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Sleep and Breathing
Published in: Sleep and Breathing 3/2013

01-09-2013 | Original Article

The relationship between cephalometric carotid artery calcification and Framingham Risk Score profile in patients with obstructive sleep apnea

Authors: Hiroko Tsuda, Yasutaka Moritsuchi, Fernanda R. Almeida, Alan A. Lowe, Toru Tsuda

Published in: Sleep and Breathing | Issue 3/2013

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Abstract

Purpose

The morbidity rate of arteriosclerosis becomes clinically manifested as acute cardiovascular events. In the progress of atherosclerosis, the carotid artery calcifies and sometimes appears as a calcified mass on a cephalometric radiograph. This study was designed to evaluate cardiovascular risks according to the Framingham Risk Score (FRS) between subjects with and without visible carotid artery calcification on a cephalogram.

Methods

Subjects diagnosed with obstructive sleep apnea (OSA) were divided into two groups according to whether or not calcification was visible on a cephalometric radiograph in the carotid artery area, and the characteristic differences between the two groups were analyzed. The evaluated variables included age, BMI, apnea–hypopnea index (AHI), SpO2, ESS, blood pressure, medication history, diabetes mellitus (DM), drinking, smoking, and lipid-related measurements. FRSs for stroke, general cardiovascular disease (GCD), and coronary heart disease (CHD) were calculated. Statistical analyses were performed (SPSS 18.0) with significance defined as a two-tailed p value less than 0.05.

Results

A total of 811 subjects completed the data collection (727 males, age 53.0 ± 12.5 years, AHI 31.7 ± 22.6, times/h). From FRSs, probabilities of a GCD, stroke, and CHD within 10 years were 16.0 ± 9.7, 9.8 ± 6.7, and 11.9 ± 8.3 %, respectively. Some 84 subjects exhibited calcification in the carotid arterial area. Calcification subjects were higher GCD risk and older than subjects who had no identified calcification (20.3 ± 10.1 vs 15.6 ± 20.3 %, p = 0.013, 58.8 ± 11.4 vs. 52.3 ± 12.5 years, p < 0.001). Although there is no significant difference in OSA-related variables and FRSs, subjects with visible calcifications have higher prevalence of high blood pressure medication and DM (p < 0.01).

