Sleep and Breathing

, Volume 22, Issue 4, pp 1125–1135 | Cite as

Assessment of atherosclerotic plaque activity in patients with sleep apnea using hybrid positron emission tomography/magnetic resonance imaging (PET/MRI): a feasibility study

  • Vaishnavi Kundel
  • Maria Giovanna Trivieri
  • Nicolas A. Karakatsanis
  • Phillip M. Robson
  • Venkatesh Mani
  • Jorge R. Kizer
  • Robert Kaplan
  • Zahi Fayad
  • Neomi ShahEmail author
Sleep Breathing Physiology and Disorders • Original Article



Evidence suggests that the inflammatory state of an atherosclerotic plaque is important in predicting future risk of plaque rupture. This study aims to investigate the feasibility of measuring plaque inflammation in patients with obstructive sleep apnea (OSA) utilizing advanced vascular imaging — hybrid positron-emission tomography/magnetic resonance imaging (PET/MRI) with fluorodeoxyglucose (FDG) tracer—before and after continuous positive airway pressure (CPAP).


Patients with newly diagnosed moderate to severe OSA underwent baseline PET/MRI for assessment of vascular inflammation of the carotid arteries and thoracic aorta prior to initiation of CPAP. Those adherent to CPAP returned for repeat imaging after 3–6 months of CPAP use. Atherosclerotic plaque activity, as measured by arterial wall FDG uptake, was calculated using target-to-background ratios (TBR) before and after CPAP.


Five patients were recruited as part of a focused project. Mean age was 52 years (80% male), and mean apnea-hypopnea index (AHI) was 33. Three patients were objectively adherent with CPAP. In the pre-CPAP phase, all patients had focal FDG uptake in the carotid arteries and aorta. After CPAP, there was an average reduction in TBR of 5.5% (TBRmean) and 6.2% (TBRmax) in carotid and aortic plaque inflammation, similar in magnitude to the reduction observed with statin therapy alone in non-OSA patients (previously reported by others).


We demonstrate the feasibility of using hybrid PET/MRI to assess atherosclerotic plaque inflammation in patients with OSA before and after CPAP. Use of the vascular PET/MRI platform in patients with OSA may provide better insight into the role of OSA and its treatment in reducing atherosclerotic inflammation.


Obstructive sleep apnea CPAP Atherosclerosis Plaque Inflammation PET/MRI 



The study was supported by the American Sleep Medicine Foundation Focused Project Award (126-FP-15) and Dr. Shah has funding from the National Institute of Health/National Heart, Lung, and Blood Institute Research Career Development Award (5K23HL125923-03). The authors report no conflicts of interest. All authors have read and approved the submitted manuscript.


The American Sleep Medicine Foundation provided financial support in the form of the Focused Project Award (126-FP-15) funding. Dr. Shah also has funding from the National Institute of Health/National Heart, Lung, and Blood Institute Research Career Development Award (5K23HL125923-03). The sponsor had no role in the design or conduct of this award.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Icahn School of Medicine at Mount Sinai and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vaishnavi Kundel
    • 1
  • Maria Giovanna Trivieri
    • 2
    • 3
  • Nicolas A. Karakatsanis
    • 2
    • 4
  • Phillip M. Robson
    • 2
  • Venkatesh Mani
    • 2
    • 3
  • Jorge R. Kizer
    • 5
  • Robert Kaplan
    • 5
    • 6
  • Zahi Fayad
    • 2
    • 3
  • Neomi Shah
    • 1
    • 5
    Email author
  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  4. 4.Division of Radiopharmaceutical Sciences, Department of RadiologyWeill Cornell Medical CollegeNew YorkUSA
  5. 5.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  6. 6.Fred Hutchinson Cancer Research CenterSeattleUSA

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