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Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD.

Methods

One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment.

Results

Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12–11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence.

Conclusions

Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.

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References

  1. Rumsfeld JS, Alexander KP, Goff DC et al (2013) Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation 127(22):2233–2249. https://doi.org/10.1161/CIR.0b013e3182949a2e

    Article  PubMed  Google Scholar 

  2. Kaul P, Naylor CD, Armstrong PW, Mark DB, Theroux P, Dagenais GR (2009) Assessment of activity status and survival according to the Canadian Cardiovascular Society angina classification. Can J Cardiol 25(7):e225–e231. https://doi.org/10.1016/S0828-282X(09)70506-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wolff G, Dimitroulis D, Andreotti F, Kołodziejczak M, Jung C, Scicchitano P, Devito F, Zito A, Occhipinti M, Castiglioni B, Calveri G, Maisano F, Ciccone MM, de Servi S, Navarese EP (2017) Survival benefits of invasive versus conservative strategies in heart failure in patients with reduced ejection fraction and coronary artery disease. Circ Hear Fail 10(1):e003255. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003255

    Article  Google Scholar 

  4. Smith SC, Benjamin EJ, Bonow RO et al (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 124(22):2458–2473. https://doi.org/10.1161/CIR.0b013e318235eb4d

    Article  PubMed  Google Scholar 

  5. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504. https://doi.org/10.5664/jcsm.6506

    Article  PubMed  PubMed Central  Google Scholar 

  6. Glantz H, Thunstroöm E, Herlitz J et al (2013) Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort. Ann Am Thorac Soc 10(4):350–356. https://doi.org/10.1513/AnnalsATS.201211-106OC

    Article  PubMed  Google Scholar 

  7. Zhang J-J, Gao X-F, Ge Z, Jiang XM, Xiao PX, Tian NL, Kan J, Lee CH, Chen SL (2016) Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention. Patient Prefer Adherence 10:871–878

    PubMed  PubMed Central  Google Scholar 

  8. Lee C-H, Sethi R, Li R, Ho HH, Hein T, Jim MH, Loo G, Koo CY, Gao XF, Chandra S, Yang XX, Furlan SF, Ge Z, Mundhekar A, Zhang WW, Uchôa CHG, Kharwar RB, Chan PF, Chen SL, Chan MY, Richards AM, Tan HC, Ong TH, Roldan G, Tai BC, Drager LF, Zhang JJ (2016) Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation 133(21):2008–2017. https://doi.org/10.1161/CIRCULATIONAHA.115.019392

    Article  PubMed  Google Scholar 

  9. Jilek C, Krenn M, Sebah D, Obermeier R, Braune A, Kehl V, Schroll S, Montalvan S, Riegger GAJ, Pfeifer M, Arzt M (2011) Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 13(1):68–75. https://doi.org/10.1093/eurjhf/hfq183

    Article  PubMed  Google Scholar 

  10. O’Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, Benjafield AV, Woehrle H, Blase AB, Lindenfeld JA, Oldenburg O (2017) Cardiovascular outcomes with minute ventilation–targeted adaptive servo-ventilation therapy in heart failure: the CAT-HF trial. J Am Coll Cardiol 69(12):1577–1587. https://doi.org/10.1016/j.jacc.2017.01.041

    Article  PubMed  Google Scholar 

  11. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS, SAVE Investigators and Coordinators (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375(10):919–931. https://doi.org/10.1056/NEJMoa1606599

    Article  PubMed  Google Scholar 

  12. Gooneratne NS, Weaver TE, Cater JR, Pack FM, Arner HM, Greenberg AS, Pack AI (2003) Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc 51(5):642–649. https://doi.org/10.1034/j.1600-0579.2003.00208.x

    Article  PubMed  Google Scholar 

  13. Gu G, Zhou Y, Zhang Y, Cui W (2016) Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment. BMC Psychiatry 16(1):1–9. https://doi.org/10.1186/s12888-016-0972-9

    Article  Google Scholar 

  14. Barnason SA, Zimmerman LM, Brey B, Catlin S, Nieveen JL (2006) Patterns of recovery following percutaneous coronary intervention: a pilot study. Appl Nurs Res 19(1):31–37. https://doi.org/10.1016/j.apnr.2004.12.002

    Article  PubMed  Google Scholar 

  15. Weaver TE, Mancini C, Maislin G, Cater J, Staley B, Landis JR, Ferguson KA, George CFP, Schulman DA, Greenberg H, Rapoport DM, Walsleben JA, Lee-Chiong T, Gurubhagavatula I, Kuna ST (2012) Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 186(7):677–683. https://doi.org/10.1164/rccm.201202-0200OC

    Article  PubMed  PubMed Central  Google Scholar 

  16. Weaver TE, Maislin G, Dinges DF et al (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30(6):711–719. https://doi.org/10.1016/S8756-3452(08)70707-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Walia HK, Thompson NR, Katzan I, Foldvary-Schaefer N, Moul DE, Mehra R (2017) Impact of sleep-disordered breathing treatment on quality of life measures in a large clinic-based cohort. J Clin Sleep Med 13(11):1255–1263

