Kundel Vaishnavi, Trivieri Maria Giovanna, Karakatsanis Nicolas A, Robson Phillip M, Mani Venkatesh, Kizer Jorge R, Kaplan Robert, Fayad Zahi, Shah Neomi
Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1232, New York, NY, 10029, USA.
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Sleep Breath. 2018 Dec;22(4):1125-1135. doi: 10.1007/s11325-018-1646-2. Epub 2018 Mar 5.
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% (TBR) and 6.2% (TBR) 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.
有证据表明，动脉粥样硬化斑块的炎症状态对于预测斑块破裂的未来风险很重要。本研究旨在探讨利用先进的血管成像技术——带有氟脱氧葡萄糖（FDG）示踪剂的正电子发射断层扫描/磁共振成像（PET/MRI）混合成像，在持续气道正压通气（CPAP）治疗前后测量阻塞性睡眠呼吸暂停（OSA）患者斑块炎症的可行性。
新诊断为中度至重度OSA的患者在开始CPAP治疗前接受基线PET/MRI检查，以评估颈动脉和胸主动脉的血管炎症。那些坚持使用CPAP的患者在使用CPAP 3 - 6个月后返回进行重复成像。通过动脉壁FDG摄取测量的动脉粥样硬化斑块活性，在CPAP治疗前后使用靶本底比值（TBR）进行计算。
作为一个重点项目的一部分，招募了5名患者。平均年龄为52岁（80%为男性），平均呼吸暂停低通气指数（AHI）为33。3名患者客观上坚持使用CPAP。在CPAP治疗前阶段，所有患者的颈动脉和主动脉均有局灶性FDG摄取。CPAP治疗后，颈动脉和主动脉斑块炎症的TBR平均分别降低了5.5%和6.2%，其幅度与非OSA患者单独使用他汀类药物治疗时观察到的降低幅度相似（此前其他人曾报道过）。
我们证明了使用PET/MRI混合成像评估OSA患者在CPAP治疗前后动脉粥样硬化斑块炎症的可行性。在OSA患者中使用血管PET/MRI平台可能有助于更好地了解OSA及其治疗在减轻动脉粥样硬化炎症中的作用。
