Association of REM predominant obstructive sleep apnoea severity with depression and quality of life in adults with coronary artery disease in the RICCADSA cohort

Abstract

Background: Obstructive sleep apnoea (OSA) is common in adults with coronary artery disease (CAD). OSA that occurs predominantly during REM-sleep has been identified as a specific OSA phenotype. Aims and Objective: We addressed whether or not there is a dose-response relationship between REM-predominant OSA and functional outcomes, mood and quality of life in a CAD cohort. Methods: The current study was a secondary analysis of the RICCADSA trial. In all, 286 OSA patients with total sleep time ≥240 min, and REM sleep ≥30 min, were included. REM- predominant OSA was defined as REM-apnoea hypopnoea index (AHI) /non-REM (NREM)-AHI ≥2. Multiple regression analyzes were used to address the association of REM-AHI with the Functional Outcome of Sleep Questionnaire (FOSQ), Zung Self-rated Depression Scale (SDS) and Anxiety Scale (SAS) as well as Short Form-36 Health Survey (SF- 36) scores. Results: In all, 73 (25.5%) had REM-predominant OSA. There was a significant dose-response relationship between Zung SDS scores and REM-AHI. No correlation was found between REM-AHI and FOSQ as well as Zung SAS scores. SF-36 subdomains vitality, mental health, and mental composite score (MCS) were inversely correlated with REM-AHI. In the multivariate models, only the inverse relationship between REM-AHI and MCS remained significant after adjustment for age, body-mass-index, and sex (β-coefficient -2.20, %95 CI [-0.56, -0.03] ; p=0.03). Conclusions: Our results suggest an independent inverse dose-response relationship between REM-AHI and mental composite score. The relationship between REM-AHI and SDS, vitality and mental health were dependent on female sex.