目的:收集嗜睡症和特发性睡眠过度的参与者(被认为是“嗜睡专家”)在昏昏欲睡驾驶之前经历的前驱症状和用于保持警觉的反策略。
方法:系统,面对面访谈(使用半结构化问卷),包括临床措施,车祸/险些失踪的频率,以及在即将发生的昏昏欲睡的驾驶发作和对策之前经历的症状。
结果:在61名参与者中(32名患有嗜睡症,29例特发性睡眠过度;56名司机),61%的驾驶员至少有一次终生事故/未遂事故。他们的嗜睡得分较高(14±4vs.11±5,P<0.04)比没有事故/险些,但人口统计学上没有其他差异,驾驶体验,医疗条件,症状,睡眠测试,和治疗。除三名参与者外,所有参与者都出现了昏昏欲睡的前驱症状,其中包括姿势和运动变化(86.9%:轴向张力减退-例如,眼睑下垂,刻板的动作),认知障碍(53.3%:自动转向,集中注意力/转移困难,解离,心灵徘徊,dreaming),感觉(65%:感觉异常,疼痛,刚度,沉重,钝的感知,如失去3D的平面仪表板,幻觉和幻觉),和自主神经症状(10%,心率/呼吸频率改变,阴茎勃起)。对策包括来自外部来源的自我刺激(疼痛,冷空气,音乐,饮料,光脚驾驶),运动变化(直立姿势,运动),和惊喜(突然刹车)。
结论:昏昏欲睡的驾驶症状可能是由“本地”NREM引起的,进入N1睡眠,和混合唤醒/快速眼动睡眠状态。这些来自发作性睡病和特发性睡眠过度患者的丰富定性见解,以及复杂的反策略,可以收集以降低这一人群的撞车风险,而且在没有经验的健康司机中也是如此。
OBJECTIVE: To collect prodromal symptoms experienced by participants with
narcolepsy and idiopathic hypersomnia (considered \"hypersomnolence experts\") prior to drowsy driving and counter-strategies used to maintain alertness.
METHODS: Systematic, face-to-face interview (using a semi-structured questionnaire), including clinical measures, frequency of car accidents/near misses, and symptoms experienced before impending drowsy driving episodes and counter-strategies.
RESULTS: Among 61 participants (32 with
narcolepsy, 29 with idiopathic hypersomnia; 56 drivers), 61% of drivers had at least one lifetime accident/near miss. They had a higher sleepiness score (14 ± 4 vs. 11 ± 5, P<0.04) than those without an accident/near miss, but no other differences in demographics, driving experience, medical conditions, symptoms, sleep tests, and treatment. All but three participants experienced prodromal symptoms of drowsy driving, which included postural and motor changes (86.9%: axial hypotonia - e.g., eyelid droop, stereotyped movements), cognitive impairment (53.3%: automatic steering, difficulty concentrating/shifting, dissociation, mind wandering, dreaming), sensory (65%: paresthesia, pain, stiffness, heaviness, blunted perceptions such as a flat dashboard with loss of 3D, illusions and hallucinations), and autonomic symptoms (10%, altered heart/breath rate, penile erection). Counterstrategies included self-stimulation from external sources (pain, cold air, music, drinks, driving with bare feet), motor changes (upright posture, movements), and surprise (sudden braking).
CONCLUSIONS: Drowsy driving symptoms can result from \"local\" NREM, entry in N1 sleep, and hybrid wake/REM sleep states. These rich qualitative insights from participants with
narcolepsy and idiopathic hypersomnia, as well as sophisticated counter-strategies, can be gathered to reduce the crash risk in this population, but also in inexperienced healthy drivers.