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

Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

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.

Funding

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.

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Correspondence to Neomi Shah.

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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.

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Kundel, V., Trivieri, M.G., Karakatsanis, N.A. et al. Assessment of atherosclerotic plaque activity in patients with sleep apnea using hybrid positron emission tomography/magnetic resonance imaging (PET/MRI): a feasibility study. Sleep Breath 22, 1125–1135 (2018). https://doi.org/10.1007/s11325-018-1646-2

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Keywords

  • Obstructive sleep apnea
  • CPAP
  • Atherosclerosis
  • Plaque
  • Inflammation
  • PET/MRI