Celik Yeliz, Thunström Erik, Strollo Patrick J, Peker Yüksel
Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
Sleep Med. 2021 Jan;77:96-103. doi: 10.1016/j.sleep.2020.11.034. Epub 2020 Dec 4.
Anxiety and obstructive sleep apnea (OSA) coexist among adults with coronary artery disease (CAD) following revascularization. Continuous positive airway pressure (CPAP) is the first line treatment of OSA patients with daytime sleepiness. The current study evaluated the effect of CPAP on anxiety in CAD patients with nonsleepy OSA.
Two hundred forty-four revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale score <10) were randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung Self-rating Anxiety Scale (SAS) was administered at baseline and after 3 and 12 months with higher scores suggesting more anxiety.
A total of 208 patients with complete SAS scores at baseline and 12-month follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the intention-to-treat analysis, CPAP had no significant effect on the SAS scores. On-treatment analysis revealed a significant increase in the median of delta SAS score (+3.75) after three months among the participants using the device 2.8 h/day or more while there was a decline in the median of delta SAS score (-1.25) in the non-adherent or no-CPAP group (p = 0.031). The increase in the SAS score (+1.25) in the adherent group, and the decline (-1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p = 0.011). Baseline SAS score predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval (CI) 1.04-1.18; p = 0.003], and there was an association between the increase in the SAS scores and accumulated CPAP hours/day [standardized β = 0.144 (95% CI 0.005-0.695), p = 0.047].
Our results suggest that anxiety should be considered in the management of CAD patients with nonsleepy OSA following revascularization.
NCT00519597.
在接受血运重建的成年冠心病（CAD）患者中，焦虑与阻塞性睡眠呼吸暂停（OSA）并存。持续气道正压通气（CPAP）是治疗伴有日间嗜睡的OSA患者的一线治疗方法。本研究评估了CPAP对无嗜睡症状的CAD合并OSA患者焦虑情绪的影响。
2005年至2010年期间，244例接受血运重建的无嗜睡症状的CAD合并OSA患者（呼吸暂停低通气指数≥15次/小时，爱泼沃斯嗜睡量表评分<10）被随机分为CPAP组或非CPAP组。在基线、3个月和12个月时采用zung自评焦虑量表（SAS）进行评估，得分越高表明焦虑程度越高。
共有208例患者在基线和12个月随访时获得完整的SAS评分（CPAP组，n = 103；非CPAP组，n = 105）。在意向性分析中，CPAP对SAS评分无显著影响。治疗分析显示，每天使用该设备2.8小时或更长时间的参与者在3个月后SAS评分中位数显著增加（+3.75），而非依从性或非CPAP组的SAS评分中位数下降（-1.25）（p = 0.031）。一年后，依从性组的SAS评分增加（+1.25），非依从性/非CPAP组的评分下降（-1.25分）仍然显著（p = 0.011）。基线SAS评分可预测非依从性[调整后的优势比1.11；95%置信区间（CI）1.04 - 1.18；p = 0.003]，并且SAS评分的增加与每天累计使用CPAP的小时数之间存在关联[标准化β = 0.144（95% CI 0.005 - 0.695），p = 0.047]。
我们的结果表明，在对接受血运重建的无嗜睡症状的CAD合并OSA患者进行管理时应考虑焦虑因素。
NCT00519597。
