CPAP and Health-Related Quality of Life in Adults With Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea in the RICCADSA Trial

Abstract

Study objectives: To determine the effect of continuous positive airway pressure (CPAP) treatment on health-related quality of life (HRQoL) in adults with coronary artery disease (CAD) and nonsleepy obstructive sleep apnea (OSA).

Methods: This was a secondary outcome analysis of the RICCADSA trial, conducted in Sweden between 2005 and 2013. Adults with CAD, nonsleepy OSA (apnea-hypopnea index [AHI] ≥ 15 events/h; Epworth Sleepiness Scale [ESS] score < 10) and complete Short-Form (SF)-36 questionnaires at baseline and after 12 months were included. Patients were randomized to CPAP (n = 102) or no CPAP (n = 104). The primary outcome was the between-group difference in absolute change in the SF-36 components. Within-group changes as well as variables associated with absolute change in the domains in the entire population were also tested.

Results: Mean SF-36 scores were similar at baseline, ranging from 44.9 ± 9.6 to 92.2 ± 15.8 in various domains, and between-group changes from baseline were not statistically significant at 1 year. There was a significant increase in Role physical, Vitality, Role emotional, Mental health and Mental Component Summary (MCS), and a decrease in Bodily pain and General health scores in the CPAP group. The change in Physical Component Summary (PCS) was determined by female sex (beta coefficient -0.19, 95% confidence interval [CI] -7.25 to -0.98, P = .010), baseline AHI (beta coefficient -0.19, 95% CI -0.21 to -0.03, P = .009), CPAP use (h/night) (beta coefficient -0.16, 95% CI -0.93 to -0.06, P = .028), and acute myocardial infarction at baseline (beta coefficient 0.18, 95% CI 0.59 to 5.19, P = .014). Determinants of the change in MCS from baseline were change in the ESS score (beta coefficient -0.14, 95% CI -0.87 to -0.01, P = .054) and change in the Zung Self-rated Depression Scale scores (beta coefficient -0.33, 95% CI -0.58 to -0.24, P < .001).

Conclusions: Assignment to CPAP treatment compared to no CPAP had no significant effect on HRQoL as measured by the SF-36 in adults with CAD and nonsleepy OSA. Although several components of the SF-36 scores were improved within the CPAP group, CPAP use was associated with a decrease in PCS. The improvement in MCS was determined by the improvement in daytime sleepiness and depressive mood.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT00519597.

Citation: Wallström S, Balcan B, Thunström E, Wolf A, Peker Y. CPAP and health-related quality of life in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial. J Clin Sleep Med. 2019;15(9):1311-1320.

Keywords: SF-36; cardiovascular disease; health-related quality of life; sleep apnea.

© 2019 American Academy of Sleep Medicine.

Figures

Figure 1. Flow of study participants.

AHI = apnea-hypopnea index, CAD = coronary artery disease, CPAP = continuous positive airway pressure, CSA-CSR = central sleep apnea-Cheyne Stokes respiration, ESS = Epworth Sleepiness Scale, OSA = obstructive sleep apnea, RICCADSA = Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea, SF-36 = Short Form-36 Health Survey.

Figure 2. Mean differences in change from baseline with standard error of means in subdomains of the SF-36 questionnaires in intention-to-treat population.

(A) Differences between treatment groups. (B) Difference between CPAP adherence. BP = Bodily pain, CPAP = continuous positive airway pressure, GH = General health, MCS = Mental Composite Score, MH = Mental health, PCS = Physical Composite Score, PF = Physical functioning, RE = Role emotional, RF = Role physical, SF = Social functioning, SF-36 = Short Form-36 Health Survey, VT = Vitality.