Maintenance of wakefulness test: how does it predict accident risk in patients with sleep disorders?

Philip, Pierre; Guichard, Kelly; Strauss, Mélanie; Léger, Damien; Pepin, Emilie; Arnulf, Isabelle; Sagaspe, Patricia; Barateau, Lucie; Lopez, Régis; Taillard, Jacques; Micoulaud‐Franchi, Jean‐Arthur; Dauvilliers, Yves

doi:10.1016/j.sleep.2020.04.007

Cited by 31 publications

(23 citation statements)

References 28 publications

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“…According to the NOS on cross-sectional (n:17) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]; case–control (n:25) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] and cohort studies (n:7) [ 64 , 65 , 66 , 67 , 68 , 69 , 70 ], the authors evaluated the qualities and the risk of bias of all included studies based on object selection, comparability and exposure [ 71 ]. A star was described as an appropriate entry, with each star representing one point.…”

Section: Resultsmentioning

confidence: 99%

“…Controls: 538 car crashes in subjects without OSAS and 7914 subjects without OSAS [ 24 , 25 , 40 , 41 , 43 , 45 , 46 , 47 , 48 , 50 , 52 , 53 , 65 , 70 ] 2093 non-car accident in subjects with OSAS and 5328 non-car accidents [ 22 , 28 , 42 , 49 , 51 , 54 , 55 , 59 , 60 , 61 ] 3000 car crashes in subjects without ESS ≥ 10 and 8517 subjects without ESS ≥ 10 [ 27 , 31 , 37 , 58 ] 264 car crashes in subjects without SDB and 573 subjects without SDB [ 33 , 57 ]. …”

Section: Resultsmentioning

confidence: 99%

“…2093 non-car accident in subjects with OSAS and 5328 non-car accidents [ 22 , 28 , 42 , 49 , 51 , 54 , 55 , 59 , 60 , 61 ]…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Luzzi

Mazur

Guaragna

et al. 2022

JCM

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Obstructive sleep apnea syndrome (OSAS) is an under-recognized clinical condition and is correlated with sleepiness and impaired cognitive function. Objectives: The primary aim of this systematic review, developed within the Sleep@OSA project, was to determine the correlations of obstructive sleep apnea syndrome, daytime sleepiness and sleep-disordered breathing with the risk of car accidents in adult working populations; a secondary aim was to analyze the epidemiologic data with a gender-based approach to identify differences between women and men in the data and in associated risk factors. Methods: Clinical trials and studies reporting data on the frequency of car accidents involving adult working population with daytime sleepiness and/or OSAS compared with a control group of participants were included. Literature searches of free text and MeSH terms were performed using PubMed, Google Scholar, the Cochrane Library and Scopus from 1952 to 3 May 2021. Results and Conclusions: The search strategy identified 2138 potential articles. Of these, 49 papers were included in the qualitative synthesis, and 30 were included in the meta-analysis. Compared with controls, the odds of car accidents were found to be more than double in subjects with OSAS (OR = 2.36; 95% CI 1.92–2.91; p < 0.001), with a similar risk between commercial motor vehicle drivers (OR = 2.80; 95% CI 1.82–4.31) and noncommercial motor vehicle drivers (OR = 2.32; 95% CI 1.84–2.34). No significant correlation was found between sleepiness and car crashes, but subjects with sleep-disordered breathing were at increased risk of car accidents (OR = 1.81; 95% CI 1.42–2.31; p < 0.001). To our surprise, although epidemiological studies on the risk of road accidents in the adult population with OSAS and daytime sleepiness are currently very abundant, specific data on the female population are not available.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Luzzi

Mazur

Guaragna

et al. 2022

JCM

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“…In narcolepsy, correlations ranging between low (0.26) and moderate (0.56) were found (Philip et al, 2014 ; Sagaspe et al, 2019 ). In a recent study among patients with various sleep‐related disorders, retrospective MWT outcomes were associated with self‐reported near misses or accidents in the past year (Philip et al, 2020 ). However, these MWT tests were performed for clinical purposes and not for the evaluation of fitness to drive.…”

