Association Between OSA and Quantitative Atherosclerotic Plaque Burden: A Coronary CT Angiography Study

Chest. 2021 Nov;160(5):1864-1874. doi: 10.1016/j.chest.2021.07.040. Epub 2021 Jul 28.

Abstract

Background: Limited evidence is available regarding the association between OSA and coronary plaque assessed by using quantitative coronary CT angiography.

Research question: Are there any associations between OSA severity-related indexes and the presence and burden of coronary plaque?

Study design and methods: Cross-sectional data from 692 patients who underwent sleep monitoring and coronary CT angiography were used for this study. Of these patients, 120 (17.3%) underwent polysomnography, and 572 (82.7%) underwent respiratory polygraphy. Multivariable logistic and linear regression analyses were used to investigate the associations of OSA severity-related indexes with the presence, volume, and composition of plaque.

Results: In multivariable analyses, patients with moderate to severe OSA were more likely to have coronary plaques (P = .037), and plaques were more likely to contain a noncalcified plaque (NCP) component (P = .032) and a low-density NCP (LD NCP) component (P = .030). Furthermore, the apnea-hypopnea index and oxygen desaturation index as continuous variables were both associated with the presence of plaque, NCP, and LD NCP (all, P < .05). Multivariable linear regression models showed that moderate to severe OSA was associated with NCP volume (β = 50.328; P = .042) and LD NCP volume (β = 15.707; P = .011). Moreover, the apnea-hypopnea index (P = .015), oxygen desaturation index (P = .005), and percentage of nighttime with oxygen saturation < 90% (P = .017) were all significant predictors of LD NCP volume. Compared with those with no or mild OSA, patients with severe OSA had a significantly higher total plaque volume (P = .036), NCP volume (P = .036), and LD NCP volume (P = .013).

Interpretation: OSA was independently associated with the presence and burden of coronary plaque, which suggests an increased risk of coronary events.

Clinical trial registration: Chinese Clinical Trial Registry; No. ChiCTR-ROC-17011027; http://chictr.org.cn.

Keywords: atherosclerosis; coronary CT angiography; hypoxemia; obstructive sleep apnea.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China / epidemiology
  • Comorbidity
  • Computed Tomography Angiography / methods
  • Coronary Angiography / methods
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / epidemiology
  • Coronary Artery Disease* / physiopathology
  • Correlation of Data
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypoxia* / diagnosis
  • Hypoxia* / etiology
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic / diagnostic imaging*
  • Polysomnography / methods*
  • Risk Factors
  • Severity of Illness Index
  • Sleep Apnea, Obstructive* / diagnosis
  • Sleep Apnea, Obstructive* / epidemiology
  • Sleep Apnea, Obstructive* / physiopathology

Associated data

  • ChiCTR/ChiCTR-ROC-17011027