Skip to main content
SpringerLink
Log in

Vigilance in patients with obstructive sleep apnea and surgical patients

The Marburg Vigilance Test (VigiMar)

Vigilanz bei Patienten mit obstruktiver Schlafapnoe und chirurgischen Patienten

Der Marburger Vigilanztest (VigiMar)

  • Originalien
  • Published:
Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Abstract

Aim

The Marburg vigilance test (VigiMar) is a vigilance task implemented as a four-choice reaction time task with long duration and low stimulus rate. It tests readiness for reaction under monotonous conditions characterized by sensory deprivation. This study was conducted to compare test results of subjects without sleep disorders to those of patients with untreated obstructive sleep apnea (OSA). In addition, whether patients treated for OSA by continuous positive airway pressure (CPAP) exhibited improvements in vigilance testing and whether subjects without sleep disorders have stable test results in a retest after 2 days were investigated. As test results are given for test thirds separately, these were used to determine whether there was a time-on-task effect for patients with untreated OSA and to check for internal consistency of the VigiMar test.

Patients and methods

A total of 20 patients with OSA and 20 surgical patients (knee arthroscopy) between 25 and 65 years of age were included. All patients were male. Vigilance testing was performed on the day before CPAP treatment was started or on the day before arthroscopy and 2 days later after the second CPAP night or on the first day after the surgical procedure, respectively.

Results

In the baseline vigilance test, reaction times of OSA patients were longer than those of surgical patients, especially during the last third of the test. After 2 nights CPAP, reaction times of OSA patients improved to the same level as those of surgical patients who exhibited homogenous results in baseline and postintervention testing.

Conclusion

The VigiMar test is suitable for the assessment of impaired vigilance. Its internal consistency is high, retest reliability is satisfactory, and it is sensitive for changes in vigilance after only 2 nights CPAP treatment.

Zusammenfassung

Fragestellung

Der Marburger Vigilanztest (VigiMar) ist ein klassischer Vigilanztest in Form eines Vierfach-Wahl-Reaktionszeit-Tests mit langer Dauer und niedriger Reizfrequenz, der die Reaktionsbereitschaft unter monotonen, von Reizarmut charakterisierten Bedingungen erfasst. In dieser Untersuchung sollte analysiert werden, ob sich Schlafgesunde bei den Testergebnissen von Patienten mit unbehandelter Schlafapnoe unterscheiden. Außerdem war von Interesse, ob Patienten mit Schlafapnoe nach 2 Nächten CPAP-Therapie („continuous positive airway pressure“) Verbesserungen im Vigilanztest zeigen und ob Schlafgesunde bei Testwiederholung nach 2 Tagen stabile Testergebnisse haben. Da Ergebnisse für einzelne Testdrittel ausgegeben werden, sollte mit ihnen geprüft werden, ob es für Patienten mit unbehandelter Schlafapnoe einen Time-on-Task-Effekt gibt bzw. wie hoch die interne Konsistenz des VigiMar ist.

Patienten und Methoden

In die Studie wurden 20 Patienten mit OSA und 20 chirurgische Patienten (Arthroskopie des Knies) im Alter zwischen 25 und 65 Jahren aufgenommen. Alle Patienten waren Männer. Am Tag vor der Operation bzw. vor dem Beginn der CPAP-Therapie und 2 Tage später wurde der VigiMar durchgeführt.

Ergebnisse

Bei der Baselinetestung waren die Reaktionszeiten der OSA-Patienten besonders im letzten Drittel des Tests länger als bei den chirurgischen Patienten. Nach 2 Nächten CPAP reduzierten sich die Reaktionszeiten der OSA-Patienten auf das Niveau der Schlafgesunden, was im Vor- und Nachtest recht homogen war.

