Long-term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea

Abstract

Background: Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long-term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort.

Hypothesis: Long-term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA.

Methods: Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow-up was 4.8 years for the main trial, with a predefined minimum follow-up of 2 years.

Results: The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long-term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long-term CPAP use.

Conclusions: Long-term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long-term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.

Keywords: Adherence; Coronary Artery Disease; Obstructive Sleep Apnea; Positive Airway Pressure; Sleepiness.

Conflict of interest statement

PJS has received personal fees from ResMed, Inspire Medical Systems, and Philips Respironics; has served as a consultant for Jazz Pharmaceuticals and Itamar Medical; has been a member of the NFL General Medical Committee; and has given expert testimony for Harris v Emory. ET received lecture fees from ResMed and Pfizer. YP received institutional grants and lecture fees from ResMed and consultant fees from BresoTec, outside the submitted work. The authors declare no other potential conflicts of interest.

© 2017 Wiley Periodicals, Inc.

Figures

Figure 1

Kaplan–Meier plot showing the proportion of sleepy and nonsleepy patients using CPAP therapy vs time. Abbreviations: CPAP, continuous positive airway pressure