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.

Do We Finally Know Whether CPAP Improves Quality of Life in Non-Sleepy Patients?

“…9,10 Only 47.2% of participants in the Wallström et al study had nightly use of at least 5 hours with an overall sample mean nightly use of 4.5 ± 2.3 h/night on all nights. 3 Use greater than 4 hours did not alter the findings of this analysis, although CPAP use was weakly related to improvement in Mental Component Summary score, but negatively correlated to the Physical Component Summary score. Of course, it is acknowledged that low nightly use often occurring in clinical trials reflects what is typically seen in clinical practice and has spurred the identification of interventions to promote higher use.…”

“…Using the SF36 to measure quality of life, Wallström and coworkers compared participants with OSA, an Epworth Sleepiness Scale score < 10, and had undergone treatment for coronary artery disease who received CPAP therapy against those with the same characteristics, but had not received CPAP. 3 Although half of the SF36 within group subscale scores improved with CPAP, there were no statistically significant differences between groups.…”

“…With 102 and 104 participants per group (CPAP versus no CPAP) in the secondary analysis of the RICCADSA trial, adequate power was attained for the SF36 Mental Component Summary Scale (89% power), but not for the Physical Component Summary Scale (36% power). 3 In contrast, the SAVE study, almost 3,000 participants with cardiovascular disease and a mean Epworth Sleepiness Scale value < 8, showed adequate power finding significant differences with CPAP treatment compared to usual care for both the SF36 Physical and Mental Component Summary Scales. 8 Where previous research, for the most part, failed to illustrate benefit of CPAP treatment in those without sleepiness, this study succeeded principally due to the power generated by the large sample size.…”

“…2 It is with this intent that Wallström and colleagues in this issue of Journal of Clinical Sleep Medicine, analyzed data from the RICCADSA trial to address the effect of continuous positive airway pressure (CPAP) treatment on quality of life (QOL) in nonsleepy patients with obstructive sleep apnea (OSA) who received interventions for acute myocardial infarction. 3 It has been solidly demonstrated that in sleepy patients with OSA, CPAP treatment improves QOL, even in those with milder disease. [4][5][6] However, the question remains if CPAP therapy improves quality of life in those who do not manifest sleepiness.…”

Continuous Positive Airway Pressure and Adaptive Servoventilation in Heart Failure Patients With Central Sleep Apnea With Cheyne Stokes Respiration: Are They Useful in Ameliorating Cardiac Systolic Dysfunction?

“…Several studies have shown that positive pressure ventilation effectively controls CSA/CSR, with remarkable improvements on several pulmonary endpoints, but there is uncertainty as to whether treatment of CSA/CSR in heart failure is beneficial in terms of quality of life, cardiac function, and cardiovascular outcomes. [1][2][3][4][5][6][7][8] Continuous positive airway pressure (CPAP) provides constant positive pressure. By contrast, adaptive servoventilation (ASV) provides dynamic adjustment (breath by breath) of the pressure support with a backup rate to normalize breathing patterns relative to a predetermined target (different algorithms in use).…”