Fazit

Der Vigimar ist zur Objektivierung beeinträchtigter Vigilanz geeignet. Er zeigt eine hohe interne Konsistenz bei zufriedenstellender Retest-Reliabilität und ist sensitiv für Vigilanzveränderungen nach nur 2 Nächten CPAP-Behandlung.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. ICSD-2 – International classification of sleep disorders: Diagnostic and coding manual (2010) 2nd edn. Westchester, American Academy of Sleep Medicine

  2. Becker H, Ficker J, Fietze I et al (2009) S3-Leitlinie Nicht erholsamer Schlaf. Somnologie 13(Suppl 1):4–160

    Article  Google Scholar 

  3. Bortz J (1989) Statistik für Sozialwissenschaftler. Springer, Berlin Heidelberg New York London Paris Tokyo

  4. Browman CP, Sampson MG, Yolles SF et al (1984) Obstructive sleep apnea and body weight. Chest 85(3):435–438

    Article  PubMed  CAS  Google Scholar 

  5. Bühner M (2006) Einführung in die Test- und Fragebogenkonstruktion. 2 edn. Pearson Studium, München

  6. Carskadon MA, Dement WC, Mitler MM et al (1986) Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 9(4):519–524

    PubMed  CAS  Google Scholar 

  7. Cassel W, Ploch T, Becker C et al (1996) Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. Eur Respir J 9(12):2606–2611

    Article  PubMed  CAS  Google Scholar 

  8. Cassel W, Ploch T, Kesper K (2011) Marburger Vigilanztest – VigiMar. In: Schulz H, Geisler P, Rodenbeck A (eds) Kompendium Schlafmedizin für Ausbildung, Klinik und Praxis. eco-med Verlagsgesellschaft, Landsberg

  9. Giles TL, Lasserson TJ, Smith BH et al (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 3:CD001106

    PubMed  CAS  Google Scholar 

  10. Grier RA, Warm JS, Dember WN et al (2003) The vigilance decrement reflects limitations in effortful attention, not mindlessness. Hum Factors 45(3):349–359

    Article  PubMed  Google Scholar 

  11. Head H (1923) The concept of nervous and mental energy. II. Vigilance: a psychological state of the nervous system. Br J Psychol 14:125–147

    Google Scholar 

  12. Hoddes E, Zarcone V, Smythe H et al (1973) Quantification of sleepiness: a new approach. Psychophysiology 10(4):431–436

    Article  PubMed  CAS  Google Scholar 

  13. Iacovides S, Avidon I, Bentley A, Baker FC (2009) Diclofenac potassium restores objective and subjective measures of sleep quality in women with primary dysmenorrhea. Sleep 32(8):1019–1026

    PubMed  Google Scholar 

  14. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    PubMed  CAS  Google Scholar 

  15. Lafrance C, Dumont M, Lesperance P, Lambert C (1998) Daytime vigilance after morning bright light exposure in volunteers subjected to sleep restriction. Physiol Behav 63(5):803–810

    Article  PubMed  CAS  Google Scholar 

  16. Le BO, Hoffmann G, Tecco J et al (2000) Mild to moderate sleep respiratory events: one negative night may not be enough. Chest 118(2):353–359

    Article  Google Scholar 

  17. Lee MAM, Kleitman N (1923) Attempts to demonstrate functional changes in the nervous system during experimential insomnia. Am J Physiol 67:141–152

    Google Scholar 

  18. Levendowski D, Steward D, Woodson BT et al (2009) The impact of obstructive sleep apnea variability measured in-lab versus in-home on sample size calculations. Int Arch Med 2(1):2

    Article  PubMed  Google Scholar 

  19. Mackworth NH (1948) The breakdown of vigilance during prolonged visual search. Q J Exp Psychol 1:6–21

    Article  Google Scholar 

  20. Mitler MM, Gujavarty KS, Browman CP (1982) Maintenance of wakefulness test: a polysomnographic technique for evaluation treatment efficacy in patients with excessive somnolence. Electroencephalogr Clin Neurophysiol 53(6):658–661

    Article  PubMed  CAS  Google Scholar 

  21. Mongrain V, Noujaim J, Blais H, Dumont M (2008) Daytime vigilance in chronotypes: diurnal variations and effects of behavioral sleep fragmentation. Behav Brain Res 190(1):105–111

    Article  PubMed  Google Scholar 

  22. Nerfeldt P, Nilsson BY, Mayor L et al (2010) A two-year weight reduction program in obese sleep apnea patients. J Clin Sleep Med 6(5):479–486

