The Effects Of treating Obstructive Sleep Apnea With Continuous Positive Airway Pressure On Illness Outcome、Anxiety And Depressive Symptoms、And Quality Of Life In Patients Comorbid Obstructive Sleep Apnea With Coronary Artery Disease

• Main Authors: LEE,MING-CHUNG, 李明聰
• Other Authors: SHEN,YU-CHIH
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/esdz2n

碩士 === 慈濟大學 === 人類發展學系碩士班 === 104 === The obstructive sleep apnea (OSA) has been verified to be an important risk factor for causing the cardiovascular diseases. For patients that have suffered from the cardiovascular disease, OSA might increase complications of the cardiovascular disease and lead to bad prognosis. Besides, patients who suffer from OSA generally have high degrees of depression and anxiety. Furthermore, depression and anxiety are also risk factors of prognosis for the coronary artery disease (CAD). The primary therapy method for OSA patients is continuous positive airway pressure (CPAP). This study mainly discusses patients who suffer from both CAD and OSA, and probes into influences exerted on the prognosis of CAD, degrees of depression and anxiety and the quality of life when treating OSA by CPAP. In the recruited hospital of the study, patients who present a stable status and leave hospital after doing a cardiac catheterization procedure for the CAD and simultaneously merge the OSA with the diagnosis of doctors were divided into two groups according to the fact that whether they have accepted CPAP treatment. Within 1 month and after 6 months after taking the treatment of cardiac catheter, six types of questionnaires were tested in two tests, including the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire-for sleep apnea (BQ), the WHO Quality of Life-BREF (WHOQOL-BREF) and Short - Form 36 (SF-36). In this way, the study compared changes and differences between degrees of depression and anxiety and quality of life of patients who have accepted the CPAP treatment and those who haven’t. In addition, the study also recorded Major Adverse Cardiac and Cerebrovascular Events (MACCEs) of patients in the past six months and one year to compare the correlation between the fact that whether have accepted the CPAP treatment and the prognosis of CAD or different degrees of depression and anxiety and the prognosis of CAD. Patients suffered from both OSA and CAD were divided into two groups according to the fact that whether they have accepted the CPAP treatment. By comparison, basic data, the severity of CAD and the severity of OSA were undifferentiated between two groups, which means that they have the common starting point. MACCEs within 6 months for two groups did not express significant differences while the occurrence of MACCEs of the untreated group after 1 year significantly increased. As to the untreated group, different degrees of depression and anxiety were not significantly associated with MACCEs within 6 months and 1 year. As to conditions of depression and anxiety, changes of BAI and BDI within six months for two groups did not achieve significant difference. Regarding the sleepiness case, ESS within 6 months of two groups also did not present significant differences. With respect to the quality of sleep, BQ fatigue sense for the group with CPAP treatment within 6 months were improved while various classes of BO of the untreated group within 6 months did not show significant variation. As to the quality of life, satisfaction degrees concerning the quality of life shown on the self-assessment in the WHOQOL-BREF by the group of CPAP treatment within 6 months obviously improved. Nevertheless, pains of bodies, according to the SF-36, were remarkably regressed due to the limitation on emotional factors. For the untreated group, the social relationship and self-assessment for satisfaction degrees concerning the quality of life in the WHOQOL-BREF within 6 months, and body functions in SF-36 showed a substantially setback out of the limitation of emotional factors. Moreover, when dividing patients into four groups on the basis of the fact that whether they have taken the CAD/CPAP treatment: (A) a group that takes the CPAP treatment with OSA combines with CAD, (B) an untreated group with OSA combines with CAD, (C) a group that takes the CPAP treatment without OSA combing with CAD, and (D) an untreated group without OSA combining with CAD. From the perspective of anxiety, it could be found that the anxiety of (A) group, (C) group and (D) group presented a more significant improvement than that of (B) group. With same groups as mentioned above, regarding the aspect of depression, (A) group and (C) group presented a more substantial improvement to that of (B) group, while (C) group presented a more significant improvement than that of (D) group in BDI. In recent years, the correlation between OSA and CAD has been repeatedly mentioned. The study reveals that the occurrence of MACCEs would increase if not treating OSA appropriately. It is suggested that CAD patients shall positively screen and take the treatment for dealing with OSA. In the study, depression and anxiety are not main risk factors of the prognosis of CAD. The possible reason for the case is that influences of comorbidities have outdistanced influences of depression and anxiety when OSA merging with CAD. That is, influences of depression and anxiety on the prognosis will be less important when diseases are becoming complex. The sleepiness and quality of sleep in the study did not show great differences throughout the course, whether the patient was or wasn’t treated. It might be caused for the fact that most of subjects of the study are severe OSA patients. Therefore, unlike the treatment for mild illnesses, no significant improvement could be found here in spite of the CPAP treatment of six months. As to differences of the quality of life in the study, the self-assessment of the treated group showed that they feel the improvement of the quality of life, patients, however, have to wear CPAP when sleeping which might make them feel inconvenient, give rise to mental disorders or complications of CPAP and then further lead to bad evaluation concerning some items of the quality of life. In the end, if make comparisons about improvements of depression and anxiety by classifying patients according to facts that whether they suffer from comorbidities of CAD or whether they accept the CPAP treatment, it could be shown that: degrees of comorbidities and whether accept the CPAP treatment could decide differences of improvements of anxiety and depression. In conclusion, this study discovers that the treatment of CPAP positively assists in the prognosis of CAD. Actively screening and treating OSA within CAD patients can reduce the deterioration or relapse of CAD so as to prolong patients’ life-span.