Patricia Sagaspe1, Jean-Arthur Micoulaud-Franchi1, Olivier Coste2, Damien Léger3, Stéphane Espié4, Damien Davenne5, Régis Lopez6, Yves Dauvilliers6, Pierre Philip7. 1. Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France; CNRS, SANPSY, USR 3413, Bordeaux, France; CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France. 2. CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France. 3. Université Paris Descartes, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Centre Hypersomnies Rares, Paris, France. 4. IFSTTAR/TS2/SIMU&MOTO, Paris, France. 5. UMR 1075, INSERM, Université de Caen, Caen, France. 6. Reference National Center for Narcolepsy, Sleep Unit, CHU Montpellier, Montpellier, France; INSERM U1061, Université Montpellier 1, Montpellier, France. 7. Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France; CNRS, SANPSY, USR 3413, Bordeaux, France; CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France. Electronic address: pr.philip@free.fr.
Abstract
STUDY OBJECTIVES: To assess the relationship between real and simulated driving performance and the objective level of alertness as measured by the Maintenance of Wakefulness Test (MWT) in patients suffering from narcolepsy or idiopathic hypersomnia. METHODS:Twenty-seven patients (10 patients with narcolepsy, type 1 (n = 7) and type 2 (n = 3), and 17 patients with idiopathic hypersomnia, mean age = 33.8 ± 11.1 years, range = 18-65 y; four males) were recruited in a randomized, crossover, double-blind placebo-controlled trial, and compared to 27 matched healthy controls. Patients were randomly assigned to receive modafinil (400 mg) or placebo before the driving test (2 h of real and 2 h of simulated highway driving for each patient). Standard deviation of lateral position (SDLP) of the vehicle in real and simulated driving and mean sleep latency in a 4 × 40 min MWT were assessed. RESULTS: Untreated patients presented shorter sleep latencies on the MWT (20.8 (IQ range 16.1-32.9) vs. 34.9 min (IQ range 28.1-40.0)) and worse simulated driving performance (P < 0.001) than treated patients. Nevertheless, treated patients still exhibited shorter mean sleep latencies on the MWT than controls (34.9 (IQ range 28.1-40.0) vs. 40 min (IQ range 37.1-40.0), P < 0.05), but driving performance was identical in both groups. The SDLP of the vehicle in real driving conditions and the MWT score correlated with the SDLP in simulated driving (respectively, r = 0.34, P < 0.05 and r = -0.56, P < 0.001). CONCLUSIONS: In patients with narcolepsy/idiopathic hypersomnia, simulated driving and MWT explore different dimensions of fitness-to-drive and could be used complementarily to better evaluate sleep-related driving impairment.
RCT Entities:
STUDY OBJECTIVES: To assess the relationship between real and simulated driving performance and the objective level of alertness as measured by the Maintenance of Wakefulness Test (MWT) in patients suffering from narcolepsy or idiopathic hypersomnia. METHODS: Twenty-seven patients (10 patients with narcolepsy, type 1 (n = 7) and type 2 (n = 3), and 17 patients with idiopathic hypersomnia, mean age = 33.8 ± 11.1 years, range = 18-65 y; four males) were recruited in a randomized, crossover, double-blind placebo-controlled trial, and compared to 27 matched healthy controls. Patients were randomly assigned to receive modafinil (400 mg) or placebo before the driving test (2 h of real and 2 h of simulated highway driving for each patient). Standard deviation of lateral position (SDLP) of the vehicle in real and simulated driving and mean sleep latency in a 4 × 40 min MWT were assessed. RESULTS: Untreated patients presented shorter sleep latencies on the MWT (20.8 (IQ range 16.1-32.9) vs. 34.9 min (IQ range 28.1-40.0)) and worse simulated driving performance (P < 0.001) than treated patients. Nevertheless, treated patients still exhibited shorter mean sleep latencies on the MWT than controls (34.9 (IQ range 28.1-40.0) vs. 40 min (IQ range 37.1-40.0), P < 0.05), but driving performance was identical in both groups. The SDLP of the vehicle in real driving conditions and the MWT score correlated with the SDLP in simulated driving (respectively, r = 0.34, P < 0.05 and r = -0.56, P < 0.001). CONCLUSIONS: In patients with narcolepsy/idiopathic hypersomnia, simulated driving and MWT explore different dimensions of fitness-to-drive and could be used complementarily to better evaluate sleep-related driving impairment.
Authors: Denise Bijlenga; Bram Urbanus; Nick N J J M van der Sluiszen; Sebastiaan Overeem; Jan G Ramaekers; Annemiek Vermeeren; Gert Jan Lammers Journal: J Sleep Res Date: 2021-11-09 Impact factor: 5.296