    PubMed  Google Scholar 

  23. Peter JH (1988) Therapy of Sleep Disordered Breathing (personal communication)

  24. Peter JH, Cassel W, Ehrig B et al (1990) Occupational performance of a paced secondary task under conditions of sensory deprivation. II. The influence of professional training. Eur J Appl Physiol Occup Physiol 60(4):315–320

    Article  PubMed  CAS  Google Scholar 

  25. Ploch T, Kemeny C, Gilbert G et al (1993) Significance of a screening questionnaire for diagnosis of sleep apnea. Pneumologie 47(Suppl 1):108–111

    PubMed  Google Scholar 

  26. Sanchez AI, Martinez P, Miro E et al (2009) CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function. Sleep Med Rev 13(3):223–233

    Article  PubMed  Google Scholar 

  27. Schwarzenberger-Kesper F, Becker H, Penzel T et al (1987) Excessive daytime sleepiness in apnea patients – diagnostic significance and objective assessment using the vigilance test and synchronous EEG recording during the day. Prax Klin Pneumol 41(10):401–405

    PubMed  CAS  Google Scholar 

  28. Scott WA, Whitwam JG, Wilkinson RT (1983) Choice reaction time. A method of measuring postoperative psychomotor performance decrements. Anaesthesia 38(12):1162–1168

    Article  PubMed  CAS  Google Scholar 

  29. Van Dongen HP, Dinges DF (2005) Sleep, circadian rhythms, and psychomotor vigilance. Clin Sports Med 24(2):237-viii

    Article  Google Scholar 

  30. Verster JC, Pandi-Perumal SR, Streiner DL (2008) Sleep and Quality of Life in Clinical Medicine. Humana Press

  31. Weeß HG, Sauter C, Geisler P et al (2000) Vigilanz, Einschlafneigung, Daueraufmerksamkeit, Müdigkeit, Schläfrigkeit – Diagnostische Instrumentarien zur Messung müdigkeits- und schläfrigkeitsbezogener Prozesse und deren Gütekriterien. Somnologie 4:20–38

    Article  Google Scholar 

  32. Williams HL, Granda AM, Jones RC et al (1962) EEC-frequency and finger pulse volume as predictors of reaction time during sleep loss. Electroencephalogr Clin Neurophysiol 14:64–70

    Article  PubMed  CAS  Google Scholar 

  33. Wise MS (2006) Objective measures of sleepiness and wakefulness: application to the real world? J Clin Neurophysiol 23(1):39–49

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We wish to express our gratitude to Dipl.-Psych. Bettina Niess who contributed substantially to data collection, and Dr. Eckhard Fuchs, Dipl.-Ing. Frank Schüttler, Carola Becker, Avelke Edel, Wilma Littel, Petra Mayr, Christa Nau, Daniela Schach, Agata Scherer, Dirk Stawenow, Nicole Stawenow, and Ewa Tympel who all worked with the VigiMar over the years and helped to develop it to its present state.

Conflict of interest

The corresponding author states that there are not conflicts of interest.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University Marburg, Sleep Disorders Center, Baldingerstr. 1, 35043, Marburg, Deutschland

    W. Cassel Dipl.-Psych., T. Ploch, K. Kesper, T. Speicher & S. Canisius

  2. OxMed Ltd Oxford, United Kingdom, UK

    R. Conradt

  3. Law Office Faust & Tietze, Göttingen, Deutschland

    M. Faust

  4. Sleep Disorders Center Nordsee, Wesselburen, Deutschland

    P. Langanke

  5. Sleep Disorders Center, Center for Cardiology, Charité, Berlin, Deutschland

    T. Penzel

  6. Medical Office Kesper & Schwarzenberger-Kesper, Gladenbach, Deutschland

    F. Schwarzenberger-Kesper

Authors
  1. W. Cassel Dipl.-Psych.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Ploch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Kesper
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Speicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Conradt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Faust
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Langanke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Penzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Schwarzenberger-Kesper
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Canisius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Cassel Dipl.-Psych..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cassel, W., Ploch, T., Kesper, K. et al. Vigilance in patients with obstructive sleep apnea and surgical patients. Somnologie 15, 97–104 (2011). https://doi.org/10.1007/s11818-011-0512-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-011-0512-2

Keywords

Schlüsselwörter

Search

Navigation