CPAP treatment increases anxiety in coronary artery disease patients with nonsleepy obstructive sleep apnoea: the RICCADSA randomized controlled trial

Abstract

Background: Revascularization is related with increased anxiety in coronary artery disease (CAD). Impact of obstructive sleep apnoea (OSA) as well as treatment with continuous positive airway pressure (CPAP) on anxiety in cardiac cohorts is unknown. Aims and Objective: We explored the state of anxiety after CPAP therapy in CAD patients with nonsleepy OSA. Methods: This was one of the secondary outcomes of the RICCADSA randomized controlled trial, conducted in Sweden between 2005 and 2013. In all, 237 adults with nonsleepy OSA (apnea-hypopnea index ≥15/h, and Epworth Sleepiness Scale <10) who filled the Zung Self-rating Anxiety Scale (SAS) were included. Participants were assigned to CPAP (n=119), or no-CPAP (n=118). Between-group difference in absolute change on the SAS scores after 3- and 12 months of CPAP therapy was examined. Results: Intention-to-treat analysis showed no significant difference between the CPAP and no-CPAP groups. Notwithstanding, there was an increase in the median score (+3.75 points) after 3 months in the group using the device at least 3 hrs/night, while there was a decline (-1.25 points) in the non-adherent/no-CPAP group (p=0.01). The increase in the SAS score (+1.25 points) in the adherent group and the decline (-1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p=0.04). In a multivariate linear regression model, there was an association between the increase in the SAS scores and CPAP hrs/night (β coefficient =0.14 [95% CI 0.00-0.69], p=0.05). Conclusions: CPAP treatment increases anxiety in revascularized CAD patients with nonsleepy OSA.