Health-related Quality of Life in CPAP-treated Patients With Obstructive Sleep Apnea With vs Without Excessive Sleepiness in the Riccadsa Cohort

Abstract Background: Both Coronary Artery Disease (CAD) and Obstructive sleep apnea (OSA) are associated with impaired health-related quality of life (HRQoL). Continuous positive airway pressure (CPAP) is the standard treatment for OSA and has been associated with HRQoL benefits, but these benefits are unknown in adults with CAD and OSA with vs without excessive daytime sleepiness (EDS). Methods: The current protocol was a secondary analysis of the RICCADSA trial, conducted in Sweden from 2005 to 2013, including 228 participants with OSA (apnea-hypopnea index [AHI] ≥15 events/h) treated with CPAP (126 with EDS, 102 without EDS). EDS was defined as an Epworth Sleepiness Scale (ESS) score of at least 10. HRQoL was assessed at baseline and after one year of treatment using the 36-item Short Form Health Survey (SF-36), which evaluates 8 health-related domains and 2 component summary scores (physical and mental). Results: At baseline, sleepy patients had a higher mean AHI (32.1 vs. 28.3 events/hour) and ESS scores (12.2 vs. 5.6) and presented significantly lower scores in most of the SF-36 domains compared to the non-sleepy patients. Sleepy patients experienced significant improvements in ESS and role physical, vitality, social functioning, role emotional and mental health domains as well as in mental component summary (MCS) scores. Modest improvements were observed in role physical, vitality and MCS sores, and a slightly worsening was seen in bodily pain and general health perception among the non-sleepy patients. CPAP hours/night was significantly associated with the decline in ESS, which predicted the improvements in several domains of the SF-36. Conclusions: Response to one year of CPAP treatment regarding HRQoL in CAD patients with OSA was mainly dependent on the presence or absence of EDS at baseline in this revascularized cohort, and there was a linear association between CPAP use and decline in ESS in the entire cohort. The slight decrease in the bodily pain and general health domains among the non-sleepy participants may require further attention in consideration of CPAP adherence in patients with CAD.