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Is the 2 h recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea dr

Is the 2 h recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea drivers?. A.J . Filtness, L.A. Reyner ESRS 2010 - Occupation and environment Thursday, 16 September 2010. Overview . Background Method Driving simulator Results

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Is the 2 h recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea dr

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  1. Is the 2 h recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea drivers? A.J. Filtness, L.A. Reyner ESRS 2010 - Occupation and environment Thursday, 16 September 2010

  2. Overview Background Method • Driving simulator Results • Successful completion • Safe driving time Conclusion

  3. Background Driver fatigue recommendation The UK Department for Transport produces the Highway code. A list of rules and recommendations for road users. Obstructive Sleep Apnoea (OSA) Group 1 licence holders (car/ motorcycle) diagnosed with sleep apnoea must stop driving until the symptoms have been controlled and confirmed by medical opinion.

  4. UK Highway Code The Highway code - Fitness to drive: rule 91 Driving when you are tired greatly increases your risk of collision. To minimise this risk • make sure you are fit to drive. Do not begin a journey if you are tired. Get a good night’s sleep before embarking on a long journey • avoid undertaking long journeys between midnight and 6 am, when natural alertness is at a minimum • plan your journey to take sufficient breaks. A minimum break of at least 15 minutes after every two hours of driving is recommended • if you feel at all sleepy, stop in a safe place. Do not stop on the hard shoulder of a motorway • the most effective ways to counter sleepiness are to drink, for example, two cups of caffeinated coffee and to take a short nap (at least 15 minutes).

  5. UK Highway Code The Highway code - Fitness to drive: rule 91 Driving when you are tired greatly increases your risk of collision. To minimise this risk • make sure you are fit to drive. Do not begin a journey if you are tired. Get a good night’s sleep before embarking on a long journey • avoid undertaking long journeys between midnight and 6 am, when natural alertness is at a minimum • plan your journey to take sufficient breaks. A minimum break of at least 15 minutes after every two hours of driving is recommended • if you feel at all sleepy, stop in a safe place. Do not stop on the hard shoulder of a motorway • the most effective ways to counter sleepiness are to drink, for example, two cups of caffeinated coffee and to take a short nap (at least 15 minutes).

  6. Aim To assess the appropriateness of this recommendation for OSA patients treated with CPAP, compared with healthy controls of a similar age. Following a normal night’s sleep (OSA with CPAP) Under sleep restriction conditions (5h) (OSA with CPAP) Following normal sleep length, OSA without CPAP

  7. Method – Driving Simulator Repeat measure counterbalanced design • Normal nights sleep (8 h) • Sleep restriction to (5 h) • Additional study night • OSA participants without CPAP (n=11) 38 participants male, age 50 – 75y 19 OSA patients, ave 8.6y CPAP 19 healthy control participants Dual carriageway 2 h afternoon drive

  8. Measures Driving Incidents: car wheels crossed a lane demarcation line Incidents were classified as “sleep related” or “non sleep related”

  9. Results Percent of drives successfully completed Average time to first incident

  10. Results – Percent of Successful Completion

  11. Results – Percent of Successful Completion

  12. Results – Percent of Successful Completion

  13. Results – Safe Driving Time

  14. Results – Safe Driving Time Condition [F(1,36) = 9.24, p<0.05] Condition, group interaction [F(1,36) = 4.16, p<0.05]

  15. Results – Safe Driving Time OSA. Condition [F(2,20) = 8.8, p<0.05]

  16. Summary of findings • UK Highway Code recommends to break from driving every 2 hours to avoid driver fatigue. • 52.6% of all 2h drives were completed successfully. • The drive presented was a ‘worst case scenario’. • Sleep restriction significantly affected both control and OSA participants. • OSA participants were more affected by sleep restriction than controls.

  17. Implications • Recommend older drivers take a break from driving every 90 minutes, more often if sleep restricted. • Older drivers do not cause a high percent of road traffic incidents so may break from driving every 2 hours for reasons other than sleepiness. • Education of OSA patients: non-compliance with CPAP can significantly impair driving performance and vulnerability to sleep restriction.

  18. Conclusion It is important to get a full night’s sleep prior to completing a long motorway drive. It is important for OSA drivers to be compliant with CPAP treatment every night.

  19. Acknowledgements Prof. Jim Horne, Loughborough University Dr Andrew Hall and Dr Chris Hanning, Leicester General Hospital Thank you for listening

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