Korean J Radiol.  2019 Apr;20(4):631-640. 10.3348/kjr.2018.0550.

Carotid Arterial Calcium Scoring Using Upper Airway Computed Tomography in Patients with Obstructive Sleep Apnea: Efficacy as a Clinical Predictor of Cerebrocardiovascular Disease

• Lee JH
• Kang EJ
• Bae WY
• Kim JK
• Choi JH
• Kim CH
• Kim SJ
• Jo KS
• Kim MS
• Koh TK

• KMID: 2440486
• DOI: http://doi.org/10.3348/kjr.2018.0550

Abstract

OBJECTIVE
To evaluate the value of airway computed tomography (CT) in patients with obstructive sleep apnea (OSA) as a predictor of cerebrocardiovascular disease (CCVD) clinically, by quantitatively analyzing carotid arterial calcification (CarAC).
MATERIALS AND METHODS
This study included 287 patients aged 40-80 years, who had undergone both polysomnography (PSG) and airway CT between March 2011 and October 2015. The carotid arterial calcium score (CarACS) was quantified using the modified Agatston method on each upper airway CT. The OSA severity was categorized as normal, mild, moderate, and severe using the PSG results. Clinical characteristics, comorbid diseases, and lipid profiles of all patients were analyzed, and the prevalence of CCVDs was investigated during the follow up period (52.2 ± 16.0 months).
RESULTS
CCVD occurred in 27 patients (9.3%) at the end of follow-up, and the CCVD-present groups showed a significantly older mean age (57.5 years vs. 54.2 years), higher prevalence of hypertension (59% vs. 34%) and CarAC (51.9% vs. 20.8%), whereas sex, other comorbid diseases, and severity of OSA were not significantly different from the CCVD-absent group. A univariate analysis showed that age, hypertension, incidence of CarAC, and CarACS were risk factors for the occurrence of CCVD events. In a multivariate analysis, the incidence of CarAC was the only independent risk factor for CCVD.
CONCLUSION
CarAC is an independent risk factor for CCVD, whereas the severity of OSA is not a contributory risk factor in patients with OSA. Therefore, additional analysis of CarACS based on airway CT scans may be useful for predicting CCVD.

Keyword

Airway; Calcification; Carotid artery; Computed tomography; Obstructive sleep apnea

MeSH Terms

Calcium*
Carotid Arteries
Fluorouracil
Follow-Up Studies
Humans
Hypertension
Incidence
Methods
Multivariate Analysis
Polysomnography
Prevalence
Risk Factors
Sleep Apnea, Obstructive*
Tomography, X-Ray Computed
Calcium
Fluorouracil

Figure

• 

  Fig. 1 Patient flow diagram.Total of 408 patients who had undergone PSG and upper airway CT scan and 303 patients aged 40–80 years were included. Sixteen patients were excluded due to incomplete data or history of cardiovascular or cerebrovascular event, and 287 patients were included as final subjects. CT = computed tomography, PSG = polysomnography

• 

  Fig. 2 Representative images of airway CT scans.(A) CT scans starts from frontal sinus of skull (‘FS’) to carina level of distal trachea (‘C’), including both upper airway and trachea; (B) Semi-automatic measurement of CarAC for calculating Agatston score; software automatically highlights calcification (coding to yellow color) with CT number higher than 130 Hounsfield units. Following this, reader determines carotid arterial calcium (arrow) based on anatomical information on each of CT images, and sum of calcium score is automatically quantified using software. CarAC = carotid arterial calcification

• 

  Fig. 3 Kaplan-Meier analysis of cerebrocardiovascular disease events of 287 patients according to presence or absence of CarAC (CarACS).Comparison between incidence curve proved to be significant (Log-rank test, p = 0.001). CarACS = carotid arterial calcium score

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