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Sleepiness, Aging, and Driving Skills
Sleepiness has been recognized as one of the main factors that affect driving skills. Sleepiness has been defined as difficulty maintaining wakefulness without external stimuli. Excessive daytime sleepiness (EDS) is present in 10–20% of the general population and negatively impacts reaction time, vigilance, and judgment of performance at the wheel. The sleepiness level can be evaluated by subjective or objective methods and may be influenced by poor sleep hygiene, circadian rhythm, or alcohol and drugs.
2. Age-Related Effect of Sleepiness on Driving Performance
2.1. Self-Reported Sleepiness
The project by Vaz Fragoso and colleagues produced three studies on longitudinal data collecting from a sample of 430 older adults (≥70 years) . They aimed to assess the relationship between drowsiness/sleep complaints and driving capacity. Both sleepiness and driving measures were self-reported in all studies . Moreover, other sleep questionnaires to evaluate insomnia and sleep apnea risk were administered. Older adults had chronic disturbances, e.g., diabetes and hypertension, while a small part of the sample reported sleep apnea. As assessed by the Epworth sleepiness scale (ESS) , subjective sleepiness was related both to sleep apnea risk and chronic disease.
In a second study, the authors assessed the longitudinal association between sleep disturbances and adverse driving events in the same cohort of older adults . Longitudinal evaluations of these episodes (i.e., crash or traffic infraction and near-crash or getting lost) were planned every six months for two years. Overall, 418 older drivers participated in the follow-up. Among the participants, 215 older drivers had at least one crash, traffic infraction, near-crash, or getting lost. Crashes appeared to be correlated with a traffic infraction and near-crash with getting lost. Subjects with these adverse events showed at the baseline higher ESS scores and greater driving frequency than older adults not experiencing these events at the wheel. However, it should be noted that the median ESS score was not clinically relevant .
Moreover, sleep disturbances did not significantly affect the odds of having adverse driving events . In a third article, Vaz Fragoso and colleagues evaluated the relationship between sleep disturbances at the baseline and the subsequent driving cessation over a two-years period . Results revealed that insomnia, daytime sleepiness, and sleep apnea risk were not longitudinally associated with driving cessation.
Moreover, AMT significantly advantaged the younger group who made more driving errors than older drivers during the first and second monotonous segments. Older adults did not show increased mistakes with fatigue. Surprisingly, AMT did not negatively impact their driving performance. However, they showed increased speed variability when driving with AMT .
2.2. Behavioral Task
Leufkens et al.  and Bartolacci et al.  used the psychomotor vigilance task (PVT)  as an instrument to assess psychomotor vigilance. The PVT is based on a simple visual reaction time test and is generally accompanied by a self-reported sleepiness rating (e.g., Karolinska sleepiness scale—KSS ). The study by Leufkens et al.  involved 63 subjects with 50–75 years who were subdivided into three groups: insomnia group with medications, insomnia group without medications, and healthy subjects. All participants performed the highway driving test , measuring tracking road performance. The standard deviation of lateral position (SDLP) was used as an index of individual driving performance. Moreover, other tasks were administered to assess driving-related skills (e.g., selective attention, decision making, stimulus interpretation, speed, and adaptive motor response to driving events; divided attention). A preliminary sleep assessment with polysomnography was performed, not finding differences between groups. Subjective sleepiness and sleep complaints were also assessed. Older good sleepers and older insomniacs did not differ in driving performance and driving-related skills, as well as in PVT performance. Reaction times at the PVT differed only between morning and evening performance . Indeed, mean reaction time in the PVT was faster in the morning than the evening in controls, but not in subjects with insomnia.
More recently, Bartolacci et al.  compared 40 healthy older adults with 40 young subjects. Along with the subjective assessment of sleep quality and self-reported sleepiness, the PVT was administered to collect a behavioral sleepiness evaluation. Moreover, driving-related skills were tested: selective attention, tachistoscopic perception (e.g., the ability to obtain an overview, the skills about visual orientation, and the perceptual speed), and the risk assumption. Older adults reported lower sleep efficiency and worse performance in PVT (tendency to make more mistakes and slowing reaction times in the 10% of fastest responses) than the younger group.
2.3. Electrophysiological Pattern
The entry is from 10.3390/brainsci11081090
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