CPAP treatment in CAD patients with sleepy OSA reduced the Epworth Sleepiness Scale score by 3.4 points (p < 0.001) over 2 years, predicted by improvements in negative mood symptoms.
RCT (n=399)
randomized
Does improvement in depressive symptoms predict changes in excessive daytime sleepiness in adults with coronary artery disease and obstructive sleep apnea on CPAP?
In patients with coronary artery disease and sleepy obstructive sleep apnea treated with CPAP, improvements in excessive daytime sleepiness over 2 years are predicted by improvements in negative mood symptoms of depression.
p-value: p=<0.001
Excessive daytime sleepiness (EDS) is a factor associated with both obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive airway pressure (CPAP) treatment may decrease EDS in adults with OSA; however, the modulatory role of depressive symptoms on the improvement of EDS is not known. We aimed to explore the association between subscales of the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale (ESS) over a 2-year period in coronary artery disease (CAD) patients with OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399 adults with CAD (155 sleepy OSA apnea–hypopnea index ≥ 15/h and ESS score ≥ 10, who were offered CPAP; and 244 nonsleepy OSA ESS < 10), randomized to CPAP n = 122 or no-CPAP n = 122) were included. Three factors were extracted from the Zung SDS, based on the principal component analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3, appetite. In a mixed model, the ESS score decreased by 3.4 points (p < 0.001) among the sleepy OSA phenotype, which was predicted by the decline in the F2, but not in the F1 and F3 scores. The fixed effects of time were not significant in the nonsleepy OSA groups, and thus, further analyses were not applicable. Additional within-group analyses showed a significant decrease in all subscales over time both in the sleepy and nonsleepy OSA patients on CPAP whereas there was a significant increase in the nonsleepy OSA group randomized to no-CPAP. We conclude that the improvement in negative mood symptoms of depression, but not changes in cognitive symptoms and anhedonia as well as appetite, was a significant predictor of decline in the ESS scores over a 2-year period in this CAD cohort with sleepy OSA on CPAP treatment.
Çelik et al. (Mon,) conducted a rct in Coronary artery disease and obstructive sleep apnea (n=399). CPAP vs. no-CPAP was evaluated on Change in Epworth Sleepiness Scale (ESS) score and its association with Zung Self-rated Depression Scale subscales (p=<0.001). CPAP treatment in CAD patients with sleepy OSA reduced the Epworth Sleepiness Scale score by 3.4 points (p < 0.001) over 2 years, predicted by improvements in negative mood symptoms.