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

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea. doncamel@dau.ac.kr
  • 2Department of Radiology, Dong-A University College of Medicine, Busan, Korea.
  • 3Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
  • 4Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea.
  • 5Department of Oral and Maxillofacial Surgery, Dong-A University College of Medicine, Busan, Korea.
  • 6Department of Otorhinolaryngology-Head and Neck Surgery, St. Mary's Medical Center, Busan, Korea.

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
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