Are OSAS patients impaired in their driving ability on a circuit with medium traffic density?

OBJECTIVES: Many studies have demonstrated that patients with Obstructive Sleep Apnea Syndrome (OSAS), a very common sleep-related breathing disorder, are usually impaired in their driving ability because of decreased sleep quality. However, most of the simulation procedures in laboratories are designed to create monotonic conditions with low traffic density, if any, thereby leading to a dramatic decrease in performance in OSAS patients because of the lack of stimulation. The aim of this study was therefore to evaluate driving abilities in OSAS patients involved in a driving simulation task with medium traffic density, in order to replicate as far as possible real world conditions. The behavioral and physiological attributes likely to predict driving performance in these patients were also investigated. METHODS: After a normal night of sleep, 12 OSAS patients and 8 healthy controls performed 6 driving sessions during a 24-h period of sustained wakefulness. Driving performances (speed, lateral position, distances...) were measured and correlated to sleep parameters and to a waking EEG recorded during the task. RESULTS: Compared to controls, patients showed difficulties in speed adjustment. However, they maintained longer inter-vehicle distances, including during overtaking. Their waking EEG, while driving, showed increased spectral power in theta (3.9-7.8Hz) but also in beta (12.7-29.2Hz) activity, alpha power (7.9-12.6Hz) being increased in both groups due to sustained wakefulness. Poor sleep indices were correlated to increased theta and beta activities, as well as to more cautious behavior. DISCUSSION: In medium traffic density conditions, driving performance in OSAS patients remained at near normal levels, but with more cautious behavior than controls. This could be the result of a bigger effort to stay awake, as suggested by an increased beta activity in these patients.     

Cognitive components of simulated driving performance: Sleep loss effects and predictors

Driving is a complex task, which can be broken down into specific cognitive processes. In order to determine which components contribute to drowsy driving impairments, the current study examined simulated driving and neurocognitive performance after one night of sleep deprivation. Nineteen professional drivers (age 45.3 ± 9.1) underwent two experimental sessions in randomised order: one after normal sleep and one after 27 h total sleep deprivation. A simulated driving task (AusEd), the psychomotor vigilance test (PVT), and neurocognitive tasks selected from the Cognitive Drug Research computerised neurocognitive assessment battery (simple and choice RT, Stroop Task, Digit Symbol Substitution Task, and Digit Vigilance Task) were administered at 10:00 h in both sessions. Mixed-effects ANOVAs were performed to examine the effect of sleep deprivation versus normal sleep on performance measures. To determine if any neurocognitive tests predicted driving performance (lane position variability, speed variability, braking RT), neurocognitive measures that were significantly affected by sleep deprivation were then added as a covariate to the ANOVAs for driving performance. Simulated driving performance and neurocognitive measures of vigilance and reaction time were impaired after sleep deprivation (p < 0.05), whereas tasks examining processing speed and executive functioning were not significantly affected by sleep loss. PVT performance significantly predicted specific aspects of simulated driving performance. Thus, psychomotor vigilance impairment may be a key cognitive component of driving impairment when sleep deprived. The generalisability of this finding to real-world driving remains to be investigated.     

Alertness maintaining tasks (AMTs) while driving

We evaluated the effectiveness of alertness maintaining tasks (AMTs) on driver performance, subjective feelings, and psychophysiological state in monotonous simulated driving in two experiments. In the first experiment, 12 professional truck drivers participated in five sessions of simulated driving: driving only, driving with one of three AMTs (counterbalanced), and driving while listening to music. AMTs were not equally effective in maintaining alertness. The trivia AMT prevented driving performance deterioration, and increased alertness (measured by standardized HRV). The choice reaction time AMT was least demanding but also increased subjective sleepiness and reduced arousal (measured by alpha/beta ratio). The working memory AMT caused a significant decrement in driving speed, increased subjective fatigue, and was regarded by the participants as detrimental to driving. Trivia was preferred by the majority of the drivers over the other two AMTs. Experiment 2 further examined the utility of the trivia AMT. When the drivers engaged in the trivia AMT they maintained better driving performance and perceived the driving duration as shorter than the control condition. The two experiments demonstrated that AMTs can have a positive effect on alertness. The effect is localized in the sense that it does not persist beyond the period of the AMT activation.     

