As far as I know from Windows Vista onward you can no longer access your sound hardware directly without some custom drivers. Everything goes through WASAPI. And Windows has full control of this Core Audio. And if it decides that some other part has greater priority the audio will suffer.
I still remember of how much problems with audio I had on my Acer Aspire laptop with Realtek Sound Card and Windows 7 installed. Main problem was that laptop comes equipped with Tuba speaker to generate some strong base sounds. But since this tuba speaker receives combined sound from both left and right speakers (boosted to generate more base sounds) it is imperative that left and right channels remain in sync. If they get out of sync then any sound that was to be played on both left and right speakers at the same time gets garbled.
So how can it come to this desynchronization of left and right channel? Realtek sound drivers are designed to process each of the sound channels within its own thread. But since threads are controlled by Windows Core Audio easily one of them might get lower priority and thus not being able to proces its data fast enough thus it becomes lagging behind.
Any way after installing Window XP on that laptop the problem went away because on Windows XP sound drivers have full control over their own threads and can even run them with Realtime priority. On Windows Vista and newer sound drivers are no longer able to run their own threads with Realtime priority as they could on Windows XP.
PS: As for DirectDraw as far as I know it is now simulated through DirectX. And it is simulated poorly at best. Many DirectDraw based games won't even draw properly (garbled colors) due the fact that DirectDraw simulations is quite limited. There are several 3rd party fixes for DirectDraw that try to fix such problems. One day I even saw one that instead of simulating DirectDraw with DirectX actually simulates it using OpenGL but unfortunately it wasn't stable enough and ran only on specific hardware.
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