TY - JOUR
T1 - Effect of obstructive sleep apnea on response to cognitive behavior therapy for depression after an acute myocardial infarction
AU - Freedland, Kenneth E.
AU - Carney, Robert M.
AU - Hayano, Junichiro
AU - Steinmeyer, Brian C.
AU - Reese, Rebecca L.
AU - Roest, Annelieke M.
N1 - Funding Information:
This research was supported in part by Grant No. 1UO-1HL58946 and contracts NO1-HC-55140 , NO1-HC-55142 , NO1-HC-55146 , and NO1-HC-55148 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland. NHLBI personnel contributed to the design of the study; and provided oversight of the collection, analysis, and interpretation of data. Although NHLBI personnel have contributed to the writing of other ENRICHD reports and conducted preliminary reviews of the primary manuscripts, no NHLBI personnel were involved in writing or reviewing this manuscript.
PY - 2012/4
Y1 - 2012/4
N2 - Objective: To determine whether obstructive sleep apnea (OSA) interferes with cognitive behavior therapy (CBT) for depression in patients with coronary heart disease. Methods: Patients who were depressed within 28. days after an acute myocardial infarction (MI) were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 289 (12%) of the 2481 participants in ENRICHD met the criteria for inclusion in this ancillary study. Results: A validated ambulatory ECG algorithm was used to detect OSA. Of the 289 participants, 64 (22%) met the criteria for OSA. CBT was efficacious relative to usual care (UC) for depression (p=.004). OSA had no effect on 6-month Beck Depression Inventory (BDI) scores (p=.11), and there was no interaction between OSA and treatment (p=.42). However, the adjusted mean (s.e.) 6-month BDI scores among patients without OSA were 12.2 (0.8) vs. 9.0 (0.8) in the UC and CBT groups (Cohen's d=.40); among those with OSA, they were 9.5 (1.4) and 8.1 (1.5) in the UC and CBT groups (d=.17). There were no significant OSA × Treatment interactions in the major depression (n=131) or minor depression (n=158) subgroups, but in those with major depression, there was a larger treatment effect in those without (d=.44) than with (d=.09) OSA. In those with minor depression, the treatment effects were d=.37 and d=.25 for the non-OSA and OSA subgroups. Conclusion: CBT is efficacious for depression after an acute myocardial infarction in patients without obstructive sleep apnea, but it may be less efficacious for post-MI patients with OSA.
AB - Objective: To determine whether obstructive sleep apnea (OSA) interferes with cognitive behavior therapy (CBT) for depression in patients with coronary heart disease. Methods: Patients who were depressed within 28. days after an acute myocardial infarction (MI) were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 289 (12%) of the 2481 participants in ENRICHD met the criteria for inclusion in this ancillary study. Results: A validated ambulatory ECG algorithm was used to detect OSA. Of the 289 participants, 64 (22%) met the criteria for OSA. CBT was efficacious relative to usual care (UC) for depression (p=.004). OSA had no effect on 6-month Beck Depression Inventory (BDI) scores (p=.11), and there was no interaction between OSA and treatment (p=.42). However, the adjusted mean (s.e.) 6-month BDI scores among patients without OSA were 12.2 (0.8) vs. 9.0 (0.8) in the UC and CBT groups (Cohen's d=.40); among those with OSA, they were 9.5 (1.4) and 8.1 (1.5) in the UC and CBT groups (d=.17). There were no significant OSA × Treatment interactions in the major depression (n=131) or minor depression (n=158) subgroups, but in those with major depression, there was a larger treatment effect in those without (d=.44) than with (d=.09) OSA. In those with minor depression, the treatment effects were d=.37 and d=.25 for the non-OSA and OSA subgroups. Conclusion: CBT is efficacious for depression after an acute myocardial infarction in patients without obstructive sleep apnea, but it may be less efficacious for post-MI patients with OSA.
KW - Ambulatory
KW - Cognitive Therapy
KW - Depression
KW - Depressive disorder/psychology
KW - Depressive disorder/therapy
KW - Electrocardiography
KW - Myocardial infarction/psychology
KW - Obstructive
KW - Sleep apnea
UR - http://www.scopus.com/inward/record.url?scp=84857996214&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychores.2011.12.012
DO - 10.1016/j.jpsychores.2011.12.012
M3 - Article
C2 - 22405221
AN - SCOPUS:84857996214
SN - 0022-3999
VL - 72
SP - 276
EP - 281
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
IS - 4
ER -