Research, Hull York Medical School, University of Hull, Hull, UK
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Colizzi M, Bhattacharyya S. Neurocognitive effects of cannabis: Lessons learned from human experimental studies. PROGRESS IN BRAIN RESEARCH 2018; 242:179-216. [DOI: 10.1016/bs.pbr.2018.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Comparing the effects of oxazepam and diazepam in actual highway driving and neurocognitive test performance: a validation study. Psychopharmacology (Berl) 2018; 235:1283-1294. [PMID: 29500585 PMCID: PMC5869943 DOI: 10.1007/s00213-018-4844-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Screening of drug-induced performance impairment is needed to provide meaningful information for users and prescribers regarding the impact of drugs on driving. The main objective was to assess the effects of oxazepam 10 mg (OXA10), oxazepam 30 mg (OXA30), and diazepam 10 mg (DIA10) on standard deviation of lateral position (SDLP) in a highway driving test in actual traffic and to determine the ability of eight neurocognitive tests to detect comparable effects. METHODS Twenty-three healthy volunteers participated in a four-way double-blind, placebo-controlled, crossover study. The highway driving test was conducted between 4 and 5 h after drug intake. A range of neurocognitive tests was conducted before and after driving, 2 and 6 h post-treatment, respectively. RESULTS Mean SDLP increased by 1.83, 3.03, and 7.57 cm after OXA10, DIA10, and OXA30, respectively. At 2 h post-treatment, all neurocognitive tests, except the useful field of view, showed performance impairment in all active treatments. Effect sizes (ES) were moderate for OXA10, large ES for DIA10, and largest ES for OXA30. Modest correlations were found between changes in SDLP and performance in the attention network test (ANT), the divided attention test (DAT), and the psychomotor vigilance test (PVT). CONCLUSION OXA10 caused minor, DIA10 moderate, and OXA30 severe driving impairment. No neurocognitive test was both dose dependently sensitive and able to be associated with driving impairment. No neurocognitive test can replace the on-the-road highway driving test.
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Schumacher MB, Jongen S, Knoche A, Petzke F, Vuurman EF, Vollrath M, Ramaekers JG. Effect of chronic opioid therapy on actual driving performance in non-cancer pain patients. Psychopharmacology (Berl) 2017; 234:989-999. [PMID: 28190085 DOI: 10.1007/s00213-017-4539-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/16/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Chronic non-cancer pain (CNCP) is a major health problem. Patients are increasingly treated with chronic opioid therapy (COT). Several laboratory studies have demonstrated that long-term use of opioids does not generally impair driving related skills. But there is still a lack of studies investigating on-the-road driving performance in actual traffic. OBJECTIVES The present study assessed the impact of COT on road-tracking and car-following performance in CNCP patients. METHODS Twenty CNCP patients, long-term treated with stable doses of opioid analgesics, and 19 healthy controls conducted standardized on-the-road driving tests in normal traffic. Performance of controls with a blood alcohol concentration (BAC) of 0.5 g/L was used as a reference to define clinically relevant changes in driving performance. RESULTS Standard Deviation of Lateral Position (SDLP), a measure of road-tracking control, was 2.57 cm greater in CNCP patients than in sober controls. This difference failed to reach statistical significance in a superiority test. Equivalence testing indicated that the 95% CI around the mean SDLP change was equivalent to the SDLP change seen in controls with a BAC of 0.5 g/L and did not include zero. When corrected for age differences between groups the 95% CI widened to include both the alcohol reference criterion and zero. No difference was found in car-following performance. CONCLUSIONS Driving performance of CNCP patients did not significantly differ from that of controls due to large inter-individual variations. Hence in clinical practice determination of fitness to drive of CNCP patients who receive opioid treatments should be based on an individual assessment.
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Affiliation(s)
- Markus B Schumacher
- Federal Highway Research Institute (BASt), Bruederstrasse 53, D-51427, Bergisch Gladbach, Germany.