Sleepiness in professional drivers: effect of age and time of day

The effect of age and time of day on objective and subjective sleepiness in professional drivers was investigated during a simulated driving task. Thirty-six young and middle-aged professional males drivers, free from any sleep disorder, took part in two simulated driving sessions; one carried out in the afternoon (between 2 and 4 p.m.) the other in the evening (between 11 p.m. and 1 a.m.). Half of each age group drove in a low traffic condition while the second half drove in a heavy traffic condition. Throughout the driving task, subjects' electroencephalogram and Karolinska sleepiness scale (KSS) scores were recorded. Visual analog scales measuring alertness and sleepiness levels were also completed before and after the driving. After each session, subjects filled out the NASA-TLX questionnaire and were asked if they had felt sleepy during the driving. Young professional drivers presented a significant decrease in alertness (raise of the spectral power in the alpha band) in the low traffic condition and a strong propensity to sleep during the evening test in contrast to middle-aged professional drivers.     

Wertheim's hypothesis on 'highway hypnosis': empirical evidence from a study on motorway and conventional road driving

This paper aims to study the phenomenon known as ‘highway hypnosis’ or ‘driving without attention mode’, which has been defined as a state showing sleepiness signs and attention slip resulting from driving a motor vehicle for a long period in a highly predictable environment with low event occurrence, this being the case with motorways and very familiar roads [Highway hypnosis: a theoretical analysis. In: Gale, A.G., Brown, I.D., Haslegrave, C.M., Moorhead, I., Taylor, S. (Eds.), Vision in Vehicles-III. Elsevier, North-Holland, pp. 467–472]. According to Wertheim’s hypothesis on ‘highway hypnosis’, long-term driving on motorways and conventional roads, e.g. main roads, secondary roads—implies differences in the predictability of the movement pattern of the visual stimulation, in the eye musculature activity and in the type of feedback used in visual information processing (mostly extra-retinal on motorways and retinal and extra-retinal on conventional roads). All this ultimately leads to alertness differences between both road types. Our research is intended to provide empirical evidence from the hypothesis, based on the data recorded during the actual driving experience of a group of subjects on a motorway and a conventional road. We studied whether or not significant alertness differences were found-measured by EEG data relative to time periods of on-target eye-tracking performance—between motorway and conventional road driving. Our results partially support the hypothesis, as drowsiness proved to be higher on motorways than on conventional roads during the final driving period but not during the starting stage, when the opposite trend was noticed. This result could be explained by the fact that during the first driving periods the effects of the stimulus movement predictability had not yet become apparent, since they tend to show after a long drive.     

How fleeting emotions affect hazard perception and steering while driving: The impact of image arousal and valence

Video-billboards and portable video-display devices are becoming increasingly common and the images they project can often be dramatic or provocative. This study investigated the lingering effects of emotion-evoking images on driving as measured in a driving simulator. Images were projected on an in-vehicle display while drivers followed a lead vehicle at a safe distance. To ensure attention to the images drivers were required to indicate whether each image was positive or negative by pressing a button. Occasional braking events (sudden decelerations in the lead vehicle that necessitated braking) occurred either 250 or 500 ms after the button press. In the 250 ms delay condition braking RT was faster after high arousal images (fastest for high arousal positive images); following a 500 ms delay braking RT was slower after high arousal images (slowest for high arousal negative images). Responding to all images reduced steering performance (in the period after the image but before the button press) but image valence had an effect on steering as well. Positive images were associated with better steering performance than negative images, especially when they were both low in arousal: a result that supports the broaden-and-build hypothesis of positive emotions and the theory that ambient (wide field/peripheral) vision controls steering performance. We discuss implications for both basic research on attention–emotion and applied research on driving.     

