**3.3 Sustained attention test** *Carsim* **(Fig. 6)**

The Ambrock sustained attention test "Carsim" by Büttner et al. (2000a/b, 2001) recorded its performance over a period of 30 minutes. The image with a road median and lane boundary is simulated polychrome. On the right side of the road obstacles (in the kind of no entry signs) can be presented, which are only briefly visible in each case (e.g. for 200 ms). Their appearance is timely random, in which a fixed number of events can be adjusted with a 5-minute section. The patient now has the task to keep up with the help of

The Effects of Sleep-Related Breathing Disorders on Waking Performance 133

With the computerized sustained attention "Clock test" of Quatember and Maly (Wiener Testsystem TM, Schufried, Austria 1994; modified for Task force *Vigilance* and *SIESTA group* of DGSM2) the sustained attention will be evaluated under monotone conditions and the processing diligence will be measured in the kind of errors and reaction times over a period of 60 minutes. There are two types of errors: missed and incorrect (delayed) responses reactions. Patients are instructed to press a key on the computer keyboard when the "moving point" in a points circle one point skips. At the beginning of the test will be started shortly to introduce the circular arrangement of points. During implementation, the patients

sit in a relaxed position ca. 60-80 cm in front of the screen in a semi-darkened room.

The average reaction rate (in milliseconds), the degree of right, incorrect and omitted responses were recorded at Q&M-sustained attention test.Danker-Hopfe, Sauter and Popp (2006) determined in a standardization study with healthy volunteers cut-off values of more than 3 for omitted responses, more than 4 for incorrect responses and longer than 498 milliseconds for the response times of subjects. Standard values for OSAS patients are not

The driving simulator *Carda*, similar to the test developed by Findley, does not fulfil the requirements that are important on a real tracking test. It is rather a reaction test, which

Krieger et al. (1997) were able to demonstrate by means of questionnaires that the accident rate in OSAS patients was often caused by sleepiness and that both the rate of accidents and

2 DGSM = Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (engl.: German Society of Sleep

**3.4 Sustained attention test** *Quatember & Maly* **(Fig. 7)** 

Fig. 7. Sustained attention test by Quatember and Maly (1994)

describes the attention and the vigilance.

**Evaluation** 

yet available.

**3.5 Conclusion** 

Research and Sleep Medicine)

a steering wheel in his lane the ideal track (*tracking*) and by using of two buttons (both same function), which are located on the steering console, to respond on appearing obstacles (*visual search*).

Fig. 6. Driving Simulator *Carsim* by Büttner et al. 1999, 2000

#### **Evaluation**

Depending on the steering wheel movements, the position of the vehicle on the road will be recalculated and visualized on-line. The program records the time deviation from the ideal line (*tolerance deviation time*) and of the lane (*tracking deviation time*) and the right, the missing, the unfounded reactions and the reaction time (Büttner et al. 2000a/b, Büttner 2001). Tolerance or track deviation is the number of tracking errors, which in absolute terms described, exceeds the tolerance and lane width in the test. By converting the number of pixels we obtain the time in seconds, which was driven outside the tolerance range or beyond the roadway.