Conclusion

While the presence of a calcified mass on a cephalometric radiograph is not diagnostic of atherosclerosis, this information indicates some cardiovascular risk.
Literature
1.
Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P (1996) Sleep-disordered breathing in men with coronary artery disease. Chest 109(3):659–663PubMedCrossRef
2.
Peker Y, Kraiczi H, Hedner J, Loth S, Johansson A, Bende M (1999) An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 14(1):179–184PubMedCrossRef
3.
Schafer H, Koehler U, Ewig S, Hasper E, Tasci S, Luderitz B (1999) Obstructive sleep apnea as a risk marker in coronary artery disease. Cardiology 92(2):79–84PubMedCrossRef
4.
Curry BD, Bain JL, Yan JG, Zhang LL, Yamaguchi M, Matloub HS, Riley DA (2002) Vibration injury damages arterial endothelial cells. Muscle Nerve 25(4):527–534PubMedCrossRef
5.
Koskenvuo M, Kaprio J, Telakivi T, Partinen M, Heikkila K, Sarna S (1987) Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J (Clin Res Ed) 294(6563):16–19CrossRef
6.
7.
8.
Leineweber C, Kecklund G, Janszky I, Akerstedt T, Orth-Gomer K (2004) Snoring and progression of coronary artery disease: The Stockholm Female Coronary Angiography Study. Sleep 27(7):1344–1349PubMed
9.
Hu FB, Willett WC, Manson JE, Colditz GA, Rimm EB, Speizer FE, Hennekens CH, Stampfer MJ (2000) Snoring and risk of cardiovascular disease in women. J Am Coll Cardiol 35(2):308–313PubMedCrossRef
10.
11.
Hedner J (1994) Speculations on the interaction between vascular disease and obstructive sleep apnea. In: SNaS C (ed) Sleep and breathing. Marcel Dekker, New York, pp 823–846
12.
Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, Wheatley JR (2008) Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31(9):1207–1213PubMed
13.
Amatoury J, Howitt L, Wheatley JR, Avolio AP, Amis TC (2006) Snoring-related energy transmission to the carotid artery in rabbits. J Appl Physiol 100(5):1547–1553PubMedCrossRef
14.
Cho JG, Witting PK, Verma M, Wu BJ, Shanu A, Kairaitis K, Amis TC, Wheatley JR (2011) Tissue vibration induces carotid artery endothelial dysfunction: a mechanism linking snoring and carotid atherosclerosis? Sleep 34(6):751–757PubMed
15.
Allison MA, Tiefenbrun J, Langer RD, Wright CM (2005) Atherosclerotic calcification and intimal medial thickness of the carotid arteries. Int J Cardiol 103(1):98–104PubMedCrossRef
16.
O’Leary DH, Polak JF (2002) Intima-media thickness: a tool for atherosclerosis imaging and event prediction. Am J Cardiol 90(10C):18L–21LPubMedCrossRef
17.
Chung S, Yoon IY, Lee CH, Kim JW (2011) The effects of nasal continuous positive airway pressure on vascular functions and serum cardiovascular risk factors in obstructive sleep apnea syndrome. Sleep Breath 15(1):71–76PubMedCrossRef
18.
Yiallourou TI, Odier C, Heinzer R, Hirt L, Martin BA, Stergiopulos N, Haba-Rubio J (2012) The effect of continuous positive airway pressure on total cerebral blood flow in healthy awake volunteers. Sleep Breath. doi:10.​1007/​s11325-012-0688-0
19.
Cohen SN, Friedlander AH, Jolly DA, Date L (2002) Carotid calcification on panoramic radiographs: an important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94(4):510–514PubMedCrossRef
20.
Lewis DA, Brooks SL (1999) Cartoid artery calcification in a general dental population: a retrospective study of panoramic radiographs. Gen Dent 47(1):98–103PubMed
21.
Friedlander AH, Manesh F, Wasterlain CG (1994) Prevalence of detectable carotid artery calcifications on panoramic radiographs of recent stroke victims. Oral Surg Oral Med Oral Pathol 77(6):669–673PubMedCrossRef
22.
Madden RP, Hodges JS, Salmen CW, Rindal DB, Tunio J, Michalowicz BS, Ahmad M (2007) Utility of panoramic radiographs in detecting cervical calcified carotid atheroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(4):543–548PubMedCrossRef
23.
Yoon SJ, Yoon W, Kim OS, Lee JS, Kang BC (2008) Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery. Dentomaxillofac Radiol 37(2):104–108PubMedCrossRef
24.
Almog DM, Illig KA, Khin M, Green RM (2000) Unrecognized carotid artery stenosis discovered by calcifications on a panoramic radiograph. J Am Dent Assoc 131(11):1593–1597PubMed
25.
Ravon NA, Hollender LG, McDonald V, Persson GR (2003) Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results. J Clin Periodontol 30(12):1084–1090PubMedCrossRef
26.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA (2010) Cephalometric calcified carotid artery atheromas in patients with obstructive sleep apnea. Sleep Breath 14(4):365–370PubMedCrossRef
27.
28.
Mason RH, Mehta Z, Fonseca AC, Stradling JR, Rothwell PM (2012) Snoring and severity of symptomatic and asymptomatic carotid stenosis: a population-based study. Sleep 35(8):1147–1151PubMed
29.
Allison MA, Criqui MH, Wright CM (2004) Patterns and risk factors for systemic calcified atherosclerosis. Arterioscler Thromb Vasc Biol 24(2):331–336PubMedCrossRef
30.
Drager LF, Bortolotto LA, Krieger EM, Lorenzi-Filho G (2009) Additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension 53(1):64–69PubMedCrossRef
31.
Odink AE, van der Lugt A, Hofman A, Hunink MG, Breteler MM, Krestin GP, Witteman JC (2007) Association between calcification in the coronary arteries, aortic arch and carotid arteries: the Rotterdam study. Atherosclerosis 193(2):408–413PubMedCrossRef
32.
Franklin KA, Sahlin C, Stenlund H, Lindberg E (2012) Sleep apnoea is a common occurrence in females. Eur Respir J.
33.
Shaalan WE, Cheng H, Gewertz B, McKinsey JF, Schwartz LB, Katz D, Cao D, Desai T, Glagov S, Bassiouny HS (2004) Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. J Vasc Surg 40(2):262–269PubMedCrossRef
34.
Hunt JL, Fairman R, Mitchell ME, Carpenter JP, Golden M, Khalapyan T, Wolfe M, Neschis D, Milner R, Scoll B, Cusack A, Mohler ER 3rd (2002) Bone formation in carotid plaques: a clinicopathological study. Stroke 33(5):1214–1219PubMedCrossRef
35.
Nandalur KR, Hardie AD, Raghavan P, Schipper MJ, Baskurt E, Kramer CM (2007) Composition of the stable carotid plaque: insights from a multidetector computed tomography study of plaque volume. Stroke 38(3):935–940PubMedCrossRef
36.
Fanning NF, Walters TD, Fox AJ, Symons SP (2006) Association between calcification of the cervical carotid artery bifurcation and white matter ischemia. AJNR Am J Neuroradiol 27(2):378–383PubMed
37.
Russell DA, Wijeyaratne SM, Gough MJ (2007) Changes in carotid plaque echomorphology with time since a neurologic event. J Vasc Surg 45(2):367–372PubMedCrossRef
38.
O’Leary DH, Bots ML (2010) Imaging of atherosclerosis: carotid intima-media thickness. Eur Heart J 31(14):1682–1689PubMedCrossRef
39.
Matthews KA, Strollo PJ Jr, Hall M, Mezick EJ, Kamarck TW, Owens JF, Buysse DJ, Reis SE (2011) Associations of Framingham risk score profile and coronary artery calcification with sleep characteristics in middle-aged men and women: Pittsburgh SleepSCORE study. Sleep 34(6):711–716PubMed
Metadata
Title
The relationship between cephalometric carotid artery calcification and Framingham Risk Score profile in patients with obstructive sleep apnea
Authors
Hiroko Tsuda
Yasutaka Moritsuchi
Fernanda R. Almeida
Alan A. Lowe
Toru Tsuda
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
Sleep and Breathing / Issue 3/2013
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-012-0790-3

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