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Patients with obstructive sleep apnoea syndrome (OSAS) have an increased car accident rate. Investigations on accident frequency are based on case history, insurance reports and driving simulator studies. The present study combines neuropsychological testing of different attention aspects engaged in driving a car and driving simulation to evaluate a suitable instrument for assessing therapeutic effects of continuous positive airway pressure (CPAP). Driving simulator investigation and neuropsychological testing of alertness, vigilance and divided attention were performed in 31 patients with polysomnographically confirmed OSAS (apnoea-hypopnoea index 24.8+/-21.5.h(-1)) before, and 2 and 42 days after initiation of CPAP. Divided attention and alertness improved significantly during CPAP, whereas vigilance remained unchanged. However, accident frequency (OSAS before therapy: 2.7+/-2.0; 2 days after CPAP: 1.5+/-1.4; 42 days after CPAP: 0.9+/-1.3) and frequency of concentration faults (OSAS before therapy: 12.4+/-5.1; 2 days after CPAP: 6.5+/-3.9; 42 days after CPAP: 4.9+/-3.3) decreased in the simulated driving situation after 2 and 42 days of therapy. There was no relation between accident frequency, concentration faults and daytime sleepiness, as measured by the Epworth Sleepiness Scale, and polysomnographic or neuropsychological findings, respectively. In conclusion, the present results suggest that driving simulation is a possible benchmark parameter of driving performance in obstructive sleep apnoea syndrome patients.

Six subjects performed a breathholding maneuver during facial cooling and immersed their foot in cold water, without drugs and after the intravenous administration of propranolol plus atropine (P + A). Cardiac interval (INT), mean interval for longest consecutive 5 cycles (L5INT/5); systolic time intervals including electromechanical systole (EMS), left ventricular ejection time (LVET), pre-ejection period (PEP), and PEP/LVET; and systolic (SP) and diastolic pressures (DP) were monitored during supine rest, during apnea with a plastic bag of ice water on the face, and from 16-30th and 46-60th sec of 1-min periods of foot immersion in 4 degrees C water. P+A administration induced reduction in INT, L5INT/5, and LVET and increase in PEP, PEP/LVET, and DP. INT, L5INT/5, PEP, SP, and DP increased during facial cooling without drugs. Only the increases in INT and L5INT/5 were abolished by P+A and thus considered to result from reflexes mediated by vagal or sympathetic outflow to the heart. Reductions in INT, L5INT/5, EMS, PEP, and PEP/LVET at 16-30 sec of foot immersion without drugs were not observed after P+A; 46-60 sec responses neared resting values, however, with and without P+A. These results indicate an initial cardiac reflex response to foot immersion may be overpowered by the ventricular afterload and the foot immersion may be overpowered by the ventricular afterload and the baroreceptor response due to the increased arterial pressure.