SEARCH WITHIN CONTENT
Citation Information : Eat, Sleep, Work. Volume 1, Issue 1, Pages 10-25, DOI: https://doi.org/10.21913/JDRSSesw.v1i1.981
License : (CC BY-NC-ND 3.0)
Published Online: 10-September-2020
This study compared the temporal pattern of non-verbal behaviours (actions not directly related to task performance) in obstructive sleep apnoea (OSA) drivers under monotonous driving conditions following sleep restriction versus normal sleep. Seventeen patients with untreated severe OSA completed a 90-minute driving simulator task during mid-afternoon under two experimental conditions: prior normal habitual sleep (~8h) and prior sleep restriction (4h time in bed). Steering deviation and crash events were identiﬁed using a driving simulator. Non-verbal behaviours (self-centred gestures, non-verbal facial activities, postural adjustments, non-self-centred gestures and eye closures) were identiﬁed using video recording and a behavioural ethogram. Participants demonstrated increased steering deviation over the drive (p<0.001) and following sleep restriction (p<0.001). All non-verbal behaviours, except non-verbal facial activities, increased over the drive (all p<0.01). Compared to normal sleep condition, the incidence rate was 2.1 times higher for eye closures (95%CI 1.75-2.60) and 1.5 times higher for postural adjustments (95%CI 1.29-1.72) following sleep restriction, while non-self-centred gestures reduced by 50% (IRR 0.53, 95%CI 0.36-0.78), all p<0.01. In the 10 minute period prior to simulator crash events, eye closure frequency increased compared to equivalent periods without a crash event 2.1 (95%CI 1.4-3.8, p<0.01). Kaplain-Meier analyses showed a progressive cessation of non-verbal facial activities leading up to crash events (X²=6.2, p=0.013). Although eye-closure appears to be a more sensitive marker of poor vigilance, behavioural observation could provide a novel further method for assessing vigilance failure in OSA and could assist in the development of novel video-based in-car devices for detection of driver sleepiness/ fatigue.
1. Beebe DW, Groesz L, Wells C, Nichols A, McGee K. The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case controlled data. Sleep. 2003;26(3):298-307.
2. Verstraeten E. Neurocognitive effects of obstructive sleep apnea syndrome. Curr Neurol Neurosci Rep. 2007;7(2):161-166.
3. Ellen RL, Marshall SC, Palayew M, Molnar FJ, Wilson KG, Man-Son-Hing M. Systematic review of motor vehicle crash risk in persons with sleep apnea. J Clin Sleep Med. 2006;2(2):193-200.
4. George CF, Findley LJ, Hack MA, McEvoy RD. Acrosscountry viewpoints on sleepiness during driving. Am J Respir Crit Care Med. 2002;165(6):746-749.
5. Vakulin A, Catcheside PG, Baulk SD, Antic NA, Banks S, Dorrian J, McEvoy RD. Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea. J Clin Sleep Med. 2014;10(6):647-655.
6. Baulk SD, Biggs SN, Reid KJ, van den Heuvel CJ, Dawson D. Chasing the silver bullet: measuring driver fatigue using simple and complex tasks. Accid Anal Prev. 2008;40(1):396-402.
7. Poyatos F. Nonverbal verbal communication across disciplines: paralanguage, kinesics, silence, personal and environmental interaction. Amsterdam: John Benjamins Publishing Company; 2002.
8. Ftouni S, Rahman SA, Crowley KE, Anderson C, Rajaratnam SM, Lockley SW. Temporal dynamics of ocular indicators of sleepiness across sleep restriction. J Biol Rhythms. 2013;28(6):412-424.
9. Roge J, Becht J, Eschenlauer R, Pebayle T, Muzet A, editors. Effect of paretial sleep deprivation on frequency of hypovigilance episodes occurring during driving simulation. International Conference on Alcohol, Drugs and Trafﬁc Safety; Centre d’Etudes et de Recherches en Medecine du Traﬁc (CERMIT), Annecey; 1997.
10. Roge J, Pebayle T, Muzet A. Variations of the level of vigilance and of behavioural activities during simulated automobile driving. Accid Anal Prev. 2001;33(2):181-186.
