Abstract
ObjectiveThe aim of this study is to compare actual driving performance and skills related to driving of patients using benzodiazepine anxiolytics or hypnotics for at least 6 months to that of healthy controls.MethodsParticipants were 44 long‐term users of benzodiazepine and benzodiazepine‐related anxiolytics (n = 12) and hypnotics (n = 32) and 65 matched healthy controls. Performance was assessed using an on‐the‐road driving test measuring standard deviation of lateral position (SDLP, in cm) and a battery of neurocognitive tasks. Performance differences between groups were compared with a blood alcohol concentration of 0.5 mg/ml to determine clinical relevance.ResultsCompared with controls, SDLP was significantly increased in hypnotic users (+1.70 cm) but not in anxiolytic users (+1.48 cm). Anxiolytic and hypnotic users showed significant and clinically relevant impairment on neurocognitive task measuring executive functioning, vigilance, and reaction time. For patients using hypnotics for at least 3 years, no significant driving impairment was observed.ConclusionImpairing effects of benzodiazepine hypnotics on driving performance may mitigate over time following longer term use (i.e. 3 years or more) although neurocognitive impairments may remain.
Highlights
The primary objective of the present study was to evaluate driving performance of long-term users of benzodiazepine anxiolytics and long-term users of hypnotics separately, as compared with that of a normative control group consisting of healthy volunteers
This study aimed to compare driving performance of long-term users of benzodiazepine or benzodiazepine-related anxiolytics and hypnotics to that of a normative control group consisting of healthy volunteers, in order to evaluate whether classification of these drugs in Category III may be too conservative for patients who receive longterm treatment
This seemed mainly due to patients who had been using hypnotic less than 3 years, as the difference in standard deviation of lateral position (SDLP) form controls was significant in this group but not in those who had received hypnotics treatment for more than 3 years
Summary
The study was designed as a multicentre trial (Universities of Maastricht, Utrecht and Groningen, the Netherlands) comparing groups of long-term users of benzodiazepines with healthy controls. Patients treated with benzodiazepines anxiolytics and hypnotics were analysed separately, because of the difference between these groups in time of drug intake relative to time of driving. It is known that the impairing effects of benzodiazepines on driving decrease with increased time after intake. Hypnotics are taken at bedtime, and driving occurs the day, 8 hr or more after administration. A combination of self-reported indication and usual time of drug administration was used to classify a patient as user of hypnotics or anxiolytics. To explore the potential difference in impairment before and after 3 years of use, hypnotic users were subdivided into two groups based on duration of treatment, that is, long-term use between 6 months– 3 years (LT3−) and long-term use >3 years (LT3+). Anxiolytic users could not be divided based on treatment duration due to the low sample size of this group
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