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Association between Sleep Disordered Breathing and Nighttime Driving Performance in Mild Cognitive Impairment

  • Nathan Cross (a1) (a2) (a3), Zoe Terpening (a1), Shantel L. Duffy (a1) (a2) (a3) (a4), Simon J.G. Lewis (a1) (a2) (a3) (a5), Ron Grunstein (a2) (a3) (a5), Keith Wong (a2) (a3) (a5) and Sharon L. Naismith (a1) (a3) (a4)...


Objectives: The effect of sleep disordered breathing (SDB) on driving performance in older adults has not been extensively investigated, especially in those with mild cognitive impairment (MCI). The aim of this study was to examine the relationship between severity measures of SDB and a simulated driving task in older adults with and without MCI. Methods: Nineteen older adults (age ≥50) meeting criteria for MCI and 23 age-matched cognitively intact controls underwent neuropsychological assessment and a driving simulator task in the evening before a diagnostic sleep study. Results: There were no differences in driving simulator performance or SDB severity between the two groups. In patients with MCI, a higher oxygen desaturation index (ODI) was associated with an increased number of crashes on the simulator task, as well as other driving parameters such as steering and speed deviation. Poorer driving performance was also associated with poorer executive functioning (set-shifting) but the relationship between ODI and crashes was independent of executive ability. Conclusions: While driving ability did not differ between older adults with and without MCI, oxygen saturation dips in MCI were related to worse driving performance. These results suggest that decreased brain integrity may render those with SDB particularly vulnerable to driving accidents. In older adults, both cognition and SDB need to be considered concurrently in relation to driving ability. (JINS, 2017, 23, 502–510)


Corresponding author

Correspondence and reprint requests to: Sharon L. Naismith, Healthy Brain Ageing Program, 94 Mallett Street, Camperdown NSW 2050, Australia. E-mail:


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Akerstedt, T., & Gillberg, M. (1990). Subjective and objective sleepiness in the active individual. The International Journal of Neuroscience, 52(1-2), 2937.
Alchanatis, M., Zias, N., Deligiorgis, N., Amfilochiou, A., Dionellis, G., & Orphanidou, D. (2005). Sleep apnea-related cognitive deficits and intelligence: An implication of cognitive reserve theory. Journal of Sleep Research, 14(1), 6975. doi: 10.1111/j.1365-2869.2004.00436.x
Almeida, O.P., & Pfaff, J.J. (2005). Sleep complaints among older general practice patients: Association with depression. The British Journal of General Practice, 55(520), 864866.
Ancoli-Israel, S., Kripke, D.F., Klauber, M.R., Mason, W.J., Fell, R., & Kaplan, O. (1991). Sleep-disordered breathing in community-dwelling elderly. Sleep, 14(6), 486495.
Arbuthnott, K., & Frank, J. (2000). Trail making test, part B as a measure of executive control: Validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology, 22(4), 518528. doi: 10.1076/1380-3395(200008)22:4;1-0;ft518
Banks, S., & Dinges, D.F. (2007). Behavioral and physiological consequences of sleep restriction. Journal of Clinical Sleep Medicine, 3(5), 519528.
Bedard, M., Guyatt, G.H., Stones, M.J., & Hirdes, J.P. (2002). The independent contribution of driver, crash, and vehicle characteristics to driver fatalities. Accident; Analysis and Prevention, 34(6), 717727.
Bedard, M., Weaver, B., Darzins, P., & Porter, M.M. (2008). Predicting driving performance in older adults: We are not there yet!. Traffic Injury Prevention, 9(4), 336341. doi: 10.1080/15389580802117184
Beebe, D.W. (2005). Neurobehavioral effects of obstructive sleep apnea: An overview and heuristic model. Current Opinion in Pulmonary Medicine, 11(6), 494500.
Beebe, D.W., & Gozal, D. (2002). Obstructive sleep apnea and the prefrontal cortex: Towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. Journal of Sleep Research, 11(1), 116.
Bunce, D., Young, M.S., Blane, A., & Khugputh, P. (2012). Age and inconsistency in driving performance. Accident; Analysis and Prevention, 49, 293299. doi: 10.1016/j.aap.2012.01.001
Cooper, P.J., Tallman, K., Tuokko, H., & Beattie, B.L. (1993). Vehicle crash involvement and cognitive deficit in older drivers. Journal of Safety Research, 24(1), 917. doi: 10.1016/0022-4375(93)90047-Q
D’Rozario, A.L., Cross, N.E., Vakulin, A., Bartlett, D.J., Wong, K.K.H., Wang, D., & Grunstein, R.R. (2016). Quantitative electroencephalogram measures in adult obstructive sleep apnea - Potential biomarkers of neurobehavioural functioning. doi:
Dempsey, J.A., Veasey, S.C., Morgan, B.J., & O’Donnell, C.P. (2010). Pathophysiology of sleep apnea. Physiological Reviews, 90(1), 47112. doi: 10.1152/physrev.00043.2008
Desai, A.V., Marks, G.B., Jankelson, D., & Grunstein, R.R. (2006). Do sleep deprivation and time of day interact with mild obstructive sleep apnea to worsen performance and neurobehavioral function? Journal of Clinical Sleep Medicine, 2(1), 6370.
Desai, A.V., Wilsmore, B., Bartlett, D.J., Unger, G., Constable, B., Joffe, D., & Grunstein, R.R. (2007). The utility of the AusEd driving simulator in the clinical assessment of driver fatigue. Behavior Research Methods, 39(3), 673681.
Dobbs, B.M., & Shergill, S.S. (2013). How effective is the Trail Making Test (Parts A and B) in identifying cognitively impaired drivers? Age and Ageing, 42(5), 577581. doi: 10.1093/ageing/aft073
Dorrian, J., Rogers, N.L., & Dinges, D.F. (2005). Psychomotor vigilanceperformance: Neurocognitive assay sensitive to sleep loss. In C. Kushida (Ed.), Sleep deprivation: Clinical issues, pharmacology and sleep loss effects, (Vol. 193, pp. 3968). New York: Marcel Dekker Inc.
Duffy, S.L., Lagopoulos, J., Hickie, I.B., Diamond, K., Graeber, M.B., Lewis, S.J., & Naismith, S.L. (2014). Glutathione relates to neuropsychological functioning in mild cognitive impairment. Alzheimer’s & Dementia, 10(1), 6775. doi: 10.1016/j.jalz.2013.01.005
Ellen, R.L., Marshall, S.C., Palayew, M., Molnar, F.J., Wilson, K.G., & Man-Son-Hing, M. (2006). Systematic review of motor vehicle crash risk in persons with sleep apnea. Journal of Clinical Sleep Medicine, 2(2), 193200.
Engleman, H.M., & Douglas, N.J. (2004). Sleep. 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax, 59(7), 618622.
Fietze, I., Dingli, K., Diefenbach, K., Douglas, N.J., Glos, M., Tallafuss, M., & Witt, C. (2004). Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. The European Respiratory Journal, 24(6), 987993. doi: 10.1183/09031936.04.00100203