Measuring the effect of the rainfall on the windshield in terms of visual performance

Driving through rain results in reduced visual performance, and car designers have proposed countermeasures in order to reduce the impact of rain on driving performance. In this paper, we propose a methodology dedicated to the quantitative estimation of the loss of visual performance due to the falling rain. We have considered the rain falling on the windshield as the main factor which reduces visual performance in driving. A laboratory experiment was conducted with 40 participants. The reduction of visual performance through rain was considered with respect to two driving tasks: the detection of an object on the road (contrast threshold) and reading a road sign. This experiment was conducted in a laboratory under controlled artificial rain. Two levels of rain intensity were compared, as well as two wiper conditions (new and worn), while the reference condition was without rain. The reference driving situation was night driving. Effects of both the rain level and the wipers characteristics were found, which validates the proposed methodology for the quantitative estimation of rain countermeasures in terms of visual performance.     

The alerting effect of hitting a rumble strip—A simulator study with sleepy drivers

A moving base driving simulator experiment was carried out in order to investigate the effects of milled rumble strips on driver fatigue. There were rumble strips both at the edge line and centre line. Four different physical designs of milled rumble strips (yielding noise values from 1.5 to 16 dBA) and two placements on shoulder were used in the experiment. Sound and vibrations from real milled rumble strips were reproduced in the simulator. In total 35 regular shift workers drove during the morning hours after a full night shift. The main results showed an increase in sleepiness indicators (EEG alpha/theta activity, eye closure duration, standard deviation of lateral position, subjective sleepiness) from start to before hitting the rumble strip, an alerting effect in most parameters (not subjective sleepiness) after hitting the strip. The alertness enhancing effect was, however, short and the sleepiness signs returned 5 min after the rumble strip hit. Essentially no effects were seen due to type of strip. It was concluded that various aspects of sleepiness are increased before hitting a rumble strip and that the effect is very short-lived. Type of strip, as used in the present study did not have any effect.     

Short and long sleep duration and risk of drowsy driving and the role of subjective sleep insufficiency

Experimental sleep restriction increases sleepiness and impairs driving performance. However, it is unclear whether short sleep duration in the general population is associated with drowsy driving. The goal of the present study was to evaluate whether individuals in the general population who obtained sleep of 6 h or less are more likely to report drowsy driving, and evaluate the role of perceived sleep sufficiency. Data exploring whether subgroups of short sleepers (those who report the most or least unmet sleep need) show different risk profiles for drowsy driving are limited. From the 2009 Behavioral Risk Factor Surveillance System (N = 31,522), we obtained the following self-reported data: (1) sleep duration (≤5, 6, 7, 8, 9, or ≥10 h/night); (2) number of days/week of perceived insufficient sleep; (3) among drivers, yes/no response to: “During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?” (4) demographics, physical/mental health. Using 7 h/night as reference, logistic regression analyses evaluated whether self-reported sleep duration was associated with drowsy driving. Overall, 3.6% reported drowsy driving. Self-identified short-sleepers reported drowsy driving more often, and long sleepers, less often. Among those who perceived sleep as always insufficient, drowsy driving was reported more often when sleep duration was ≤5 h, 6 h, or ≥10 h. Among those who perceived sleep as always sufficient, drowsy driving was reported more often among ≤5 h and 6 h sleepers. Overall, drowsy driving was common, particularly in self-identified short-sleepers as a whole, as well as subgroups based on sleep insufficiency.     

Chasing the silver bullet: measuring driver fatigue using simple and complex tasks

Driver fatigue remains a significant cause of motor-vehicle accidents worldwide. New technologies are increasingly utilised to improve road safety, but there are no effective on-road measures for fatigue. While simulated driving tasks are sensitive, and simple performance tasks have been used in industrial fatigue management systems (FMS) to quantify risk, little is known about the relationship between such measures. Establishing a simple, on-road measure of fatigue, as a fitness-to-drive tool, is an important issue for road safety and accident prevention, particularly as many fatigue related accidents are preventable. This study aimed to measure fatigue-related performance decrements using a simple task (reaction time - RT) and a complex task (driving simulation), and to determine the potential for a link between such measures, thus improving FMS success. Fifteen volunteer participants (7 m, 8 f) aged 22-56 years (mean 33.6 years), underwent 26 h of supervised wakefulness before an 8h recovery sleep opportunity. Participants were tested using a 30-min interactive driving simulation test, bracketed by a 10-min psychomotor vigilance task (PVT) at 4, 8, 18 and 24h of wakefulness, and following recovery sleep. Extended wakefulness caused significant decrements in PVT and driving performance. Although these measures are clearly linked, our analyses suggest that driving simulation cannot be replaced by a simple PVT. Further research is needed to closely examine links between performance measures, and to facilitate accurate management of fitness to drive, which requires more complex assessments of performance than RT alone.     

