title: Effect of obstructive sleep apnea on response to cognitive behavior therapy for depression after an acute myocardial infarction.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. freedlak@bmc.wustl.edu
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hayano
authors.forename: Brian C
authors.initials: BC
authors.lastname: Steinmeyer
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Reese
authors.forename: Annelieke M
authors.initials: AM
authors.lastname: Roest
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000523:psychology*; D016896:Treatment Outcome