Driving simulators in the clinical assessment of fitness to drive in sleepy individuals: A systematic review

“…In the USA, which is seen as an automobile‐centric country, drowsiness is thought to be the primary cause of 15–20% of all traffic accidents, and drowsiness, dizziness, and wobble can be caused by not only a variety of diseases, but also a variety of medications (e.g., opioids, antihistamines, benzodiazepines [BZD], antidepressants) used as therapeutic agents. Therefore, countermeasures are strongly required . The World Health Organization (WHO) also declared in 2004 that ‘Road traffic injuries are a major but neglected global public health problem, requiring concerted efforts for effective and sustainable prevention’ .…”

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confidence: 91%

Evaluation method regarding the effect of psychotropic drugs on driving performance: A literature review

Iwata

Iwamoto

Kawano

et al. 2018

Psychiatry Clin Neurosci

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Although automobile driving is necessary for many people, including patients with mental disorders, the influence of psychotropic drugs on driving performance remains unclear and requires scientific verification. Therefore, the objective of this study was to conduct a review of the literature in order to aid the development of a valid evaluation method regarding the influence of medication on driving performance. We conducted a literature search using two sets of terms on PubMed. One set was related to psychotropic drugs, and the other to driving tests. We excluded reviews and case studies and added literature found on other sites. A total of 121 relevant reports were found. The experiments were roughly divided into on-the-road tests (ORT) and driving simulators (DS). Although highway driving tests in ORT are most often used to evaluate driving performance, DS are becoming increasingly common because of their safety and low cost. The validity of evaluation methods for alcohol should be verified; however, we found that there were few validated tests, especially for DS. The scenarios and measurement indices of each DS were different, which makes it difficult to compare the results of DS studies directly. No evaluation indices, except for SD of lateral position, were sufficiently validated. Although highway ORT are the gold standard, DS were shown to have an increasing role in evaluating driving performance. The reliability of DS needs to be established, as does their validation with alcohol in order to accumulate more high-quality evidence.

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“…Sleepiness can negatively affect reaction time and performance, similar or even more severe than driving with an illegal blood alcohol concentration (Dawson and Reid, 1997;Williamson and Feyer, 2000;Arnedt et al, 2001;Thomann et al, 2014). However, unlike the quantification of breath or blood alcohol concentrations, there is no method to accurately quantify sleepiness behind the wheel yet, and therefore, no legal standard exists (Williamson and Feyer, 2000;Schreier et al, 2018). Sleepiness and its impact on fitness to drive are currently assessed in a clinical setting by the use of multiple vigilance tests.…”

Section: Introductionmentioning

confidence: 99%

“…The ability to resist falling asleep is most often assessed in the maintenance of wakefulness test (MWT) (Mitler et al, 1982). Although evidence regarding the accuracy of the MWT to predict real-world driving performance is scarce (Philip et al, 2008), evidence for the use of a driving simulator to assess fitness to drive in sleepy individuals is even more limited (Schreier et al, 2018). Nevertheless, existing evidence suggests that the MWT and the driving simulator are currently the best tools at hand for the fitness-to-drive assessment in sleepy patients (Banks et al, 2005;Sagaspe et al, 2007;Pizza et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Automatically Detected Microsleep Episodes in the Fitness-to-Drive Assessment

et al. 2020

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Study Objectives: Microsleep episodes (MSEs) are short fragments of sleep (1-15 s) that can cause dangerous situations with potentially fatal outcomes. In the diagnostic sleep-wake and fitness-to-drive assessment, accurate and early identification of sleepiness is essential. However, in the absence of a standardised definition and a time-efficient scoring method of MSEs, these short fragments are not assessed in clinical routine. Based on data of moderately sleepy patients, we recently developed the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring of MSEs and corresponding machine learning algorithms for automatic MSE detection, both mainly based on the electroencephalogram (EEG). The present study aimed to investigate the relationship between automatically detected MSEs and driving performance in a driving simulator, recorded in parallel with EEG, and to assess algorithm performance for MSE detection in severely sleepy participants. Methods: Maintenance of wakefulness test (MWT) and driving simulator recordings of 18 healthy participants, before and after a full night of sleep deprivation, were retrospectively analysed. Performance of automatic detection was compared with visual MSE scoring, following the BERN criteria, in MWT recordings of 10 participants. Driving performance was measured by the standard deviation of lateral position and the occurrence of off-road events. Results: In comparison to visual scoring, automatic detection of MSEs in participants with severe sleepiness showed good performance (Cohen's kappa = 0.66). The MSE rate in the MWT correlated with the latency to the first MSE in the driving simulator (r s = −0.54, p < 0.05) and with the cumulative MSE duration in the driving simulator (r s = 0.62, p < 0.01). No correlations between MSE measures in the MWT and driving performance measures were found. In the driving simulator, multiple correlations between MSEs and driving performance variables were observed. Conclusion: Automatic MSE detection worked well, independent of the degree of sleepiness. The rate and the cumulative duration of MSEs could be promising sleepiness

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Driving simulators in the clinical assessment of fitness to drive in sleepy individuals: A systematic review

Cited by 42 publications

References 51 publications

Drowsy Driving Considerations in Non-Commercial Drivers for the Sleep Physician

Drowsy Driving Considerations in Non-Commercial Drivers for the Sleep Physician

Evaluation method regarding the effect of psychotropic drugs on driving performance: A literature review

Automatically Detected Microsleep Episodes in the Fitness-to-Drive Assessment

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