Faith S Luyster1, Patrick J Strollo2,3, Erik Thunström4,5, Yüksel Peker2,4,6. 1. School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania. 2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 3. VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 4. Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden. 5. Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden. 6. Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Abstract
BACKGROUND:Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long-term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort. HYPOTHESIS: Long-term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA. METHODS:Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow-up was 4.8 years for the main trial, with a predefined minimum follow-up of 2 years. RESULTS: The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long-term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long-term CPAP use. CONCLUSIONS: Long-term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long-term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.
RCT Entities:
BACKGROUND:Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long-term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort. HYPOTHESIS: Long-term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA. METHODS: Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow-up was 4.8 years for the main trial, with a predefined minimum follow-up of 2 years. RESULTS: The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long-term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long-term CPAP use. CONCLUSIONS: Long-term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long-term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.
Authors: T E Weaver; N B Kribbs; A I Pack; L R Kline; D K Chugh; G Maislin; P L Smith; A R Schwartz; N M Schubert; K A Gillen; D F Dinges Journal: Sleep Date: 1997-04 Impact factor: 5.849
Authors: Francisco Campos-Rodriguez; Miguel A Martinez-Garcia; Nuria Reyes-Nuñez; Isabel Caballero-Martinez; Carmen V Almeida-Gonzalez; Pablo Catalan-Serra; Nicolas Peña-Griñan Journal: Eur Respir J Date: 2013-02-08 Impact factor: 16.671
Authors: J M Montserrat; M Ferrer; L Hernandez; R Farré; G Vilagut; D Navajas; J R Badia; E Carrasco; J De Pablo; E Ballester Journal: Am J Respir Crit Care Med Date: 2001-08-15 Impact factor: 21.405
Authors: Cristiano Fava; Stefania Dorigoni; Francesco Dalle Vedove; Elisa Danese; Martina Montagnana; Gian Cesare Guidi; Krzysztof Narkiewicz; Pietro Minuz Journal: Chest Date: 2014-04 Impact factor: 9.410
Authors: Andrey V Zinchuk; Jen-Hwa Chu; Jiasheng Liang; Yeliz Celik; Sara Op de Beeck; Nancy S Redeker; Andrew Wellman; H Klar Yaggi; Yüksel Peker; Scott A Sands Journal: Am J Respir Crit Care Med Date: 2021-09-15 Impact factor: 30.528