Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography

TL;DR

This study shows that people at high risk for obstructive sleep apnea are more likely to have signs of coronary artery disease seen on routine chest CT scans.

Contribution

The study demonstrates a novel independent association between questionnaire-based sleep apnea risk and subclinical coronary atherosclerosis detected on non-cardiac CT.

Findings

High-risk OSA was independently associated with moderate-to-severe CAC (adjusted OR 2.74, p = 0.008).

Increased snoring intensity was also linked to higher CAC scores (adjusted OR 2.25, p = 0.032).

The association remained significant after adjusting for multiple cardiovascular risk factors.

Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity; however, its relationship with subclinical coronary atherosclerosis detected incidentally on routine chest computed tomography (CT) remains incompletely defined. We aimed to evaluate the association between questionnaire-based OSA risk and moderate-to-severe coronary artery calcification (CAC) in patients without known cardiac disease undergoing non-contrast chest CT for non-cardiac indications. Methods: In this prospective cross-sectional study, 268 consecutive adults undergoing routine non-contrast chest CT were included. OSA risk was assessed using the Berlin Questionnaire (BQ) and a modified BQ (mBQ), excluding hypertension and obesity components. CAC was quantified using the Agatston method on non-gated CT images, and moderate-to-severe CAC was defined as a score > 100. Multivariable logistic regression models were adjusted for age, sex, smoking status, alcohol use, obesity, lung disease, diabetes mellitus and hypertension. Results: Moderate-to-severe CAC was substantially more prevalent among patients at high risk for OSA than among those at low risk (43.1% vs. 12.0%, p < 0.001). In unadjusted analyses, high-risk OSA was strongly associated with CAC > 100. After multivariable adjustment, BQ-defined high-risk OSA remained independently associated with moderate-to-severe CAC (adjusted odds ratio [OR] 2.74, 95% confidence interval [CI] 1.29–5.78, p = 0.008). Similar results were observed with the mBQ (adjusted OR 2.62, 95% CI 1.27–5.41, p = 0.009). Increased snoring intensity was also independently associated with CAC > 100 (adjusted OR 2.25, 95% CI 1.07–4.72, p = 0.032). Conclusions: Questionnaire-defined high-risk OSA is independently associated with moderate-to-severe incidental CAC detected on routine chest CT. These findings support the integration of sleep-related risk assessment into opportunistic cardiovascular imaging frameworks and highlight the potential role of thoracic CT in multidimensional cardiovascular risk stratification.

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