Section: Introductionmentioning

confidence: 99%

Comparing objective wakefulness and vigilance tests to on‐the‐road driving performance in narcolepsy and idiopathic hypersomnia

Bijlenga

Urbanus

Sluiszen

et al. 2021

Journal of Sleep Research

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Summary Patients with narcolepsy or idiopathic hypersomnia (IH) are at increased risk of driving accidents. Both excessive daytime sleepiness, i.e. unwanted sleep episodes during the day, and disturbed vigilance are core features of these disorders. We tested on‐the‐road driving performance of patients with narcolepsy or IH coming in for a routine driving fitness evaluation and examined: (1) correlations between driving performance and the Maintenance of Wakefulness Test (MWT), Sustained Attention to Response Task (SART) and Psychomotor Vigilance Test (PVT) as objective tests; (2) the predictive power of the MWT and SART for increased risk of impaired driving; (3) the best set of objective predictors for increased risk of impaired driving. Participants were 44 patients (aged 18–75 years) with narcolepsy type 1 (NT1), type 2 (NT2) or IH. They completed the MWT, SART, PVT, a subjective sleepiness questionnaire, and a standardised on‐the‐road driving test. The standard deviation of the lateral position (SDLP) was used as outcome measure of driving performance. The MWT had low correlation with the SDLP (ρ = −0.41 to −0.49, p < 0.01). The SART and PVT had low correlations with SDLP (ρ = 0.30 and ρ = 0.39, respectively, both p < 0.05). The predictive power of MWT for an increased risk of impaired driving was significant, but low (area under the curve = 0.273, p = 0.012), and non‐significant for SART. We conclude that in our present group, none of the tests had adequate ability to predict impaired driving, questioning their use for clinical driving fitness evaluation in narcolepsy and IH. Real‐time monitoring of sleepiness while driving seems more promising in these patients.

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“…The identification of risk factors also depends on the methods used to assess sleepiness. Since ESS scores are subjective and show many limitations, the maintenance of wakefulness test (MWT) is currently considered to be the most effective tool to study sleep propensity with regard to SW, especially if the 40 min protocol is used rather than the usual 20 min protocol [65][66][67][68]. However, in addition to sleep latency, which is the main result of the MWT, very short episodes of sleep during MWT could be more sensitive markers of the risk to experience car accidents by reflecting drowsiness, i.e., the intermediate state between wakefulness and established sleep.…”

Section: Pathophysiology Of Sleepiness At the Wheel In Osa Patientsmentioning

confidence: 99%

Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review

Bonsignore

Lombardi

Lombardo

et al. 2022

JCM

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Sleepiness at the wheel (SW) is recognized as an important factor contributing to road traffic accidents, since up to 30 percent of fatal accidents have been attributed to SW. Sleepiness-related motor vehicle accidents may occur both from falling asleep while driving and from behavior impairment attributable to sleepiness. SW can be caused by various sleep disorders but also by behavioral factors such as sleep deprivation, shift work and non-restorative sleep, as well as chronic disease or the treatment with drugs that negatively affect the level of vigilance. An association between obstructive sleep apnea (OSA) and motor vehicle accidents has been found, with an increasing risk in OSA patients up to sevenfold in comparison to the general population. Regular treatment with continuous positive airway pressure (CPAP) relieves excessive daytime sleepiness and reduces the crash risk. Open questions still remain about the physiological and clinical determinants of SW in OSA patients: the severity of OSA in terms of the frequency of respiratory events (apnea hypopnea index, AHI) or hypoxic load, the severity of daytime sleepiness, concomitant chronic sleep deprivation, comorbidities, the presence of depressive symptoms or chronic fatigue. Herein, we provide a review addressing the epidemiological, physiological and clinical aspects of SW, with a particular focus on the methods to recognize those patients at risk of SW.

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Maintenance of wakefulness test: how does it predict accident risk in patients with sleep disorders?

Cited by 31 publications

References 28 publications

Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Comparing objective wakefulness and vigilance tests to on‐the‐road driving performance in narcolepsy and idiopathic hypersomnia

Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review

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