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Randomized Controlled Trial
. 2015 Jul 1;38(7):1105-11.
doi: 10.5665/sleep.4822.

Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS

Jae-Min Kim  1 , Robert Stewart  2 , Kyung-Yeol Bae  1 , Hee-Ju Kang  1 , Sung-Wan Kim  1 , Il-Seon Shin  1 , Young Joon Hong  3 , Youngkeun Ahn  3 , Myung Ho Jeong  3 , Jin-Sang Yoon  1
Affiliations
Randomized Controlled Trial

Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS

Jae-Min Kim et al. Sleep. .

Abstract

Study objectives: To investigate the correlates of sleep disturbance and to assess escitalopram treatment effects of depression on sleep disturbance in patients with acute coronary syndrome (ACS).

Design: A cross-sectional study in patients with ACS within 2 w post-ACS, and a 24-w double-blind controlled trial of escitalopram against placebo for patients with ACS who have comorbid depressive disorders.

Setting: A university hospital in South Korea.

Participants: There were 1,152 patients with ACS who were consecutively recruited. Of 446 patients with comorbid depressive disorders, 300 were randomized to the trial.

Measurements and results: Sleep disturbance was evaluated by the Leeds Sleep Evaluation Questionnaire. Demographic and clinical characteristics were assessed, including cardiovascular risk factors, current cardiac status, and depressive symptoms. Depressive symptoms were most strongly and consistently associated with sleep disturbance. In addition, older age, female sex, hypertension, and more severe ACS status were associated with certain aspects of sleep disturbance. Escitalopram was significantly superior to placebo for improving sleep disturbance over the 24-w treatment period. These effects were substantially explained by improvement in depressive symptoms.

Conclusions: Depression screening is indicated in patients with acute coronary syndrome with sleep disturbance. Successful treatment of depression has beneficial effects on sleep outcomes in these patients.

Clinical trials information: ClinicalTrial.gov identifier for the 24-w drug trial, NCT00419471.

Keywords: acute coronary syndrome; depression; double-blind study; escitalopram; sleep disorders.

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Figures

Figure 1
Figure 1
Participant recruitment process. ACS, acute coronary syndrome; BDI, Beck Depression Inventory; MINI, Mini-International Neuropsychiatric Interview; K-DEPACS, Korean DEPression in Acute Coronary Syndrome study; EsDEPACS, Escitalopram for DEPression in Acute Coronary Syndrome study.
Figure 2
Figure 2
Adjusted mean scores on the four factors of Leeds Sleep Evaluation Questionnaire (LSEQ) in the 24-w double-blind treatment of escitalopram and placebo (N = 217). Statistical coefficients were driven from repeated -measures analysis of covariance to calculate group by time interactions on the four domain scores of LSEQ. (A) Statistics adjusted for baseline GTS scores, age, sex, education, hypertension, and smoking status: F = 9.447, P = 0.003, and further adjusted for changes in MADRS scores: F = 3.783, P = 0.054. (B) Statistics adjusted for baseline QOS scores, age, sex, education, hypertension, diabetes, smoking status, and Killip class: F = 12.87, P < 0.001, and further adjusted for changes in MADRS scores: F = 4.236, P = 0.039. (C) Statistics adjusted for baseline AFS scores, age, sex, education, hypercholesterolemia, and smoking status: F = 3.156, P = 0.072, and further adjusted for changes in MADRS scores: F = 1.821, P = 0.171. (D) Statistics adjusted for baseline BFW scores, sex, education, and smoking status: F = 6.945, P = 0.009, and further adjusted for changes in MADRS scores: F = 2.139, P = 0.141. MADRS, Montgomery Asberg Depression Rating Scale.
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Comment in

  • Mend the Mind and Mind the "MCC".
    Parthasarathy S, Shetty S, Combs D. Parthasarathy S, et al. Sleep. 2015 Jul 1;38(7):1001-3. doi: 10.5665/sleep.4794. Sleep. 2015. PMID: 26085292 Free PMC article. No abstract available.

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