Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography
(2026) In Journal of Clinical Medicine 15(6).- 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... (More)
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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- author
- Atceken, Zeynep ; Kula, Sezer ; Konakci, Irem Sena ; Atasoy, Cetin ; Pihtili, Aylin and Peker, Yüksel LU
- organization
- publishing date
- 2026-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- chest computed tomography, coronary artery calcification, obstructive sleep apnea, opportunistic imaging, subclinical atherosclerosis
- in
- Journal of Clinical Medicine
- volume
- 15
- issue
- 6
- article number
- 2230
- publisher
- MDPI AG
- external identifiers
-
- scopus:105034438385
- pmid:41899154
- ISSN
- 2077-0383
- DOI
- 10.3390/jcm15062230
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2026 by the authors.
- id
- b23f5fbb-8c95-4a79-8c95-d1418bb6d5a2
- date added to LUP
- 2026-06-22 11:20:23
- date last changed
- 2026-09-01 22:54:12
@article{b23f5fbb-8c95-4a79-8c95-d1418bb6d5a2,
abstract = {{<p>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.</p>}},
author = {{Atceken, Zeynep and Kula, Sezer and Konakci, Irem Sena and Atasoy, Cetin and Pihtili, Aylin and Peker, Yüksel}},
issn = {{2077-0383}},
keywords = {{chest computed tomography; coronary artery calcification; obstructive sleep apnea; opportunistic imaging; subclinical atherosclerosis}},
language = {{eng}},
number = {{6}},
publisher = {{MDPI AG}},
series = {{Journal of Clinical Medicine}},
title = {{Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography}},
url = {{http://dx.doi.org/10.3390/jcm15062230}},
doi = {{10.3390/jcm15062230}},
volume = {{15}},
year = {{2026}},
}