Association of Excessive Daytime Sleepiness with the Zung Self-Rated Depression Subscales in Adults with Coronary Artery Disease and Obstructive Sleep Apnea.

Baran Balcan,Yüksel Peker,Yeliz Celik,Hale Yapici-Eser

doi:10.3390/diagnostics11071176

Abstract

Excessive daytime sleepiness (EDS) is a factor associated with both obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive airway pressure (CPAP) treatment may decrease EDS in adults with OSA; however, the modulatory role of depressive symptoms on the improvement of EDS is not known. We aimed to explore the association between subscales of the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale (ESS) over a 2-year period in coronary artery disease (CAD) patients with OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399 adults with CAD (155 sleepy OSA [apnea–hypopnea index ≥ 15/h] and ESS score ≥ 10, who were offered CPAP; and 244 nonsleepy OSA [ESS < 10]), randomized to CPAP [n = 122] or no-CPAP [n = 122]) were included. Three factors were extracted from the Zung SDS, based on the principal component analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3, appetite. In a mixed model, the ESS score decreased by 3.4 points (p < 0.001) among the sleepy OSA phenotype, which was predicted by the decline in the F2, but not in the F1 and F3 scores. The fixed effects of time were not significant in the nonsleepy OSA groups, and thus, further analyses were not applicable. Additional within-group analyses showed a significant decrease in all subscales over time both in the sleepy and nonsleepy OSA patients on CPAP whereas there was a significant increase in the nonsleepy OSA group randomized to no-CPAP. We conclude that the improvement in negative mood symptoms of depression, but not changes in cognitive symptoms and anhedonia as well as appetite, was a significant predictor of decline in the ESS scores over a 2-year period in this CAD cohort with sleepy OSA on CPAP treatment.

Highlights

This article is an open access articleObstructive sleep apnea (OSA) is a common sleep-related breathing disorder among adults with coronary artery disease (CAD) [1]
We have recently demonstrated significant reductions in Zung Self-rating Depression Scale [SDS] scores in nonsleepy open access articleObstructive sleep apnea (OSA) patients randomized to continuous positive airway pressure (CPAP) compared with those in the no-CPAP group in the RICCADSA trial [6]
The estimate was 12.2 points for the intercept (p < 0.001), −4.00 points for the linear growth rate (p < 0.001) and 1.1 points for the quadratic growth rate (p < 0.001). These results indicate that the time-dependent polynomials were significant predictors for the change in ESS, and both the linear and quadratic polynomials should be retained in subsequent analyses in sleepy OSA patients on CPAP

Summary

Introduction

This article is an open access articleObstructive sleep apnea (OSA) is a common sleep-related breathing disorder among adults with coronary artery disease (CAD) [1]. In OSA patients, EDS is shown to be associated with distributed under the terms and conditions of the Creative Commons. A significant number of patients with OSA experience residual EDS despite an adherent use of CPAP, and the reasons for the residual EDS are not well defined [3,4]. OSA may cause depression by disturbing sleep patterns and through its cardiovascular effects [5]. In this context, the evaluation of depression in cardiac patients with concomitant OSA is challenging due to the difficulty of distinguishing depressive symptoms from EDS and the multidirectional relationship of EDS, OSA, CAD and depression

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