Stuart D. Baulk

Countermeasures to driver fatigue: a review of public awareness campaigns and legal approaches

Objective: Driver fatigue accounts for 10–40% of road crashes and is a critical area for public health. As other major road safety issues are more successfully managed, driver fatigue becomes proportionately more important. Both public awareness and legal developments have been slow to reach the same levels as for other road safety risks. The aim of this article is to review countermeasures for non‐commercial drivers that are designed to reduce the likelihood of fatigue‐related crashes through education and legislation.

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.

Predicting the timing and duration of sleep in an operational setting using social factors

In recent years, there has been increasing interest in the use of bio‐mathematical models to predict alertness, performance, and/or fatigue in operational settings. Current models use only biological factors to make their estimations, which can be limited in operational settings where social and geo‐physical factors also dictate when sleep occurs. The interaction between social and biological factors that help determine the timing and duration of sleep during layover periods have been investigated in order to create and initially validate a mathematical model that may better predict sleep in the field. Participants were 32 male transmeridian airline pilots (17 captains, 10 first officers, and 5 second officers) flying the Sydney‐Bangkok‐London‐Singapore‐Sydney (SYD‐LHR) pattern. Participants continued their regular schedule while wearing activity monitors and completing sleep and work diaries. The theoretical sleep timing model underpinning this analysis consists of separate formulations for short (<32 h) and long (>32 h) break periods. Longer break periods are split into three distinct phases—recovery (break start until first local night), personal (first local night until last local night), and preparation phases (last local night until break end)—in order to exploit potential differences specific to each. Furthermore, an iterative procedure combining prediction and retrodiction (i.e., using future duty timing information to predict current sleep timing) was developed to optimize predictive ability. Analysis found an interaction between the social and circadian sleep pressures that changed over the break period. Correlation analysis indicated a strong relationship between the actual sleep and new models predictions (r=0.7–0.9), a significant improvement when compared to existing models (r=0.1–0.4). Social and circadian pressures play important roles in regulating sleep for international flight crews. An initial model has been developed in order to regulate sleep in these crews. The initial results have shown promise when applied to small sets of data; however, more rigorous validation must be carried out.

Auditory evoked potentials remain abnormal after CPAP treatment in patients with severe obstructive sleep apnoea.

OBJECTIVE To assess the effects of 3 months of optimal CPAP treatment on auditory event related potentials (AERP) in patients with severe obstructive sleep apnoea (OSA) compared with healthy controls. METHODS Auditory odd-ball related N1, P2, N2 and P3 AERP components were assessed in 9 severe OSA subjects and 9 healthy controls at baseline evaluation and at ∼3 months follow-up in both groups, with OSA subjects treated with continuous positive air-way pressure (CPAP) during this period. RESULTS Severe OSA subjects showed significantly delayed, P2, N2 and P3 latencies, and significantly different P2 and P3 amplitudes compared to controls at baseline (group effect, all p<0.05). At follow-up evaluation P3 latency shortened in treated OSA patients but remained prolonged compared to controls (group by treatment interaction, p<0.05) despite high CPAP compliance (6h/night). The earlier AERP (P2 and N2) components did not change in either controls or OSA patients at follow-up and remained different in patients versus controls. CONCLUSIONS This study demonstrates that in severe OSA patients AERP responses show minimal or no improvement and remain abnormal following 3 months of optimal CPAP treatment. SIGNIFICANCE Persistent cortical sensory processing abnormalities despite treatment in severe OSA may have implications for daytime neurobehavioral performance and safety in OSA patients. AERP responses may help identify residual performance deficits and risks.

Drugs, driving and traffic safety in sleep apnea

Sleep apnea affects 2–4 % of the population. It is characterised by repetitive episodes of brief upper airway obstruction during sleep, with associated arousal from sleep. Consequences of untreated sleep apnea include excessive daytime sleepiness and impaired cognitive functioning and driving performance. Sleep apnea is also associated with a number of co-morbidities, including hypertension, insomnia and cardiovascular disease. As such, many sleep apnea patients are on medications that can potentially affect their sleep apnea severity and daytime functioning, including driving performance. Centrally-acting depressant drugs, including alcohol, antihypertensives, narcotics and sedatives, can cause respiratory depression and worsen sleep apnea. They may increase sleepiness and further impair driving performance either through direct actions on the central nervous system or through increasing sleep apnea severity. This chapter describes the effects of sleep apnea on daytime sleepiness, cognitive functioning and driving performance, as well as the drugs affecting waking and nocturnal respiration.