Comparison of the effects of sleep deprivation, alcohol and obstructive sleep apnoea (OSA) on simulated steering performance.

Patients with obstructive sleep apnoea (OSA) are reported to have an increased risk of road traffic accidents. This study examines the nature of the impairment during simulated steering in patients with OSA, compared to normal subjects following either sleep deprivation or alcohol ingestion. Twenty-six patients with OSA and 12 normal subjects, either deprived of one night's sleep or following alcohol ingestion [mean (SD) alcohol blood level 71.6 mg dl(-1) (19.6)], performed a simulated steering task for a total of 90 min. Performance was measured using the tendency to wander (SD), deterioration across the task, number of 'off-road' events and the reaction time to peripheral events. Control data for OSA, sleep deprivation and alcohol were obtained following treatment with nasal continuous positive airway pressure (nCPAP), after a normal night of sleep, and following no alcohol, respectively. Patients with untreated OSA, and sleep-deprived or alcohol-intoxicated normal subjects performed significantly less well, compared to their respective controls (P<0.01 for all tests), with untreated OSA lying between that of alcohol intoxication and sleep deprivation. Alcohol impaired steering error equally throughout the whole drive, whilst sleep deprivation caused progressive deterioration through the drive, but not initially. Untreated OSA was more like sleep deprivation than alcohol, although there was a wide spread of data. This suggests that the driving impairment in patients with OSA is more compatible with sleep deprivation or fragmentation as the cause, rather than abnormal cognitive or motor skills

Trabecular rod buckling index in thoraco-lumbar vertebral bone

Published in Clinical Anatomy, 2005; 19 (1):12-18 at www.interscience.wiley.comThe need for improved mechanistic understanding of cancellous bone failure is at the core of important clinical problems such as osteoporosis, as well as basic biological issues such as bone formation and adaptation. Three-dimensional (3D) anaglyphs were produced from 15 T12 and L1 vertebral bodies, which encompass the adult life span in both sexes. The anaglyphs were viewed with red-green stereo glasses, using an image analyzer, and trabecular thickness and trabecular length were measured. From biomechanical principles, the strength of individual trabeculae can be estimated from measurement of trabecular rod thickness and trabecular rod length as the load to buckling index. The distribution of the load to buckling index was best described by a log normal curve. Trabecular rod thickness, trabecular rod length, and load to buckling index for males were consistently greater than for females. With aging, trabecular rod thickness, and the load to buckling index decrease for males while trabecular rod length increases for females. In this study, the load to buckling index for thoraco-lumbar vertebral trabecular rods potentially quantifies a greater risk of vertebral fracture for females. Decreased trabecular rod thickness or increased trabecular rod length result in the strength of trabeculae shifting closer to a putative fracture threshold. The corollary being that there is a reduced safety margin for resistance to mechanical loads for the vertebral bodies. The 3D anaglyph technique for measuring trabecular dimensions provides an accurate and precise methodology by which these morphological studies can be undertaken.Peter Sutton-Smith, Ian H. Parkinson, Andrew M.J. Linn, Simone A. Kooke and Nicola L. Fazzalar