Abstract 210: Coronary Atherosclerosis and Coronary Artery Disease in Patients With Obstructive Sleep Apnea: Assessment at Coronary CT Angiography
PURPOSE: There is increasing evidence linking obstructive sleep apnea (OSA) with coronary artery disease (CAD). We aimed at using non-invasive coronary CT angiography (cCTA) for studying the association between OSA and coronary atherosclerosis and CAD.
METHODS: 49 patients (26 male, mean age 61±11 years, body mass index-BMI 33±8kg/m2) with OSA by polysomnogram and Berlin questionnaire underwent dual-source cCTA. They were matched with 46 patients (22 male, mean age 60±12 years, BMI 30±6kg/m2) with similar cardiovascular risk, but free of OSA. All patients underwent cCTA for atypical chest pain and/or prior equivocal physiological testing. Two experienced observers in consensus analyzed all cCTA data for the presence and degree of coronary artery stenosis. They performed coronary artery calcium scoring and analyzed the segmental distribution and composition of the atherosclerotic plaque burden using dedicated software (Circulation™, Siemens). The association between OSA status, stenosis, and plaque type was tested by Χ2 and Fisher’s exact statistics.
RESULTS: There was no significant (p>0.05) difference in demographics (age, gender, BMI, cardiovascular risk) between patients with and without OSA. Global coronary artery calcium scores were not significantly different between the two groups (mean Agatston score 272±422 with OSA versus 241±415 without OSA, p>0.5). However, in patients with OSA there was a significantly (p=0.0013) higher prevalence of stenotic CAD and more extensive vessel involvement (6% one-vessel, 27% two-vessel, 22% three-vessel, 33% four-vessel CAD in OSA versus 15%/7%/13%/24% without OSA, p=0.0017). Composition of culprit lesions was notably different between the two groups, with a significantly (p=0.0043) higher prevalence of non-calcified and mixed plaque in the OSA group.
CONCLUSION: Our initial results suggest that patients with OSA have more active coronary atherosclerotic disease, with a greater degree of vessel involvement with stenosis and more stenotic non-calcified and mixed plaque than patients without OSA. If sustained by larger, prospective trials, cCTA may emerge as a useful non-invasive tool for investigating the relationship between OSA and CAD.