Abstract
Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD) and with an increased risk for myocardial infarction, stroke or death due to cardiovascular disease. Optical frequency-domain imaging (OFDI) is a useful modality for evaluating the characteristics of atherosclerotic plaque. The purpose of the study was to use OFDI to investigate the association of OSA with coronary plaque characteristics in patients undergoing percutaneous coronary intervention (PCI). We retrospectively analyzed OFDI data for coronary artery plaques from 15 patients with OSA and 35 non–OSA patients treated between October 2015 and October 2018. Plaque morphology was evaluated for 70 lesions, including 21 from patients with OSA and 49 from non–OSA patients. Compared with the non–OSA group, patients with OSA had significantly higher prevalences of thinned cap fibroatheroma (TCFA) (67% vs. 35%, P = 0.014) and microchannels (86% vs. 55%, P = 0.014); a significantly higher mean lipid index (1392 ± 982 vs. 817 ± 699, P = 0.021), macrophage grade (8.4 ± 6.4 vs. 4.8 ± 4.5, P = 0.030), and maximum number of microchannels (1.5 ± 1.0 vs. 0.7 ± 0.7, P = 0.001); and a significantly lower mean minimum fibrous cap thickness (69.4 ± 28.7 vs. 96.1 ± 51.8 μm, P = 0.008). This OFDI analysis suggests that OSA is associated with unstable plaque characteristics in patients with CAD. More intensive medical management for stabilization of coronary atherosclerotic plaque is required in patients with OSA.
Highlights
Obstructive sleep apnea (OSA) is a common disorder with an estimated prevalence of 10–50% in men and 3–24% in women [1,2,3,4]
A total of 21 lesions were examined in 15 patients with OSA based on an apnea hypopnea index (AHI) ≥ 15, and 49 lesions were examined in 35 patients without OSA (AHI < 15)
Patients presenting with left main coronary artery disease (CAD) and cardiogenic shock were already excluded from 50 consecutive patients who underwent optical frequency domain imaging (OFDI)-guided percutaneous coronary intervention (PCI)
Summary
Obstructive sleep apnea (OSA) is a common disorder with an estimated prevalence of 10–50% in men and 3–24% in women [1,2,3,4]. Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) are intravascular imaging modalities that use reflection of near-infrared light to create images. These methods give images with high resolution of 10–20 μm, which is 10 times higher than that of intravascular ultrasound (IVUS). Recent OCT and OFDI studies have reported plaque rupture, lipid-rich plaques, thinned cap fibroatheroma (TCFA), cholesterol crystals, macrophage accumulation, and microchannels as characteristics of unstable plaque [4, 10,11,12,13,14,15,16,17,18,19]
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