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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography
Zeynep Atceken1, Sezer Kula1, Irem Sena Konakci1
1Department of Radiology, Koc University School of Medicine, 34010 Istanbul, Türkiye.
Insights
High risk for obstructive sleep apnea (OSA) is linked to moderate-to-severe coronary artery calcification (CAC) found incidentally on chest CT scans. This suggests integrating sleep apnea screening into routine imaging for better cardiovascular risk assessment.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Sleep Medicine and Respiratory Disorders
- Radiology and Medical Imaging
Background:
- Obstructive sleep apnea (OSA) is recognized for its association with increased cardiovascular morbidity.
- The link between OSA and subclinical coronary atherosclerosis, particularly incidental findings on chest CT, requires further elucidation.
- Current understanding of OSA's impact on coronary artery calcification (CAC) detected incidentally is incomplete.
Purpose of the Study:
- To investigate the association between questionnaire-defined risk of OSA and moderate-to-severe CAC.
- To evaluate incidental CAC findings in patients undergoing non-contrast chest CT for non-cardiac reasons.
- To assess the independent relationship between OSA risk and subclinical coronary atherosclerosis.
Main Methods:
- Prospective cross-sectional study including 268 adults undergoing routine non-contrast chest CT.
- OSA risk assessed using the Berlin Questionnaire (BQ) and a modified BQ (mBQ).
- Coronary artery calcification (CAC) quantified using Agatston score on non-gated CT; moderate-to-severe defined as score > 100.
- Multivariable logistic regression adjusted for age, sex, smoking, alcohol, obesity, lung disease, diabetes, and hypertension.
Main Results:
- Moderate-to-severe CAC was significantly more prevalent in high-risk OSA patients (43.1%) compared to low-risk patients (12.0%; p < 0.001).
- High-risk OSA, defined by BQ, remained independently associated with moderate-to-severe CAC (aOR 2.74; 95% CI 1.29-5.78; p = 0.008).
- Increased snoring intensity also showed an independent association with CAC > 100 (aOR 2.25; 95% CI 1.07-4.72; p = 0.032).
Conclusions:
- Questionnaire-defined high-risk OSA is independently associated with incidental moderate-to-severe CAC on routine chest CT.
- Findings support integrating sleep-related risk assessment into opportunistic cardiovascular imaging.
- Thoracic CT may play a role in multidimensional cardiovascular risk stratification, identifying individuals with potential OSA.
Abstract:
Background: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity; however, its relationship with subclinical coronary atherosclerosis detected incidentally on routine chest computed tomography (CT) remains incompletely defined. We aimed to evaluate the association between questionnaire-based OSA risk and moderate-to-severe coronary artery calcification (CAC) in patients without known cardiac disease undergoing non-contrast chest CT for non-cardiac indications. Methods: In this prospective cross-sectional study, 268 consecutive adults undergoing routine non-contrast chest CT were included. OSA risk was assessed using the Berlin Questionnaire (BQ) and a modified BQ (mBQ), excluding hypertension and obesity components. CAC was quantified using the Agatston method on non-gated CT images, and moderate-to-severe CAC was defined as a score > 100. Multivariable logistic regression models were adjusted for age, sex, smoking status, alcohol use, obesity, lung disease, diabetes mellitus and hypertension. Results: Moderate-to-severe CAC was substantially more prevalent among patients at high risk for OSA than among those at low risk (43.1% vs. 12.0%, p < 0.001). In unadjusted analyses, high-risk OSA was strongly associated with CAC > 100. After multivariable adjustment, BQ-defined high-risk OSA remained independently associated with moderate-to-severe CAC (adjusted odds ratio [OR] 2.74, 95% confidence interval [CI] 1.29-5.78, p = 0.008). Similar results were observed with the mBQ (adjusted OR 2.62, 95% CI 1.27-5.41, p = 0.009). Increased snoring intensity was also independently associated with CAC > 100 (adjusted OR 2.25, 95% CI 1.07-4.72, p = 0.032). Conclusions: Questionnaire-defined high-risk OSA is independently associated with moderate-to-severe incidental CAC detected on routine chest CT. These findings support the integration of sleep-related risk assessment into opportunistic cardiovascular imaging frameworks and highlight the potential role of thoracic CT in multidimensional cardiovascular risk stratification.
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