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198.
Frittelli, C., Borghetti, D., Iudice, G., Bonanni, E., Maestri, M., Tognoni, G., & Iudice, A. (2009). Effects of Alzheimer’s disease and mild cognitive impairment on driving ability: A controlled clinical study by simulated driving test. International Journal of Geriatric Psychiatry, 24(3), 232238. doi: 10.1002/gps.2095
George, C.F., Findley, L.J., Hack, M.A., & Douglas McEvoy, R. (2002). Across-country viewpoints on sleepiness during driving. American Journal of Respiratory and Critical Care Medicine, 165(6), 746749. doi: 10.1164/ajrccm.165.6.2107112
Horne, J., & Reyner, L. (1999). Vehicle accidents related to sleep: A review. Occupational and Environmental Medicine, 56(5), 289294.
Kawano, N., Iwamoto, K., Ebe, K., Suzuki, Y., Hasegawa, J., Ukai, K., & Ozaki, N. (2012). Effects of mild cognitive impairment on driving performance in older drivers. Journal of the American Geriatrics Society, 60(7), 13791381. doi: 10.1111/j.1532-5415.2012.04021.x
Kowalski, K., Love, J., Tuokko, H., MacDonald, S., Hultsch, D., & Strauss, E. (2012). The influence of cognitive impairment with no dementia on driving restriction and cessation in older adults. Accident; Analysis and Prevention, 49, 308315. doi: 10.1016/j.aap.2011.11.011
Launois, S.H., Pepin, J.L., & Levy, P. (2007). Sleep apnea in the elderly: A specific entity? Sleep Medicine Reviews, 11(2), 8797. doi: 10.1016/j.smrv.2006.08.005
Lim, J., & Dinges, D.F. (2008). Sleep deprivation and vigilant attention. Annals of the New York Academy of Sciences, 1129, 305322. doi: 10.1196/annals.1417.002
Mathias, J.L., & Lucas, L.K. (2009). Cognitive predictors of unsafe driving in older drivers: A meta-analysis. International Psychogeriatrics, 21(4), 637653. doi: 10.1017/s1041610209009119
McKinnon, A., Terpening, Z., Hickie, I.B., Batchelor, J., Grunstein, R., Lewis, S.J., & Naismith, S.L. (2014). Prevalence and predictors of poor sleep quality in mild cognitive impairment. Journal of Geriatric Psychiatry and Neurology, 27(3), 204211. doi: 10.1177/0891988714527516
Meyers, J., & Meyers, K. (1995). The Meyers Scoring System for the Rey Complex Figure and the Recognition Trial: Professional manual. Odessa FL: Psychological Assessment Resources.
Miller, M.D., Paradis, C.F., Houck, P.R., Mazumdar, S., Stack, J.A., Rifai, A.H., & Reynolds, C.F. III (1992). Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale. Psychiatry Research, 41(3), 237248.
Mitchell, A.J., & Shiri-Feshki, M. (2009). Rate of progression of mild cognitive impairment to dementia--meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavica, 119(4), 252265. doi: 10.1111/j.1600-0447.2008.01326.x
Mowszowski, L., Hermens, D.F., Diamond, K., Norrie, L., Hickie, I.B., Lewis, S.J., & Naismith, S.L. (2012). Reduced mismatch negativity in mild cognitive impairment: Associations with neuropsychological performance. Journal of Alzheimer’s Disease, 30(1), 209219. doi: 10.3233/jad-2012-111868
Naegele, B., Thouvard, V., Pepin, J.L., Levy, P., Bonnet, C., Perret, J.E., & Feuerstein, C. (1995). Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep, 18(1), 4352.
Naismith, S., Winter, V., Gotsopoulos, H., Hickie, I., & Cistulli, P. (2004). Neurobehavioral functioning in obstructive sleep apnea: Differential effects of sleep quality, hypoxemia and subjective sleepiness. Journal of Clinical and Experimental Neuropsychology, 26(1), 4354. doi: 10.1076/jcen.
Naismith, S.L., Rogers, N.L., Lewis, S.J., Diamond, K., Terpening, Z., Norrie, L., & Hickie, I.B. (2011). Sleep disturbance in mild cognitive impairment: Differential effects of current and remitted depression. Acta Neuropsychiatrica, 23(4), 167172. doi: 10.1111/j.1601-5215.2011.00555.x
Nickl-Jockschat, T., Kleiman, A., Schulz, J.B., Schneider, F., Laird, A.R., Fox, P.T., & Reetz, K. (2012). Neuroanatomic changes and their association with cognitive decline in mild cognitive impairment: A meta-analysis. Brain Structure & Function, 217(1), 115125. doi: 10.1007/s00429-011-0333-x
Olsen, K., Taylor, J.P., & Thomas, A. (2014). Mild cognitive impairment: Safe to drive? Maturitas, 78(2), 8285. doi: 10.1016/j.maturitas.2014.03.004
Petersen, R.C. (2009). Early diagnosis of Alzheimer’s disease: Is MCI too late? Current Alzheimer Research, 6(4), 324330.
Rechtschaffen, A., & Kales, A. (1968). A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: U.S. National Institute of Neurological Diseases and Blindness, Neurological Information Network.
