Association between obstructive sleep apnea and coronary inflammation: A coronary CT angiography study

To investigate the association between obstructive sleep apnea (OSA) and coronary inflammation measured by fat attenuation index (FAI), and to examine potential gender differences in this relationship.

We consecutively enrolled patients who underwent both sleep study and coronary computed tomography angiography (CTA). Multivariable linear regression models were constructed to assess the relationship between objective OSA severity metrics- including moderate-to-severe OSA, apnea-hypopnea index (AHI), and oxygen desaturation indices- and coronary FAI. Stratified analyses by sex were performed to evaluate potential gender-specific differences in this association. Additionally, we explored whether moderate-to-severe OSA correlated with elevated coronary inflammation (FAI > -70.1 Hounsfield units).

A total of 526 patients (72.1 % male; mean age 54.7 ± 11.2 years) were finally analyzed. Of these, 307 (58.4 %) patients had moderate-to-severe OSA. Compared to patients with no or mild OSA, those with moderate-to-severe OSA exhibited significantly elevated FAI value in the right coronary artery (RCA) (P < 0.001). In contrast, no differences were observed in the left anterior descending artery (LAD) (P = 0.523) or left circumflex artery (LCX) (P = 0.379). The association between moderate-to-severe OSA and FAI in the RCA remained significant after multivariable adjustment (Model 1: β ± SE = 5.940 ± 0.680, P < 0.001; Model 2: β ± SE = 5.941 ± 0.694, P < 0.001). Furthermore, FAI_RCA showed significant correlations with AHI (P < 0.001), ODI (P < 0.001), and lowest SpO₂ (P < 0.001), but not T90 (P = 0.429), consistently across gender subgroups. Moderate-to-severe OSA was correlated with 5.33-fold increased odds of high FAI_RCA (95 % CI: 2.05-13.86, P = 0.001).

OSA severity was significantly associated with FAI around the RCA distribution, suggesting increased risk of coronary inflammation.