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Novel non-invasive assessment of upper airway inflammation in obstructive sleep apnea using positron emission tomography/magnetic resonance imaging

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To develop a novel non-invasive technique to quantify upper airway inflammation using positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with obstructive sleep apnea (OSA).

Methods

Patients with treatment naïve moderate-to-severe OSA underwent [18F]-fluoro-2-deoxy-d-glucose (FDG) PET/MRI. Three readers independently performed tracings of the pharyngeal soft tissue on MRI. Standardized uptake values (SUV) were generated from region of interest (ROI) tracings on corresponding PET images. Background SUV was measured from the sternocleidomastoid muscle. SUV and target-to-background (TBR) were compared across readers using intraclass correlation coefficient (ICC) analyses. SUV from individual image slices were compared between each reader using Bland–Altman plots and Pearson correlation coefficients. All tracings were repeated by one reader for assessment of intra-reader reliability.

Results

Five participants completed our imaging protocol and analysis. Median age, body mass index, and apnea–hypopnea index were 41 years (IQR 40.5–68.5), 32.7 kg/m2 (IQR 28.1–38.1), and 30.7 event per hour (IQR 19.5–48.1), respectively. The highest metabolic activity regions were consistently localized to palatine or lingual tonsil adjacent mucosa. Twenty-five ICC met criteria for excellent agreement. The remaining three were TBR measurements which met criteria for good agreement. Head-to-head comparisons revealed strong correlation between each reader.

Conclusions

Our novel imaging technique demonstrated reliable quantification of upper airway FDG avidity. This technology has implications for future work exploring local airway inflammation in individuals with OSA and exposure to pollutants. It may also serve as an assessment tool for response to OSA therapies.

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Data availability

All imaging and statistical analyses are presented in the current study. Full dataset used for analyses can be made available on request.

Code availability

Not applicable.

Abbreviations

AHI:

Apnea–hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

CT:

Computed tomography

EDS:

Excessive daytime sleepiness

EMR:

Electronic medical record

ESS:

Epworth sleepiness scale

FDG:

[18F]-fluoro-2-deoxy-d-glucose

GFR:

Glomerular filtration rate

HSAT:

Home sleep apnea testing

ICC:

Intraclass correlation coefficient

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

OSA:

Obstructive sleep apnea

PAT:

Peripheral arterial tonometry

PET:

Positron emission tomography

pRDI:

Peripheral arterial tonometry-respiratory disturbance index

PSG:

Polysomnography

ROI:

Region of interest

SCM:

Sternocleidomastoid

SUV:

Standardized uptake values

TBR:

Target-to-background ratio

TOF:

Time-of-flight

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Acknowledgements

Support for this study was provided by the American Academy of Sleep Medicine Foundation through a Focused Project Award (126-FP-15) to Dr. Neomi Shah.

Funding

The study was funded by an American Academy of Sleep Medicine Foundation Focused Project Award (126-FP-15) to Dr. Shah. Dr. Shah also has funding from the National Institute of Health/National Heart, Lung, and Blood Institute (1R01HL143221-01). Dr. Cohen has funding from the American Thoracic Society’s ASPIRE Fellowship.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Oren Cohen, Mira M. John, Vaishnavi Kundel, Omar Burschtin, Samira Khan & Neomi A. Shah

  2. BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Audrey E. Kaufman, Zahi Fayad & Venkatesh Mani

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  1. Oren Cohen
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All authors contributed meaningfully to this work. All authors have seen and approved this manuscript for publication.

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Correspondence to Oren Cohen or Neomi A. Shah.

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The study was approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai.

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Cohen, O., John, M.M., Kaufman, A.E. et al. Novel non-invasive assessment of upper airway inflammation in obstructive sleep apnea using positron emission tomography/magnetic resonance imaging. Sleep Breath 26, 1087–1096 (2022). https://doi.org/10.1007/s11325-021-02480-3

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