Study On Evaluation Of Driving Ability In Patients With Mild To Moderate Chronic Insomnia And Patients Companied With Mild To Moderate Anxiety And Depression By Driving Simulator

Objective: The objective is to evaluate the changes of driving ability in mild to moderate chronic insomnia patients and patients companied with mild to moderate anxiety and depression under different driving situations by taking neuropsychological scale and driving simulation test,further to explore the correlation between driving ability and cognitive function.Methods: Chronic insomnia patients who attended the Tianjin Medical University General Hospital from October 2016 to August 2018 and met the diagnostic criteria of ICSD-3 were collected.The subjective sleep quality and anxiety-depression level were evaluated by neuropsychological scale,then the patients with severe insomnia and severe anxiety-depression were excluded and patient were divided into 2 groups.There were 18 cases in mild to moderate chronic insomnia with mild to moderate anxiety and depression group(MMCI + MMAD group),15 cases in simple mild to moderate chronic insomnia group(MMCI group)and 16 cases in normal control group(CG group).The general cognitive function,executive function and memory ability were measured with the neurocognitive function scale.Different driving scenarios are simulated by the driving simulator to collect the data of driving behavior,including: reaction time of avoiding virtual pedestrian,reaction time to red light,number of virtual pedestrian collision;the driving parameters of distracted and fatigued drivers,such as speed,acceleration,steering wheel speed,throttle and brake pedal values,lateral position,are calculated.Results: 1.The scores of MOCA,visual space and executive function in MMCI + MMAD group and MMCI group were lower than those in normal control group(P<0.05).There was no significant difference between MMCI + MMAD group and MMCI group(P>0.05).2.In the alert driving test,the frequency of pedestrian collision in MMCI + MMAD group was significantly higher than that in MMCI group and CG Group(P<0.05).There was no significant difference in pedestrian collision frequency between MMCI + MMAD group and MMCI group(P>0.05).3.(1)Under simple driving task(no lane changing scene)of external distracted driving task,the average speed of MMCI + MMAD group and MMCI group was lower than that of CG group(P<0.05),and the average lateral position of MMCI + MMAD group was higher than that of CG group(P<0.05).(2)Under simple driving task(no lane changing scene)of internal distracted driving task,the average lateral position of standard deviation of MMCI group was significantly higher than that of CG group(P<0.05).(3)Under simple driving task(no lane changing scene),the acceleration standard deviation of MMCI + MMAD group in external distracted driving task,was significantly higher than that of internal distracted driving task(P<0.05).In MMCI group,the speed standard deviation,the mean value and standard deviation of brake pedal and the average acceleration were significantly higher than those of the internal distracted task(P<0.05).4.(1)Under fatigue driving task,the lateral position of standard deviation of MMCI + MMAD group and MMCI group was significantly higher than that of CG group(P<0.1)in the condition of monotonic driving(driving without front car)and carfollowing test(driving with front car).There was no significant difference between MMCI + MMAD group and MMCI group(P<0.1).(2)In MMCI and MMCI + MMAD group,the mean and standard deviation of the values of acceleration and brake pedal,the standard deviation of acceleration and the standard deviation of lateral position in car-following test were significantly increased compared with the monotonic driving(P<0.05).5.(1)In the alert driving test,there was no significant correlation between the MoCA total score and the number of virtual pedestrian collisions in MMCI + MMAD group((P>0.05),and the executive function score was negatively correlated with the number of virtual pedestrian collisions(P<0.05).(2)In the distracted driving experiment,there was a negative correlation between the executive functional domain score and the speed standard deviation of the simple driving task in the internal distracted task(P<0.05).There was a negative correlation between executive functional domain score and the average value of brake pedal,the standard deviation of brake pedal value and the standard deviation of lane deviation in the external distracted task(P<0.05).(3)In the fatigue driving test,the scores of MoCA and executive function in MMCI + MMAD group were positively correlated with the speed standard deviation(P<0.05);There was a negative correlation between MMCI executive function domain score and lane deviation standard deviation(P<0.05).Conclusion: 1.The total cognitive function and executive function of patients with mild to moderate chronic insomnia and those with mild to moderate anxiety and depression were decreased is impaired,but mild to moderate anxiety and depression may not aggravate cognitive impairment in patients with mild to moderate chronic insomnia.2.In the alert driving test,the reaction ability and alertness of the patients with mild to moderate chronic insomnia with mild to moderate anxiety depression decreased,while the patients with simple mild to moderate chronic insomnia did not.It is suggested that mild to moderate anxiety and depression may increase the risk of traffic accident.3.In the distracted driving test,the driving ability of patients with mild to moderate chronic insomnia with or without mild to moderate anxiety depression was impaired,but mild to moderate anxiety depression may not increase degree of driving ability impairment in the patients of mild to moderate chronic insomnia.4.In the fatigue driving test,the driving ability of patients with mild to moderate chronic insomnia with or without mild to moderate anxiety depression was impaired,but mild to moderate anxiety depression did not increase degree of driving ability impairment in the patients of mild to moderate chronic insomnia.5.The decrease of driving ability in patients with mild to moderate chronic insomnia and companied with mild to moderate anxiety depression may be related to impaired executive function.