Effects of continuous positive airway pressure on anxiety, depression, and major cardiac and cerebro‑vascular events in obstructive sleep apnea patients with and without coronary artery disease

Ming‑Chung Lee^a, Yu‑Chih Shen^b,c, Ji‑Hung Wang^c,d, Yu‑Ying Li^b, Tzu‑Hsien Li^a,e, En‑Ting Chang^c,f*, Hsiu‑Mei Wang^f

^aDepartment of Human Development and Psychology, College of Humanities and Social Sciences, Tzu Chi University, Hualien, Taiwan, ^bDepartment of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ^cSchool of Medicine, Tzu Chi University, Hualien, Taiwan, ^dDepartment of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ^eDepartment of Psychiatry, Pingtung Branch of Kaohsiung Armed Forces General Hospital, Pingtung, Taiwan, ^fDepartment of Chest, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Abstract

Objective: Obstructive sleep apnea (OSA) is associated with bad cardiovascular outcomes and a high prevalence of anxiety and depression. This study investigated the effects of continuous positive airway pressure (CPAP) on the severity of anxiety and depression in OSA patients with or without coronary artery disease (CAD) and on the rate of cardio‑ and cerebro‑vascular events in those with OSA and CAD. Materials and Methods: This prospective study included patients with moderate‑to‑severe OSA, with or without a recent diagnosis of CAD; all were started on CPAP therapy. Patients completed the Chinese versions of the Beck Anxiety Inventory (BAI) and Beck Depression Inventory‑II (BDI‑II) at baseline and after 6‑month follow‑up. The occurrence of major adverse cardiac and
cerebrovascular events (MACCE) was assessed every 3 months up to 1 year. Results: BAI scores decreased from 8.5 ± 8.4 at baseline to 5.4 ± 6.9 at 6 months in CPAP‑compliant OSA patients without CAD (P < 0.05). BAI scores also decreased from 20.7 ± 14.9 to 16.1 ± 14.5 in CPAP‑compliant OSA patients with CAD. BDI‑II scores decreased in CPAP‑compliant OSA patients without CAD (from 11.1 ± 10.7 at baseline to 6.6 ± 9.5 at 6 months) and in CPAP‑compliant OSA patients with CAD (from 20.4 ± 14.3 to 15.9 ± 7.3). In addition, there was a large effect size (ES) of BAI and BDI in 6‑month CPAP treatment of OSA patients with CAD and a large ES in those with OSA under CPAP treatment. In OSA patients with CAD, the occurrence of MACCE was significantly lower in CPAP‑compliant patients than that in CPAP noncompliant patients (11% in CPAP compliant and 50% in noncompliant; P < 0.05). Conclusions: CPAP improved anxiety and depression in OSA patients regardless of CAD. In OSA patients with CAD, CPAP‑compliant patients had a lower 1‑year rate of MACCE than CPAP‑noncompliant patients.

Keywords: Anxiety, Continuous positive airway pressure, Coronary artery disease, Depression, Obstructive sleep apnea