Daytime driving simulation performance and sleepiness in obstructive sleep apnoea patients

BACKGROUND: Sleepiness related car accidents are common in obstructive sleep apnoea syndrome (OSAS) patients. The objective measurements of sleepiness used in clinical setting quantify the tendency to fall asleep in quiet situations that are completely different from driving. METHODS: We studied 30 OSAS patients with subjective (subjective sleepiness scales) and objective (multiple sleep latency test, MSLT) sleepiness measurements, associated with driving simulation test (DST), previously validated in young healthy subjects. The results of subjective and objective sleepiness tests were compared with simulated driving performance in order to evaluate the suitability of our DST for measuring alertness. RESULTS: Subjective and objective sleepiness measurements were significantly correlated with driving performance on the simulator. The most significant correlates of sleepiness were the measures of the primary vehicle control task on the simulator: lane position variability and crash data. The comparison of DST and MSLT results suggested our driving simulated approach could be used to evaluate daytime sleepiness in the clinical setting of OSAS patients. CONCLUSIONS: Our DST is a suitable objective tool to detect sleepiness in OSAS patients, and could be useful in the clinical setting of sleep medicine and research.     

Cannabis use and traffic accidents in a birth cohort of young adults

Objective: to examine linkages between cannabis use and traffic accident risks in a birth cohort of 907 young New Zealanders studied from 18 to 21 years. Methods: during the course of a 21-year longitudinal study of a birth cohort of 907 New Zealand born children information was gathered on (a) annual frequency of cannabis use over the period from 18 to 21 years; (b) annual rates of traffic accidents during the period 18–21 years; (c) measures of driver behaviours and characteristics. The association between cannabis use and traffic accident risk was examined among the 907 sample members who reported driving a motor vehicle between the ages of 18 and 21 years. Results: there were statistically significant relationships between reported annual cannabis use and annual accident rates. This association was present only for ‘active’ accidents in which driver behaviours contributed to the accident; those using cannabis more than 50 times per year had estimated rates of active accidents that were 1.6 (95% CI 1.2–2.0) times higher than the rate for non-users. However, statistical control for driver behaviours and characteristics related to cannabis use (drink driving behaviour; risky/illegal driving behaviours; driver attitudes; gender) eliminated the association between cannabis use and traffic accident risks. Conclusions: although cannabis use was associated with increased risks of traffic accidents among members of this birth cohort, these increased risks appear to reflect the characteristics of the young people who used cannabis rather than the effects of cannabis use on driver performance.     

Concurrent processing of vehicle lane keeping and speech comprehension tasks

With the growing prevalence of using in-vehicle devices and mobile devices while driving, a major concern is their impact on driving performance and safety. However, the effects of cognitive load such as conversation on driving performance are still controversial and not well understood. In this study, an experiment was conducted to investigate the concurrent performance of vehicle lane keeping and speech comprehension tasks with improved experimental control of the confounding factors identified in previous studies. The results showed that the standard deviation of lane position (SDLP) was increased when the driving speed was faster (0.30 m at 36 km/h; 0.36 m at 72 km/h). The concurrent comprehension task had no significant effect on SDLP (0.34 m on average) or the standard deviation of steering wheel angle (SDSWA; 5.20° on average). The correct rate of the comprehension task was reduced in the dual-task condition (from 93.4% to 91.3%) compared with the comprehension single-task condition. Mental workload was significantly higher in the dual-task condition compared with the single-task conditions. Implications for driving safety were discussed.     

Drivers’ misjudgement of vigilance state during prolonged monotonous daytime driving

To investigate the effects of monotonous daytime driving on vigilance state and particularly the ability to judge this state, a real road driving study was conducted. To objectively assess vigilance state, performance (auditory reaction time) and physiological measures (EEG: alpha spindle rate, P3 amplitude; ECG: heart rate) were recorded continuously. Drivers judged sleepiness, attention to the driving task and monotony retrospectively every 20 min. Results showed that prolonged daytime driving under monotonous conditions leads to a continuous reduction in vigilance. Towards the end of the drive, drivers reported a subjectively improved vigilance state, which was contrary to the continued decrease in vigilance as indicated by all performance and physiological measures. These findings indicate a lack of self-assessment abilities after approximately 3 h of continuous monotonous daytime driving.     

