International Journal of Behavioral Medicine

, Volume 25, Issue 2, pp 171–182 | Cite as

Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression

  • Alicja Juskiene
  • Aurelija Podlipskyte
  • Adomas Bunevicius
  • Giedrius Varoneckas



The study aimed to examine the association between type D personality trait and sleep quality in coronary artery disease (CAD) patients with and without obstructive sleep apnea (OSA) and to explore the mediating effects of anxiety and depression symptoms.


A cross-sectional study was performed in 879 CAD patients attending cardiac rehabilitation program (mean age 57.8 years; SD = 9.0; 75% men). Participants underwent full-night polysomnography and were classified in OSA (n = 349) and no OSA (n = 530) groups. Patients were evaluated for type D personality, subjective sleep quality (Pittsburgh sleep quality index), and symptoms of anxiety and depression (hospital anxiety and depression scale).


Patients with type D personality reported poorer subjective sleep quality than non-type D patients irrespective of the presence of OSA. Type D and negative affectivity (NA) were associated with worse subjective sleep quality in patients with OSA and without OSA. The mediational analysis revealed that type D and NA were indirectly associated with Pittsburgh sleep quality index through anxiety and depression symptoms in no OSA and OSA patients.


In CAD patients, type D personality and NA are associated with worse subjective sleep quality and this association is mediated by depression and anxiety symptoms irrespective of OSA presence.


Type D personality Subjective sleep quality Anxiety Depression Coronary artery disease Obstructive sleep apnea 



The authors are grateful to staff of the Behavioral Medicine Institute, Lithuanian University of Health Sciences (Palanga, Lithuania), for their assistance in data collection. Special thanks go to experienced technician Audrius Alonderis who scored the PSG data.

Compliance with Ethical Standards

The study and its consent procedures were approved by the local ethics committee. A written informed consent was obtained from each study patient.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© International Society of Behavioral Medicine 2018

Authors and Affiliations

  1. 1.Behavioral Medicine InstituteLithuanian University of Health SciencesPalangaLithuania
  2. 2.Institute of NeurosciencesLithuanian University of Health SciencesKaunasLithuania

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