| | - Stefan Jongen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands
| | - Anja Knoche
- Federal Highway Research Institute (BASt), Bruederstrasse 53, D-51427, Bergisch Gladbach, Germany
| | - Frank Petzke
- Universitaetsmedizin Goettingen, Georg-August-Universitaet, Robert-Koch-Str. 40, D-37075, Goettingen, Germany
| | - Eric F Vuurman
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands
| | - Mark Vollrath
- Institut für Psychologie, Ingenieur- und Verkehrspsychologie, Technische Universitaet Braunschweig, Gaussstr. 23, D-38106, Braunschweig, Germany
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands
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Weisgerber DM, Nikol M, Mistlberger RE. Driving home from the night shift: a bright light intervention study. Sleep Med 2017; 30:171-179. [DOI: 10.1016/j.sleep.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 02/08/2023]
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Kosmadopoulos A, Sargent C, Zhou X, Darwent D, Matthews RW, Dawson D, Roach GD. The efficacy of objective and subjective predictors of driving performance during sleep restriction and circadian misalignment. ACCIDENT; ANALYSIS AND PREVENTION 2017; 99:445-451. [PMID: 26534845 DOI: 10.1016/j.aap.2015.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Abstract
Fatigue is a significant contributor to motor-vehicle accidents and fatalities. Shift workers are particularly susceptible to fatigue-related risks as they are often sleep-restricted and required to commute around the clock. Simple assays of performance could provide useful indications of risk in fatigue management, but their effectiveness may be influenced by changes in their sensitivity to sleep loss across the day. The aim of this study was to evaluate the sensitivity of several neurobehavioral and subjective tasks to sleep restriction (SR) at different circadian phases and their efficacy as predictors of performance during a simulated driving task. Thirty-two volunteers (M±SD; 22.8±2.9 years) were time-isolated for 13-days and participated in one of two 14-h forced desynchrony protocols with sleep opportunities equivalent to 8h/24h (control) or 4h/24h (SR). At regular intervals during wake periods, participants completed a simulated driving task, several neurobehavioral tasks, including the psychomotor vigilance task (PVT), and subjective ratings, including a self-assessment measure of ability to perform. Scores transformed into standardized units relative to baseline were folded into circadian phase bins based on core body temperature. Sleep dose and circadian phase effect sizes were derived via mixed models analyses. Predictors of driving were identified with regressions. Performance was most sensitive to sleep restriction around the circadian nadir. The effects of sleep restriction around the circadian nadir were larger for simulated driving and neurobehavioral tasks than for subjective ratings. Tasks did not significantly predict driving performance during the control condition or around the acrophase during the SR condition. The PVT and self-assessed ability were the best predictors of simulated driving across circadian phases during SR. These results show that simple performance measures and self-monitoring explain a large proportion of the variance in driving when fatigue-risk is high.
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Affiliation(s)
- Anastasi Kosmadopoulos
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia; Bushfire Cooperative Research Centre, East Melbourne, Victoria, Australia.
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Xuan Zhou
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - David Darwent
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Raymond W Matthews
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Drew Dawson
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
| | - Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, PO Box 42, Goodwood, South Australia 5034, Australia.
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Perrier J, Jongen S, Vuurman E, Bocca M, Ramaekers J, Vermeeren A. Driving performance and EEG fluctuations during on-the-road driving following sleep deprivation. Biol Psychol 2016; 121:1-11. [DOI: 10.1016/j.biopsycho.2016.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/08/2016] [Accepted: 09/28/2016] [Indexed: 01/20/2023]
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Jongen S, Vuurman EFPM, Ramaekers JG, Vermeeren A. The sensitivity of laboratory tests assessing driving related skills to dose-related impairment of alcohol: A literature review. ACCIDENT; ANALYSIS AND PREVENTION 2016; 89:31-48. [PMID: 26802474 DOI: 10.1016/j.aap.2016.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/06/2015] [Accepted: 01/02/2016] [Indexed: 06/05/2023]
Abstract
Laboratory tests assessing driving related skills can be useful as initial screening tools to assess potential drug induced impairment as part of a standardized behavioural assessment. Unfortunately, consensus about which laboratory tests should be included to reliably assess drug induced impairment has not yet been reached. The aim of the present review was to evaluate the sensitivity of laboratory tests to the dose dependent effects of alcohol, as a benchmark, on performance parameters. In total, 179 experimental studies were included. Results show that a cued go/no-go task and a divided attention test with primary tracking and secondary visual search were consistently sensitive to the impairing effects at medium and high blood alcohol concentrations. Driving performance assessed in a simulator was less sensitive to the effects of alcohol as compared to naturalistic, on-the-road driving. In conclusion, replicating results of several potentially useful tests and their predictive validity of actual driving impairment should deserve further research. In addition, driving simulators should be validated and compared head to head to naturalistic driving in order to increase construct validity.
