Effect of obstructive sleep apnea on response to cognitive behavior therapy for depression after an acute myocardial infarction

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 (se.) 6-month BDI scores among patients without OSA were 122 (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 x 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. (C) 2012 Elsevier Inc. All rights reserved.