Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Abstract

Background: Coronary artery atherosclerosis has been associated with obstructive sleep apnea (OSA). However, the type and severity of plaque formation have not been characterized. This study evaluated the association of coronary noncalcified plaques and severity of stenosis in patients with OSA. Hypothesis:Methods: This study was a retrospective analysis of 81 patients, 49 with OSA and 32 without OSA, who had undergone multidetector-row helical computed tomography scanning. The board-certified radiologist was blinded to the diagnosis of OSA and reviewed the scans for plaque characterization, severity of stenosis, and number of vessels involved. Results: Of the 81 patients reviewed, the mean apnea-hypopnea index in the OSA group was 42.2 vs 7.5 in the non-OSA group. The groups did not significantly differ in the distribution of comorbid conditions. We found that among the patients with OSA, 63% had noncalcified/mixed plaques, as opposed to 16% in the non-OSA group (P< 0.0001), with unadjusted odds ratio of 9.3 (3.0, 28.4). After adjustment for other risk factors such as age, sex, race, hypercholesterolemia, and history of smoking, the association remained strong, with an odds ratio of 7.0 (1.9, 26.5; P < 0.05). Conclusions: Our study finds that the frequency of noncalcified/mixed plaques is much higher in patients with OSA than in non-OSA patients. Patients with OSA also have more severe stenosis and a higher number of vessels involved. This study adds to a growing body of data regarding our understanding of the association of OSA and atherosclerosis.

Obstructive Sleep Apnea and Coronary Artery Disease: From Pathophysiology to Clinical Implications

“…Recently Turmel et al [45] studied 19 OSA patients with stable CAD who underwent three-dimensional intravascular ultrasound plaque evaluation and showed a higher atherosclerotic plaque volume in those patients with a more severe OSA. Similarly, Sharma et al [46] found that the frequency of noncalcified or mixed plaques is much higher in patients with OSA than in non-OSA patients.…”

Comprehensive coronary plaque assessment in patients with obstructive sleep apnea

“…Differences in diagnostic methods may lead to underdiagnosis or underestimation of severity in some patients. Moreover, studies also varied in diagnostic criteria for OSA, ranging from AHI score of 5/hr (Matthews et al., ; Medeiros et al., ; Nakanishi‐Minami et al., ; Sorajja et al., ; Weinreich et al., ) to 10/hr (Sharma et al., ), in addition to the combination of objective measures and symptoms (Pusuroglu et al., ). We hypothesised that even mild OSA may be associated with CAD (Hu et al., ); therefore, we chose AHI score of 5/hr as a diagnostic threshold without taking into account symptoms or comorbidities.…”

“…Several studies have investigated CAD in OSA using computed tomography (Arik et al, 2013;Kent et al, 2013;Kim et al, 2010;Kwon et al, 2014;Lutsey et al, 2015;Luyster, Kip, Aiyer, Reis, & Strollo, 2014;Matthews et al, 2011;Medeiros et al, 2017;Murphy et al, 2017;Nakanishi-Minami et al, 2012;Pusuroglu et al, 2017;Seo et al, 2017;Sharma et al, 2012;Sorajja et al, 2008;Weinreich et al, 2013). However, there were considerable differences in the studied populations and diagnostic tests.…”

“…Particularly, most studies used only coronary artery calcium score (CAC) to evaluate the severity of CAD (Arik et al, 2013;Kim et al, 2010;Kwon et al, 2014;Lutsey et al, 2015;Luyster et al, 2014;Matthews et al, 2011;Medeiros et al, 2017;Seo et al, 2017;Sorajja et al, 2008;Weinreich et al, 2013). However, recent studies demonstrated that coronary plaques are typically non-calcified or partially calcified in OSA (Murphy et al, 2017;Sharma et al, 2012). In addition, CAC provides only an overall burden of calcified atherosclerotic plaques, and gives no information regarding non-calcified plaques or the severity of coronary artery stenosis (Kolossvary, Szilveszter, Merkely, & Maurovich-Horvat, 2017).…”

Sleep-Disordered Breathing and Coronary Artery Disease

“…[47][48][49] The most robust data are derived from a cross-sectional analysis (n=1604) of the population-based Heinz Nixdorf Recall study. Doubling of the AHI was associated with a 19% increase in coronary artery calcium in men aged ≤65 years and with a 17% increase of the same parameter in women of any age.…”