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Affiliation(s)
- S Jongen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
| | - E F P M Vuurman
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
| | - J G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
| | - A Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
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Vermeeren A, Vets E, Vuurman EF, Van Oers AC, Jongen S, Laethem T, Heirman I, Bautmans A, Palcza J, Li X, Troyer MD, Wrishko R, McCrea J, Sun H. On-the-road driving performance the morning after bedtime use of suvorexant 15 and 30 mg in healthy elderly. Psychopharmacology (Berl) 2016; 233:3341-51. [PMID: 27424295 PMCID: PMC4989000 DOI: 10.1007/s00213-016-4375-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/29/2016] [Indexed: 01/09/2023]
Abstract
RATIONALE Suvorexant is a first-in-class orexin receptor antagonist for treating insomnia. There is a general concern that hypnotics may impair next-morning driving ability. OBJECTIVE The objective of this study was to evaluate next-morning driving performance in older adults after single and repeated doses of suvorexant. METHODS Double-blind, randomized, placebo-controlled, 4-period crossover study in 24 healthy volunteers (10 females), aged 65-80 years. Subjects were treated with suvorexant (15 and 30 mg) for eight consecutive nights, zopiclone 7.5 mg nightly on days 1 and 8, and placebo. Driving performance was assessed on days 2 and 9 (9 h after dosing) using a 1-h standardized highway driving test in normal traffic, measuring standard deviation of lateral position (SDLP). Drug-placebo differences in SDLP >2.4 cm were considered to reflect clinically meaningful driving impairment. RESULTS Driving performance as measured by SDLP was not impaired following suvorexant. Mean drug-placebo differences in SDLP following suvorexant 15 and 30 mg on day 2 and 9 were 0.6 cm or less. Their 90 % CIs were all below the threshold of 2.4 cm for clinical relevance and included zero, indicating effects were not clinically meaningful or statistically significant. Symmetry analysis showed no significant differences between the number of participants who had SDLP differences >2.4 cm and those who had SDLP differences <-2.4 cm following suvorexant. CONCLUSIONS There was no clinically meaningful residual effect of suvorexant 15 and 30 mg on next-morning driving (9 h after bedtime dosing) in healthy older adults, as assessed by mean changes in SDLP and by the number of participants on drug versus placebo that exceeded a predetermined threshold for clinically meaningful impairment.
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Affiliation(s)
- Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Eva Vets
- SGS Life Science Services, Antwerp, Belgium
| | - Eric F.P.M. Vuurman
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Anita C.M. Van Oers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Stefan Jongen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Tine Laethem
- Merck Translational Medicine Europe, MSD Europe Inc., Brussels, Belgium
| | - Ingeborg Heirman
- Merck Translational Medicine Europe, MSD Europe Inc., Brussels, Belgium
| | - An Bautmans
- Merck Translational Medicine Europe, MSD Europe Inc., Brussels, Belgium
| | | | | | | | | | | | - Hong Sun
- Merck & Co., Inc., Kenilworth, NJ USA
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Basner M, Mcguire S, Goel N, Rao H, Dinges DF. A new likelihood ratio metric for the psychomotor vigilance test and its sensitivity to sleep loss. J Sleep Res 2015; 24:702-13. [PMID: 26118830 DOI: 10.1111/jsr.12322] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
The Psychomotor Vigilance Test (PVT) is a widely used assay of behavioural alertness sensitive to the effects of sleep loss and circadian misalignment. However, there is currently no accepted PVT composite outcome metric that captures response slowing, attentional lapses and compensatory premature reactions observed typically in sleep-deprived subjects. We developed a novel likelihood ratio metric (LRM) based on relative frequency distributions in 50 categories of reaction times (RT) and false starts in alert and sleep-deprived subjects (acute total sleep deprivation: n = 31 subjects). The LRM had the largest effect size both in a 33-h total sleep deprivation protocol [1.96; 95% confidence interval (CI): 1.61-2.44; followed by response speed 1/RT, effect size 1.93, 95% CI: 1.55-2.65] and in a chronic partial sleep restriction protocol (1.22; 95% CI: 0.96-1.59; followed by response speed 1/RT, effect size 1.21, 95% CI: 0.94-1.59; 5 nights at 4 h sleep per night; n = 43 subjects). LRM scores correlated highly with response speed (R(2 ) = 0.986), and less well with five other common PVT outcome metrics (R(2 ) = 0.111-0.886). In conclusion, the new LRM is a sensitive PVT outcome metric with high statistical power that takes subtle sleep loss-related changes in the distribution of reaction times (including false starts) into account, is not prone to outliers, does not require baseline data and can be calculated and interpreted easily. Congruence between LRM and PVT response speed and their similar effect size rankings support the use of response speed as the primary, most sensitive and most parsimonious standard PVT outcome metric for determining neurobehavioural deficits from sleep loss.
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Affiliation(s)
- Mathias Basner
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sarah Mcguire
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Namni Goel
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hengyi Rao
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David F Dinges
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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