11. Bonnefond A, Roge J, Muzet A. Behavioural reactivation and subjective assessment of the state of vigilance application to simulated car driving. Int J Occup Saf Ergon. 2006;12(3):221-229.
12. Vakulin A, Baulk SD, Catcheside PG, Antic NA, van den Heuvel CJ, Dorrian J, McEvoy RD. Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with obstructive sleep apnea. Ann Intern Med. 2009;151(7):447-455.
13. Flemons WW, Buysse D, Redline S, Pack A, Strohl K, Wheatley J, Young T, Douglas N, Levy P, McNicholas W, Fleetham J, White D, Schmidt-Nowarra W, Carley D, Romaniuk J. Sleep-related breathing disorders in adults: recommendations for syndrome deﬁnition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667-689.
14. Rechtschaffen A, Kales A. Techniques, and scoring system for sleep stages of human subjects: a manual of standardised terminology. Los Angeles: UCLA Brain Information Service; 1968.
15. Desai AV, Wilsmore B, Bartlett DJ, Unger G, Constable B, Joffe D, Grunstein RR. The utility of the AusEd driving simulator in the clinical assessment of driver fatigue. Behav Res Methods. 2007;39(3):673-681.
16. Muzet A, Roge J. Detecting operator drowsiness during a complex task through behavioural and physiological parameters. In: Hockey R, Gaillard AWK, Burov O, editors. Operator Functional State: The Assessment and Prediction of Human Performance Degradation in Complex Tasks. Amsterdam: IOS Press; 2003. p. 81-89.
17. Minkel J, Htaik O, Banks S, Dinges D. Emotional expressiveness in sleep-deprived healthy adults. Behav Sleep Med. 2011;9(1):5-14.
18. Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117-126.
19. Akerstedt T, Peters B, Anund A, Kecklund G. Impaired alertness and performance driving home from the night shift: a driving simulator study. J Sleep Res. 2005;14(1):17-20.
20. Eriksson M, Papanikolopoulos NP. Driver fatigue: a vision-based approach to automatic diagnosis. Transp Res Part C Emerg Technol. 2001;9(6):399-413.
21. Nordbakke S, Sagberg F. Sleepy at the wheel: knowledge, symptoms and behaviour among car drivers. Transp Res Part F: Trafﬁc Psych Behav. 2007;10(1):1-10.
22. Verwey WB, Zaidel DM. Predicting drowsiness accidents from personal attributes, eye blinks and ongoing driving behaviour. Personality Inl Diff. 2000;28(1):123-142.
23. Ftouni S, Sletten TL, Howard M, Anderson C, Lenne MG, Lockley SW, Rajaratnam SM. Objective and subjective measures of sleepiness, and their associations with on-road driving events in shift workers. J Sleep Res. 2013;22(1):58-69.
24. Hirvonen K, Puttonen S, Gould K, Korpela J, Koefoed VF, Muller K. Improving the saccade peak velocity measurement for detecting fatigue. J Neurosci Methods. 2010;187(2):199-206.
25. Corbett MA. A drowsiness detection system for pilots: Optalert. Aviat Space Environ Med. 2009;80(2):149.
26. Reyner LA, Horne JA. Evaluation “in-car” countermeasures to sleepiness: cold air and radio. Sleep. 1998;21(1):46-50.
27. Contardi S, Pizza F, Sancisi E, Mondini S, Cirignotta F. Reliability of a driving simulation task for evaluation of sleepiness. Brain Res Bull. 2004;63(5):427-431.
28. Philip P, Sagaspe P, Moore N, Taillard J, Charles A, Guilleminault C, Bioulac B. Fatigue, sleep restriction and driving performance. Accid Anal Prev. 2005;37(3):473478.
29. George CF. Driving simulators in clinical practice. Sleep Med Rev. 2003;7(4):311-320.
30. D’Orazio T, Leo M, Guaragnella C, Distante A. A visual approach for driver inattention detection. Pattern Recognit. 2007;40(8):2341-2355.