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

Sleep and Breathing volume 22, pages 1169–1177 (2018)Cite this article

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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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.

Author information

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

Authors
  1. Lynn M. Baniak
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  3. Faith S. Luyster
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  4. Patrick J. Strollo Jr
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  5. Erik Thunström
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Corresponding author

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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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

Keywords

  • Coronary artery disease
  • Obstructive sleep apnea
  • Functional status
  • Continuous positive airway pressure