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Paper Title:
Modafinil Improves Alertness
And Driving Simulator Performance In Sleep-Deprived Mild Obstructive
Sleep Apnoea (Osa) Patients
Full paper not available
(Abstract submission only)
Authors:
R. Grunstein, J. Newcombe,
A. Desai, D.Joffe, J.P Seale
Abstract:
Mild sleep apnea (SA)
is associated with a higher risk of involvement in motor vehicle
accidents. Modafinil is a novel wakefulness-promoting drug with
few side effects. This single dose study assessed the use of modafinil
for the relief of the daytime symptoms of mild OSA when combined
with partial sleep deprivation, conditions often experienced by
professional drivers. Eight patients with mild SA (RDI = 5-15) underwent
a randomised, double-blind, crossover, placebo-controlled protocol.
Testing consisted of a performance battery followed by a 30 minute
simulated night-time, rural drive (AusEd Simulator). Waking electroencephalography
(EEG) was recorded concurrently with driving simulator runs. Baseline
performance was recorded at 2100 and subjects were put to bed at
2300. Sleep was restricted to 4 hours time in bed. Subjects were
woken at 0300 and either 200 mg modafinil or a placebo was administered.
Further testing took place at 0500 and 0900. Modafinil significantly
counteracted increases in both subjective (26% lower Effort to Stay
Awake Survey, (-0.63 + or - 0.62, 95% CI, p < 0.05) and objective
measures of sleepiness. Modafinil decreased frontal EEG power in
the alpha band (-62 + or - 37%, 95% CI, p < 0.05) and beta band
(-65 + or - 16%, 95% CI, p < 0.01) at 0500, although no significant
effects were seen at 0900. These changes in alertness were accompanied
by modafinil-induced improvements in vigilance performance at 0500
but not at 0900. A significant increase in the mean of the fastest
10% of reaction times on the Psychomotor Vigilance Task in the placebo
group at 0500 (+7.97 + or - 5.35 msec, 95% CI, p < 0.01) was
abolished by modafinil. Furthermore, modafinil reduced velocity
deviation on the driving simulator at 0500 by 14% over placebo levels
(-1.25 + or - 1.07 kilometres per hour, 95% CI, p < 0.05). However,
these effects had diminished by 0900, 6 hours after drug ingestion.
This study suggests that high plasma concentrations of modafinil,
as achieved around its tmax of 2 hours may counteract the combined
effects of mild OSA and partial sleep deprivation on vigilance.
Full paper not available
(Abstract submission only)
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