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Behavioural observation as a means of assessing sleepiness related driving impairment in obstructive sleep apnoea


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Figure 1.

Mean (SEM) steering deviation throughout the 90 minute drive in severe OSA patients following normal sleep and sleep deprivation.
Mean (SEM) steering deviation throughout the 90 minute drive in severe OSA patients following normal sleep and sleep deprivation.

Figure 2.

Mean frequency (SEM) of behaviours observed per 10 min block throughout the 90 minute simulated drive in severe OSA patients under normal and sleep restriction conditions.
Mean frequency (SEM) of behaviours observed per 10 min block throughout the 90 minute simulated drive in severe OSA patients under normal and sleep restriction conditions.

Figure 3.

Mean frequency (SEM) of behaviours observed per 1 minute time block in the 10 minutes prior to the first crash or non-crash event in severe OSA patients under sleep restriction condition.
Mean frequency (SEM) of behaviours observed per 1 minute time block in the 10 minutes prior to the first crash or non-crash event in severe OSA patients under sleep restriction condition.

Figure 4.

Kaplain-Meier curves showing the cessation of non-verbal facial activities in the 10 mins prior to crash events versus control period prior to non-crash events.
Kaplain-Meier curves showing the cessation of non-verbal facial activities in the 10 mins prior to crash events versus control period prior to non-crash events.

Patient characteristics, sleep study results, time In bed (actigraphy).

Variable N/Mean(SD)
Males/Females (N) 14/3
Age (yrs) 53.2 (11.6)
Body-Mass Index (BMI) 36.8 (8.0)
Apnea Hypopnea Index (AHI: events/hr) 64.6 (18.0)
% of sleep time with SaO2<90% 9.9 (15.1
Average SaO2 desaturation 4.9 (2.3)
Epworth Sleepiness Scale (ESS) 10.6 (5.4)
Time in Bed (mins)
Normal Sleep 444 (95)
Sleep Restriction 213 (0)

Definitions of non-verbal behaviours in OSA patients.

Behaviour Definition
Self-centred gestures
Touching head Hand touches any point on the face, defined from the jaw line upwards, inclusive of scalp, eyes and ears.
Touching neck Hand touches any point on the circumference of the neck, from thorax to nape.
Touching arms Hand touches opposite arm, from and inclusive of hand to shoulder.
Touching torso Hand touches upper torso - defined from sternum to collarbone and deltoid to deltoid.
Non-verbal facial activities
Yawn Progressive, involuntary opening of mouth during deep inhalation. A closed or open hand may move to cover the mouth during a yawn.
Stretch face Extension of facial muscles without hands present. May include: stretching of facial features along horizontal or vertical axes, exaggerated raising of eyebrows, or tightening and slight recession of ears and scalp.
Licking lip Extension of tongue onto upper or lower lips, which may be held stationary, or moved horizontally in either direction across the chosen lip.
Biting lip Insertion of either upper or lower lip into the mouth until held between upper and lower front teeth. Both lips may be inserted at the same time.
Postural Adjustments
Tilt torso Tilting of torso in any direction, keeping original point of contact on the seat.
Tilt head Tilting of head in any direction, keeping original neck position. A tilting behaviour is not to be recorded if it is a function of another behaviour. i.e. tilting head left to scratch the head.
Shift position Relocation of seating position marked by the brief rising to fall into a new position on the seat. Rising can occur either through the use of one or two hands pushing down against the armrests, or brief and partial propulsion by the legs.
Exercise shoulders Movement of one or both shoulders in a backwards direction, stretching the shoulders and chest. One or both shoulders may also be rotated from the torso in a clockwise or anticlockwise direction, stretching the shoulders and chest.
Stretch arms Removal of one or both arms from the steering wheels and full extension of one or both elbow joints, resulting in a stretch of the respective arms muscles.
Non-self-centred-gestures
Play with hair Hand extends to hair on scalp or face and commences one of the following behaviours: wrapping hair around fingers, repetitively stroking hair mass, tugs hair against follicle roots, or moving fingers through or under hair mass.
Tap fingers Repetitive initiation and cessation of contact of one or more fingers against a surface. If multiple fingers are in use, they may tap in consecutive motion.
Touch environment One or more of digits removed from the steering wheel and placed on an inanimate piece of the surrounding environment. i.e. chair, simulator cupboard.
Eye closures
Closed eyes (>1s) Simultaneous closing of both eyelids for a duration lasting for greater than one second.

Incident rate ratio for exhibiting behaviour.

Condition Time
IRR 95%CI 95%CI 95%CI
Behaviour IRR lower Upper Z IRR lower Upper Z
Crash 3.44 1.74 6.84 3.54** 1.24 1.09 1.40 3.40**
Self-centred 1.02 0.87 1.21 0.26 1.08 1.05 1.12 4.69**
Non-verbal facial 1.12 0.96 1.31 1.38 1.03 0.99 1.06 1.73
Eye closure 2.13 1.75 2.60 7.48** 1.24 1.19 1.29 10.82**
Postural 1.49 1.29 1.72 5.48** 1.11 1.08 1.41 7.42**
Non-self-centred gestures 0.53 0.36 0.78 -3.28** 1.11 1.03 1.19 2.90**

Incident rate ratio for exhibiting behaviour preceding crash or non-crash events.

Condition Time
IRR 95%CI 95%CI 95%CI
Behaviour IRR lower Upper Z IRR lower Upper Z
Self-centred 0.86 0.52 1.42 -0.57 0.98 0.9 1.07 -0.37
Non-verbal facial 1.02 0.57 1.81 0.06 0.97 0.88 1.08 -0.5
Eye closure 2.13 1.42 3.78 3.37** 1.07 0.99 1.17 1.68
Postural 0.91 0.59 1.41 -0.41 0.97 0.89 1.05 0.04
eISSN:
2206-5369
Sprache:
Englisch
Zeitrahmen der Veröffentlichung:
Volume Open
Fachgebiete der Zeitschrift:
Sozialwissenschaften, Pädagogik, andere, Sozialpädagogik, Soziale Arbeit