PREDICTION OF ADHERENCE TO CPAP THERAPY IN CARDIAC PATIENTS

Highlights

Adherence to CPAP therapy in patients with severe obstructive sleep apnea and cardiovascular diseases can be predicted using a model that includes the desaturation index and anxiety.

Aim. To evaluate the results of CPAP therapy (Continuous Positive Airway Pressure) in cardiac patients with severe obstructive sleep apnea (OSA) and to identify factors predicting adherence to CPAP therapy using prospective follow-up data.

Methods. The study included 52 patients with severe OSA (82.7% men, 55.6 ± 8.8 years) examined in 2019–2022, the data was collected from the registry of cardiac patients with OSA (n = 138). Arterial hypertension was diagnosed in 96.1% of patients, coronary artery disease (CAD) was diagnosed in 42.3% of patients, chronic heart failure was diagnosed in 86.5% of patients. Clinical and laboratory parameters, data from OSA screening scales, overnight pulse oximetry, diagnostic scales of anxiety, depression, quality of life and cognitive function were assessed before the start of CPAP therapy and 12.3 ± 7.0 months after its start. 8 patients adequately used CPAP therapy (group with CPAP) and 44 patients either refused to use it or used it inadequately (group without CPAP).

Results. When comparing the groups at baseline, there were no differences in age, gender, body mass index and clinical characteristics. Predictors of adherence to CPAP therapy were a higher desaturation index (odds ratio (OR) 1.264, 95% confidence interval (CI) 1.017–1.569, p = 0.034) and manifestations of anxiety (OR 1.056, 95% CI 1.01–1.115, p = 0.049). The sensitivity of the model was 85.7%, specificity was 78%, and area under the ROC curve was 0.843 (95% CI 0.712–0.974, p = 0.004). There were no new cases of CAD in the group with CPAP, in the group without CPAP, 5 new cases of CAD developed during follow-up.

Conclusion. Adherence to CPAP therapy in patients with severe OSA and cardiovascular disease can be predicted with high sensitivity and specificity using the model that includes the desaturation index and anxiety. Supposedly, CPAP therapy is relevant for secondary prevention of coronary artery disease.

1. Medvedeva E.A., Korostovtseva L.S., Sazonova Yu.V., Bochkarev M.V., Sviryaev Yu.V., Konradi A.О. Obstructive sleep apnea syndrome in congestive heart failure: cardiologist perspective. Russian Journal of Cardiology. 2018;1(153):78-82. doi: 10.15829/1560-4071-1018-1-78-82 (In Russian)

2. Bormina S.O., Korostovtseva L.S., Bochkarev M.V., Sviryaev Y.V., Konradi A.O., Tikhonenko V.M. Multifunctional Monitoring: is it Possible to Simultaneously Evaluate Blood Pressure and Sleep-Disordered Breathing? Kardiologiia. 2020;60(1):10–15. doi: 10.18087/cardio.2020.1.n482 (In Russian)

3. Osipova O.A., Gosteva E.V., Zhernakova N.I., Shepel R.V., Ponomarenko T.N., Inshakova K.Yu., Drapkina O.M. 24-hour blood pressure profile and systemic inflammation in patients with stable coronary artery disease with obstructive sleep apnea. Cardiovascular Therapy and Prevention. 2023;22(9):3705. doi: 10.15829/1728-8800-2023-3705 (In Russian)

4. Krupichka K.S., Agaltsov M.V., Beregovskaya S.A., Myasnikov R.P., Drapkina O.M. Sleep-related breathing disorders in patients with heart failure with reduced and mildly reduced ejection fraction: main types and their dependence on heart failure etiology. Russian Journal of Cardiology. 2023;28(1S):5261. doi: 10.15829/1560-4071-2023-5261 (In Russian)

5. Tyurin V.P., Savchuk О.V., Proskurnova V.V., Dobrikov E.A., Kulagina A.M. Odstructive sleep apnea as an independent predictor of cardiovascular mortality. Bulletin of Pirogov National Medical and Surgical Center. 2020;15(2):126-128. doi: 10.25881/BPNMSC.2020.95.30.022 (In Russian)

6. Costa L.E., Uchôa C.H., Harmon R.R., Bortolotto L.A., Lorenzi-Filho G., Drager L.F. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart. 2015;101(16):1288–1292. doi: 10.1136/heartjnl-2014-307276