Efficient driver drowsiness detection at moderate levels of drowsiness

Previous research on driver drowsiness detection has focused primarily on lane deviation metrics and high levels of fatigue. The present research sought to develop a method for detecting driver drowsiness at more moderate levels of fatigue, well before accident risk is imminent. Eighty-seven different driver drowsiness detection metrics proposed in the literature were evaluated in two simulated shift work studies with high-fidelity simulator driving in a controlled laboratory environment. Twenty-nine participants were subjected to a night shift condition, which resulted in moderate levels of fatigue; 12 participants were in a day shift condition, which served as control. Ten simulated work days in the study design each included four 30-min driving sessions, during which participants drove a standardized scenario of rural highways. Ten straight and uneventful road segments in each driving session were designated to extract the 87 different driving metrics being evaluated. The dimensionality of the overall data set across all participants, all driving sessions and all road segments was reduced with principal component analysis, which revealed that there were two dominant dimensions: measures of steering wheel variability and measures of lateral lane position variability. The latter correlated most with an independent measure of fatigue, namely performance on a psychomotor vigilance test administered prior to each drive. We replicated our findings across eight curved road segments used for validation in each driving session. Furthermore, we showed that lateral lane position variability could be derived from measured changes in steering wheel angle through a transfer function, reflecting how steering wheel movements change vehicle heading in accordance with the forces acting on the vehicle and the road. This is important given that traditional video-based lane tracking technology is prone to data loss when lane markers are missing, when weather conditions are bad, or in darkness. Our research findings indicated that steering wheel variability provides a basis for developing a cost-effective and easy-to-install alternative technology for in-vehicle driver drowsiness detection at moderate levels of fatigue.     

The effects of an exercise program on several abilities associated with driving performance in older adults

The purpose of this study was to investigate the effects of participation in an exercise program on several abilities associated with driving performance in older adults. Thirty-two subjects were randomly assigned to either an exercise group (60-81 years, n = 16) or a control group (60-82 years, n = 16). The exercise program was planned to stress perceptive, cognitive, and physical abilities. It lasted 12 weeks with a periodicity of three sessions of 60 min per week. Assessments were conducted before and after the intervention on behavioral speed (in single- and dual-task conditions), visual attention, psychomotor performance, speed perception (time-to-contact), and executive functioning. Significant positive effects were found at 12-week follow-up resulting from participation in the exercise program. Behavioral speed improvements were found in reaction time, movement time, and response time (both in single- and dual-task conditions); visual attention improvements took place in speed processing and divided attention; psychomotor performance improvements occurred in lower limb mobility. These results showed that exercise is capable of enhancing several abilities relevant for driving performance and safety in older adults and, therefore, should be promoted.     

Are drivers aware of sleepiness and increasing crash risk while driving?

Drivers are advised to take breaks when they feel too tired to drive, but there is question over whether they are able to detect increasing fatigue and sleepiness sufficiently to decide when to take a break. The aim of this study was to investigate the extent to which drivers have access to cognitive information about their current state of sleepiness, likelihood of falling asleep, and the implications for driving performance and the likelihood of crashing. Ninety drivers were recruited to do a 2 h drive in a driving simulator. They were divided into three groups: one made ratings of their sleepiness, likelihood of falling asleep and likelihood of crashing over the next few minutes at prompts occurring at 200 s intervals throughout the drive, the second rated sleepiness and likelihood of falling asleep at prompts but pressed a button on the steering wheel at any time if they felt they were near to crashing and the third made no ratings and only used a button-press if they felt a crash was likely. Fatigue and sleepiness was encouraged by monotonous driving conditions, an imposed shorter than usual sleep on the night before and by afternoon testing. Drivers who reported that they were possibly, likely or very likely to fall asleep in the next few minutes, were more than four times more likely to crash subsequently. Those who rated themselves as sleepy or likely to fall asleep had a more than 9-fold increase in the hazards of a centerline crossing compared to those who rated themselves as alert. The research shows clearly that drivers can detect changes in their levels of sleepiness sufficiently to make a safe decision to stop driving due to sleepiness. Therefore, road safety policy needs to move from reminding drivers of the signs of sleepiness and focus on encouraging drivers to respond to obvious indicators of fatigue and sleepiness and consequent increased crash risk.     

Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol

BACKGROUND: The effects of marijuana or THC on driving has been tested in several studies, but usually not in conjunction with physiological and subjective responses and not in comparison to alcohol effects on all three types of measures. OBJECTIVE: To assess the effects of two dosages of THC relative to alcohol on driving performance, physiological strain, and subjective feelings. METHOD: We tested the subjective feelings and driving abilities after placebo, smoking two dosages of THC (13 mg and 17 mg), drinking (0.05% BAC) and 24 h after smoking the high dose THC cigarette, while monitoring physiological activity of the drugs by heart rate. Fourteen healthy students, all recreational marijuana users, participated in the study. RESULTS: Both levels of THC cigarettes significantly affected the subjects in a dose-dependent manner. The moderate dose of alcohol and the low THC dose were equally detrimental to some of the driving abilities, with some differences between the two drugs. THC primarily caused elevation in physical effort and physical discomfort during the drive while alcohol tended to affect sleepiness level. After THC administration, subjects drove significantly slower than in the control condition, while after alcohol ingestion, subjects drove significantly faster than in the control condition. No THC effects were observed after 24 h on any of the measures.     

Fatigue, sleep restriction and driving performance

We ran a randomized cross-over design study under sleep-deprived and non-sleep-deprived driving conditions to test the effects of sleep restriction on real driving performance. The study was performed in a sleep laboratory and on an open French highway. Twenty-two healthy male subjects (age = 21.5 +/- 2 years; distance driven per year = 12,225 +/- 4739 km (7641 +/- 2962 miles) [mean +/- S.D.]) drove 1000 km (625 miles) over 10 h during five 105 min sessions on an open highway. Self-rated fatigue and sleepiness before each session, number of inappropriate line crossings from video recordings and simple reaction time (RT) were measured. Total crossings increased after sleep restriction (535 crossings in the sleep-restricted condition versus 66 after non-restricted sleep (incidence rate ratio (IRR): 8.1; 95% confidence interval (95% CI): 3.2-20.5; p < 0.001)), from the first driving session. The interaction between the two factors (conditionxtime of day) was also significant (F(5, 105) = 3.229; p < 0.05). Increasing sleepiness score was associated with increasing crossings during the next driving session in the sleep-restricted (IRR: 1.9; 95% CI: 1.4-2.4) but not in the non-restricted condition (IRR: 1.0; 95% CI: 0.8-1.3). Increasing self-perceived fatigue was not associated with increasing crossings in either condition (IRR: 0.95; 95% CI: 0.93-0.98 and IRR: 1.0; 95% CI: 0.98-1.02). Rested subjects drove 1000 km with four shorts breaks with only a minor performance decrease. Sleep restriction induced important performance degradation even though time awake (8h) and session driving times (105 min) were relatively short. Major inter-individual differences were observed under sleep restriction. Performance degradation was associated with sleepiness and not fatigue. Sleepiness combined with fatigue significantly affected RT. Road safety campaigns should encourage drivers to avoid driving after sleep restriction, even on relatively short trips especially if they feel sleepy.     

Assessing the driving performance of older adult drivers: on-road versus simulated driving

To validate a laboratory-based driving simulator in measuring on-road driving performance, 129 older adult drivers were assessed with both the simulator and an on-road test. The driving performance of the participants was gauged by appropriate and reliable age-specific assessment criteria, which were found to be negatively correlated with age. Using principal component analysis, two performance indices were developed from the criteria to represent the overall performance in simulated driving and the on-road assessment. There was significant positive association between the two indices, with the simulated driving performance index explaining over two-thirds of the variability of the on-road driving performance index, after adjustment for age and gender of the drivers. The results supported the validity of the driving simulator and it is a safer and more economical method than the on-road testing to assess the driving performance of older adult drivers.