The interactive effects of extended wakefulness and low-dose alcohol on simulated driving and vigilance

OBJECTIVES: Sleep deprivation and alcohol both impair driving performance. This study assessed the interactive effect of low-dose alcohol and extended wakefulness. DESIGN: Repeated-measures, crossover design evaluating psychomotor and driving function in a non-sleep-deprived state and after extended wakefulness with and without low-dose alcohol. SETTING: Teaching hospital sleep laboratory. PARTICIPANTS: Nineteen volunteer professional drivers. INTERVENTION & MEASUREMENTS: Driving simulation (AusEd) and the Psychomotor Vigilance Task (PVT) were measured in a rested state (12-15 hours awake) and after extended wakefulness (18-21 hours awake) during two sessions. Alcohol was administered during one session, with performance measured at blood alcohol concentrations (BAC) of 0.00%, 0.03%, and 0.05% in a non-sleep-deprived state, and at 0.03% after extended wakefulness (at 01:00 and 03:00). During the second session, tests were performed at the same times without alcohol. RESULTS: The combination of extended wakefulness and low-dose alcohol had significant deleterious effects on reaction time and lapses (PVT) and variation in lane position and speed (AusEd). Extended wakefulness (18-21 hours awake) combined with low-dose alcohol (0.03% BAC) resulted in more lapses (t = -2.75, P < 0.05) and greater variation in lane position (t = -3.94, P < 0.01) and speed (t = -2.79, P < 0.05) than did a BAC of 0.05% in a rested state. CONCLUSION: The combination of legal low-dose alcohol and extended wakefulness results in impairment worse than that at an alcohol level known to increase accident risk. Avoiding alcohol when driving after extended wakefulness may reduce accident risk.