Reger, M.A., Welsh, R.K., Watson, G.S., Cholerton, B., Baker, L.D., & Craft, S. (2004). The relationship between neuropsychological functioning and driving ability in dementia: A meta-analysis. Neuropsychology, 18(1), 8593. doi: 10.1037/0894-4105.18.1.85
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276. doi:
Saunamaki, T., & Jehkonen, M. (2007). A review of executive functions in obstructive sleep apnea syndrome. Acta Neurologica Scandinavica, 115(1), 111. doi: 10.1111/j.1600-0404.2006.00744.x
Silva, M.T., Laks, J., & Engelhardt, E. (2009). Neuropsychological tests and driving in dementia: A review of the recent literature. Revista da Associacao Medica Brasileira (1992), 55(4), 484488.
Terpening, Z., Lewis, S.J., Yee, B., Grunstein, R., Hickie, I.B., & Naismith, S.L. (2015). Association between sleep-disordered breathing and neuropsychological performance in older adults with mild cognitive impairment. Journal of Alzheimer’s Disease, 46, 157165. doi: 10.3233/jad-141860
Tombaugh, T.N. (2004). Trail Making Test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology, 19(2), 203214. doi: 10.1016/s0887-6177(03)00039-8
Turkington, P.M., Sircar, M., Allgar, V., & Elliott, M.W. (2001). Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax, 56(10), 800805.
Vakulin, A., Baulk, S.D., Catcheside, P.G., Anderson, R., van den Heuvel, C.J., Banks, S., & McEvoy, R.D. (2007). Effects of moderate sleep deprivation and low-dose alcohol on driving simulator performance and perception in young men. Sleep, 30(10), 13271333.
Vakulin, A., Baulk, S.D., Catcheside, P.G., Antic, N.A., van den Heuvel, C.J., Dorrian, J., & McEvoy, R.D. (2009). Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with obstructive sleep apnea. Annals of Internal Medicine, 151(7), 447455.
Vakulin, A., D’Rozario, A., Kim, J.W., Watson, B., Cross, N., Wang, D., & Grunstein, R. (2016). Quantitative sleep EEG and polysomnographic predictors of driving simulator performance in obstructive sleep apnea. Clinical Neurophysiology, 127, 14281435. doi: 10.1016/j.clinph.2015.09.004
Vaz Fragoso, C.A., Araujo, K.L., Van Ness, P.H., & Marottoli, R.A. (2008). Prevalence of sleep disturbances in a cohort of older drivers. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(7), 715723.
Vaz Fragoso, C.A., Van Ness, P.H., Araujo, K.L., Iannone, L.P., & Marottoli, R.A. (2013). Sleep disturbances and driving practices of older drivers. Journal of the American Geriatrics Society, 61(10), 17301737. doi: 10.1111/jgs.12454
Wadley, V.G., Okonkwo, O., Crowe, M., Vance, D.E., Elgin, J.M., Ball, K.K., & Owsley, C. (2009). Mild cognitive impairment and everyday function: An investigation of driving performance. Journal of Geriatric Psychiatry and Neurology, 22(2), 8794. doi: 10.1177/0891988708328215
Webb, W.B., & Dreblow, L.M. (1982). A modified method for scoring slow wave sleep of older subjects. Sleep, 5(2), 195199.
Wechsler, D. (1997). Manual for the Wechsler Adult Intelligence Scale - Third Edition. San Antonio, TX: The Psychological Corporation.
Wilson, G., Terpening, Z., Wong, K., Grunstein, R., Norrie, L., Lewis, S.J., & Naismith, S.L. (2014). Screening for sleep apnoea in mild cognitive impairment: The utility of the multivariable apnoea prediction index. Sleep Disorders, 2014, 945287. doi: 10.1155/2014/945287
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.O., & Petersen, R.C. (2004). Mild cognitive impairment--beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256(3), 240246. doi: 10.1111/j.1365-2796.2004.01380.x
Wong, I.Y., Smith, S.S., & Sullivan, K.A. (2012). The relationship between cognitive ability, insight and self-regulatory behaviors: Findings from the older driver population. Accident; Analysis and Prevention, 49, 316321. doi: 10.1016/j.aap.2012.05.031
Yaffe, K., Laffan, A.M., Harrison, S.L., Redline, S., Spira, A.P., Ensrud, K.E., & Stone, K.L. (2011). Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. Journal of the American Medical Association, 306(6), 613619. doi: 10.1001/jama.2011.1115
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749.
Young, T., Blustein, J., Finn, L., & Palta, M. (1997). Sleep-disordered breathing and motor vehicle accidents in a population- based sample of employed adults. Sleep, 20(8), 608613.


Association between Sleep Disordered Breathing and Nighttime Driving Performance in Mild Cognitive Impairment

  • Nathan Cross (a1) (a2) (a3), Zoe Terpening (a1), Shantel L. Duffy (a1) (a2) (a3) (a4), Simon J.G. Lewis (a1) (a2) (a3) (a5), Ron Grunstein (a2) (a3) (a5), Keith Wong (a2) (a3) (a5) and Sharon L. Naismith (a1) (a3) (a4)...


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