    Article  PubMed  PubMed Central  Google Scholar 

  18. Antic NA, Catcheside P, Buchan C et al (2011) The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep 34(1):111–119. https://doi.org/10.1016/j.yneu.2011.05.056

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peker Y, Glantz H, Thunström E, Kallryd A, Herlitz J, Ejdebäck J (2009) Rationale and design of the Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea--RICCADSA trial. Scand Cardiovasc J 43(1):24–31. https://doi.org/10.1080/14017430802276106

    Article  PubMed  Google Scholar 

  20. Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20(10):835–843 http://www.ncbi.nlm.nih.gov/pubmed/9415942

    CAS  PubMed  Google Scholar 

  21. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14(6):540–545. https://doi.org/10.1016/j.sleep.2007.08.004

    Article  CAS  PubMed  Google Scholar 

  22. Johns MW (1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15(4):376–381. https://doi.org/10.1093/sleep/15.4.376

    Article  CAS  PubMed  Google Scholar 

  23. Pallant J SPSS survival manual, a step by step guide to data analysis using SPSS for windows, vol 2007, 3rd edn. McGraw Hill, Sydney, pp 179–200

  24. Cohen J (1992) A power primer. Quant Methods Psychol 112(1):155–159. https://doi.org/10.1037/0033-2909.112.1.155

    Article  CAS  Google Scholar 

  25. Weaver EM, Woodson BT, Steward DL (2005) Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol - Head Neck Surg 132(2):255–262. https://doi.org/10.1016/j.otohns.2004.11.001

    Article  PubMed  Google Scholar 

  26. Khan A, Harrison SL, Kezirian EJ, Ancoli-Israel S, O’Hearn D, Orwoll E, Redline S, Ensrud K, Stone KL (2013) Obstructive sleep apnea during rapid eye movement sleep, daytime sleepiness, and quality of life in older men in Osteoporotic Fractures in Men (MrOS) Sleep Study. J Clin Sleep Med 9(3):191–198. https://doi.org/10.5664/jcsm.2474

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kezirian EJ, Harrison SL, Ancoli-Israel S, Redline S, Ensrud K, Goldberg AN, Claman DM, Spira AP, Stone KL, for the Study of Osteoporotic Fractures in Men (MrOS) Research Group (2009) Behavioral correlates of sleep-disordered breathing in older men. Sleep 32(2):253–261 http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105447435&site=ehost-live

    Article  PubMed  PubMed Central  Google Scholar 

  28. Billings ME, Rosen CL, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Zee PC, Redline S, Kapur VK (2014) Psychometric performance and responsiveness of the functional outcomes of sleep questionnaire and sleep apnea quality of life index in a randomized trial: the HomePAP study. Sleep 37(12):2017–2024. https://doi.org/10.5665/sleep.4262

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rosendorff C, Lackland DT, Allison M et al (2015) Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension 65:000–000. https://doi.org/10.1161/HYP.0000000000000018

    Article  CAS  Google Scholar 

  30. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P (2007) Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 30(3):312–319

    Article  PubMed  Google Scholar 

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Acknowledgements

We gratefully acknowledge the Swedish Research Council (521-2011-537 and 521-2013-3439), the Swedish Heart-Lung Foundation (20080592, 20090708, 20100664, and 20110469), the “Agreement concerning research and education of doctors” of Vastra Gotalandsregionen (ALFGBG-11538 and ALFGBG-150801), the research fund at Skaraborg Hospital, the Skaraborg Research and Development Council, the Heart Foundation of Kärnsjukhuset, and the ResMed Foundation and ResMed Ltd. for the research grants that supported the parent RICCADSA study.

Funding

The National Institute of Health Heart Lung and Blood Institute provided financial support in the form of an institutional grant, Translational Sleep Medicine (HL82610) at the University of Pittsburgh School of Medicine. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA

    Lynn M. Baniak, Eileen R. Chasens & Faith S. Luyster

  2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Patrick J. Strollo Jr & Yüksel Peker

  3. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Patrick J. Strollo Jr

  4. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Erik Thunström & Yüksel Peker

  5. Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden

    Erik Thunström

  6. Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey

    Yüksel Peker

  7. Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden

    Yüksel Peker

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  1. Lynn M. Baniak
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Correspondence to Lynn M. Baniak.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. However, Thunström received consultant fees from ResMed and Pfizer outside the submitted work. Strollo received institutional grants from Philips-Respironics, ResMed, Inspire Medical Systems, and National Football League PinMed, and advisory fees from ResMed, Emmi Solutions, Jazz Pharmaceuticals, Itamar Medical, Inspire Medical Systems, and Separation Design Group, all outside the submitted work. Peker received institutional grants from ResMed for the main RICCADSA trial, consultant fees from BresoTec, and lecture fees from ResMed and Philips-Respironics all outside the submitted work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Baniak, L.M., Chasens, E.R., Luyster, F.S. et al. Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial. Sleep Breath 22, 1169–1177 (2018). https://doi.org/10.1007/s11325-018-1733-4

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  • DOI: https://doi.org/10.1007/s11325-018-1733-4

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