7. Tardov M.V., Kunelskaya N.L., Filin A.A., Artemiev M.E., Studeny M.E. Cardiac arrest in obstructive sleep apnea syndrome: treatment options. Case series. Russian Bulletin of Otorhinolaryngology. 2020;85(4):43 45. doi: 10.17116/otorino20208504143 (In Russian)

8. Timkova V., Nagyova I., Reijneveld S.A., Tkacova R., Dijk J.P., Bultmann U. Quality of life of obstructive sleep apnoea patients receiving continuous positive airway pressure treatment: A systematic review and meta-analysis. Hear Lung. 2020;49(1):10-24. doi: 10.1016/J.HRTLNG.2019.10.004

9. Bakker J.P., Weaver T.E., Parthasarathy S., Aloia M.S. Adherence to CPAP what should we be aiming for, and how can we get there? Chest J. 2019;155(6):1272-1287. doi: 10.1016/j.chest.2019.01.012

10. Kapur V.K., Auckley D.H., Chowdhuri S., Kuhlmann D.C., Mehra R., Ramar K., Harrod C.G. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504. doi: 10.5664/jcsm.6506

11. Marti-Soler H., Hirotsu C., Marques-Vidal P., Vollenweider P., Waeber G., Preisig M., Tafti M., Tufik S.B., Bittencourt L., Tufik S., Haba-Rubio J., Heinzer R. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4(9):742-748. doi: 10.1016/S2213-2600(16)30075-3

12. Amra B., Javani M., Soltaninejad F., Penzel T., Fietze I., Schoebel C., Farajzadegan Z. Comparison of Berlin Questionnaire, Stop-Bang, and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients. Int J Prev Med. 2018;9(1):28. doi: 10.4103/ijpvm.IJPVM_131_17

13. Instruction manual. Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. London: Pfizer; 2021. Available at: https://www.phqscreeners.com/images/sites/g/files/g10016261/f/201412/instructions.pdf [access: 15.01.2021].

14. Ryabkova T.A., Bakhtereva E.V., Terekhov N.L. Effectiveness of rehabilitation measures in patients with posttraumatic complications based on the SF-36 questionnaire. Profilakticheskaya Meditsina. 2022;25(10):79-83. doi: 10.17116/profmed20222510179 (In Russian)

15. Serebrova E.V. Structure of cognitive impairment in patients with sleep apnea in the acute period of cerebral infarction. Recipe. 2022;25(1):52-60. doi: 10.34883/PI.2022.25.1.007 (In Belarussian)

16. Sawyer A.M., Gooneratne N.S., Marcus C.L., Ofer D., Richards K.C., Weaver T.E. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343-356. doi: 10.1016/j.smrv.2011.01.003

17. Elfimova E.M., Mikhailova O.O., Khachatryan N.T., Litvin A.Y., Сhazova I.E. Clinical profile of patients with obstructive sleep apnea syndrome in a cardiology hospital. Terapevticheskii Arkhiv. 2020;92(4):9–16. doi: 10.26442/00403660.2020.04.000553 (In Russian)

18. Mazzuca E., Battaglia S., Marrone O., Marotta A.M., Castrogiovanni A., Esguinas C., Barcelo A., Barbe F., Bonsignore M.R. Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. J Sleep Res. 2014;23(1):13-21. doi: 10.1111/jsr.12088

19. Cherkasova S.A., Shvarts Yu.G. Clinical and echocardiographic features of heart failure in patients with obstructive sleep apnea and atrial fibrillation. Saratov Journal of Medical Scientific Research. 2016;12(3):349–353. (In Russian)

20. Patel A., Chong D.J. Obstructive Sleep Apnea: Cognitive Outcomes. Clin Geriatr Med. 2021;37(3):457-467. doi: 10.1016/j.cger.2021.04.007

21. Li J., Yan W., Yi M., Lin R., Huang Z., Zhang Y. Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath. 2023;27(3):973-982. doi: 10.1007/s11325-022-02687-y

22. Mehrtash M., Bakker J.P., Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung. 2019;197(2):115-121. doi: 10.1007/s00408-018-00193-1

23. Ovchinnikov Yu.V., Mostovoy L.V., Zaitsev AA. Analysis of compliance to СPAP-treatment in elderly patients with obstructive sleep apnea syndrome and arterial hypertension. Clin. Gerontol. 2020;26(7-8):26-32. doi: 10.26347/1607-2499202007-08026-032 (In Russian)