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Volume 15 No. 09
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Accepted Papers

Scientific Investigations

CPAP and Health-Related Quality of Life in Adults With Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea in the RICCADSA Trial

Sara Wallström, RN, PhD1,2; Baran Balcan, MD3; Erik Thunström, MD, PhD4; Axel Wolf, RN, PhD1,2; Yüksel Peker, MD, PhD4,5,6,7
1Institute of Health and Care Sciences, University of Gothenburg, Sweden; 2Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; 3Department of Pulmonary Medicine, Marmara University, School of Medicine, Istanbul, Turkey; 4Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 5Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; 6Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania; 7Department of Pulmonary Medicine, Koc University, School of Medicine, Istanbul, Turkey

Study Objectives:

To determine the effect of continuous positive airway pressure (CPAP) treatment on health-related quality of life (HRQoL) in adults with coronary artery disease (CAD) and nonsleepy obstructive sleep apnea (OSA).


This was a secondary outcome analysis of the RICCADSA trial, conducted in Sweden between 2005 and 2013. Adults with CAD, nonsleepy OSA (apnea-hypopnea index [AHI] ≥ 15 events/h; Epworth Sleepiness Scale [ESS] score < 10) and complete Short-Form (SF)-36 questionnaires at baseline and after 12 months were included. Patients were randomized to CPAP (n = 102) or no CPAP (n = 104). The primary outcome was the between-group difference in absolute change in the SF-36 components. Within-group changes as well as variables associated with absolute change in the domains in the entire population were also tested.


Mean SF-36 scores were similar at baseline, ranging from 44.9 ± 9.6 to 92.2 ± 15.8 in various domains, and between-group changes from baseline were not statistically significant at 1 year. There was a significant increase in Role physical, Vitality, Role emotional, Mental health and Mental Component Summary (MCS), and a decrease in Bodily pain and General health scores in the CPAP group. The change in Physical Component Summary (PCS) was determined by female sex (beta coefficient −0.19, 95% confidence interval [CI] −7.25 to −0.98, P = .010), baseline AHI (beta coefficient −0.19, 95% CI −0.21 to −0.03, P = .009), CPAP use (h/night) (beta coefficient −0.16, 95% CI −0.93 to −0.06, P = .028), and acute myocardial infarction at baseline (beta coefficient 0.18, 95% CI 0.59 to 5.19, P = .014). Determinants of the change in MCS from baseline were change in the ESS score (beta coefficient −0.14, 95% CI −0.87 to −0.01, P = .054) and change in the Zung Self-rated Depression Scale scores (beta coefficient −0.33, 95% CI −0.58 to −0.24, P < .001).


Assignment to CPAP treatment compared to no CPAP had no significant effect on HRQoL as measured by the SF-36 in adults with CAD and nonsleepy OSA. Although several components of the SF-36 scores were improved within the CPAP group, CPAP use was associated with a decrease in PCS. The improvement in MCS was determined by the improvement in daytime sleepiness and depressive mood.

Clinical Trial Registration:

Registry:; Identifier: NCT00519597


Wallström S, Balcan B, Thunström E, Wolf A, Peker Y. CPAP and health-related quality of life in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial. J Clin Sleep Med. 2019;15(9):1311–1320.

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