title: Diagnostic accuracy of carotid intima media thickness in predicting coronary plaque burden on coronary computed tomography angiography in patients with obstructive sleep apnoea.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of common carotid artery intima media thickness (CIMT) for coronary artery disease (CAD) detection in patients with obstructive sleep apnoea (OSA).
  
  
  METHODS
  Patients with clinically suspected OSA prospectively underwent polysomnography (PSG), ultrasound CIMT measurement and coronary computed tomography angiography (CTA). An average CIMT of ≥0.9 mm in either common carotid artery designated as a positive test. Coronary CTA was the reference standard for the presence of CAD. Coronary plaque presence, volume, density and type were correlated with CIMT findings.
  
  
  RESULTS
  35 consecutive male patients were enrolled from sleep clinic. Two patients had no evidence of OSA on PSG (apnoea-hypopnea index [AHI]<5/hr), and were excluded. Of the remaining 33, 18 (54%) had mild-moderate OSA (AHI 5-30/hr) and 15 (46%) had severe OSA (AHI >30/hr). Eight (24%) patients had CAD on coronary CTA. Coronary plaques were predominantly non- or partly calcified, and located in proximal coronary artery segments. Sensitivity, specificity, positive and negative predictive and likelihood ratios for a positive CIMT (≥0.9 mm) in diagnosing CAD were 0.5 (95% confidence interval: 0.76-0.12), 0.96 (1-0.89), 80, 85.7, 12.5 and 0.52 respectively. The adjusted odds ratio was 40.8.
  
  
  CONCLUSIONS
  In patients with OSA, CIMT is a highly specific but poorly sensitive test for detecting CAD.
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: dmurphy23@partners.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Murphy
authors.affiliation: Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: s.kerrcrinion@st-vincents.ie.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Crinion
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: ciaran.redmond@svuh.ie.
authors.forename: Ciaran E
authors.initials: CE
authors.lastname: Redmond
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: ger.healy@svuh.ie.
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Healy
authors.affiliation: Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin 4, Ireland. Electronic address: walter.mcnicholas@ucd.ie.
authors.forename: Walter T
authors.initials: WT
authors.lastname: McNicholas
authors.affiliation: Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin 4, Ireland. Electronic address: s.ryan@st-vincents.ie.
authors.forename: Silke
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin 4, Ireland. Electronic address: j.dodd@st-vincents.ie.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Dodd
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis
keywords: Atherosclerotic heart disease; Cardiac computed tomography; Obstructive sleep apnoea; Polysomnography; Ultrasound