@article{4407782e51bf4f18b79bf4794603cf55,
title = "Novel non-invasive assessment of upper airway inflammation in obstructive sleep apnea using positron emission tomography/magnetic resonance imaging",
abstract = "Purpose: To develop a novel non-invasive technique to quantify upper airway inflammation using positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with obstructive sleep apnea (OSA). Methods: Patients with treatment na{\"i}ve moderate-to-severe OSA underwent [18F]-fluoro-2-deoxy-d-glucose (FDG) PET/MRI. Three readers independently performed tracings of the pharyngeal soft tissue on MRI. Standardized uptake values (SUV) were generated from region of interest (ROI) tracings on corresponding PET images. Background SUV was measured from the sternocleidomastoid muscle. SUV and target-to-background (TBR) were compared across readers using intraclass correlation coefficient (ICC) analyses. SUV from individual image slices were compared between each reader using Bland–Altman plots and Pearson correlation coefficients. All tracings were repeated by one reader for assessment of intra-reader reliability. Results: Five participants completed our imaging protocol and analysis. Median age, body mass index, and apnea–hypopnea index were 41 years (IQR 40.5–68.5), 32.7 kg/m2 (IQR 28.1–38.1), and 30.7 event per hour (IQR 19.5–48.1), respectively. The highest metabolic activity regions were consistently localized to palatine or lingual tonsil adjacent mucosa. Twenty-five ICC met criteria for excellent agreement. The remaining three were TBR measurements which met criteria for good agreement. Head-to-head comparisons revealed strong correlation between each reader. Conclusions: Our novel imaging technique demonstrated reliable quantification of upper airway FDG avidity. This technology has implications for future work exploring local airway inflammation in individuals with OSA and exposure to pollutants. It may also serve as an assessment tool for response to OSA therapies.",
keywords = "Magnetic resonance imaging, Obstructive sleep apnea, Pharynx, Positron emission tomography, Sleep-disordered breathing, Upper airway inflammation",
author = "John, \{Mira M.\} and Kaufman, \{Audrey E.\} and Vaishnavi Kundel and Omar Burschtin and Samira Khan and Zahi Fayad and Venkatesh Mani and Shah, \{Neomi A.\} and Oren Cohen",
note = "Funding Information: The study was funded by an American Academy of Sleep Medicine Foundation Focused Project Award (126-FP-15) to Dr. Shah. Dr. Shah also has funding from the National Institute of Health/National Heart, Lung, and Blood Institute (1R01HL143221-01). Dr. Cohen has funding from the American Thoracic Society{\textquoteright}s ASPIRE Fellowship. Funding Information: Support for this study was provided by the American Academy of Sleep Medicine Foundation through a Focused Project Award (126-FP-15) to Dr. Neomi Shah. Funding Information: Our study leverages a cohort recruited as part of a focused project award from the American Academy of Sleep Medicine Foundation. Patients were recruited from pulmonary and sleep clinics at the Mount Sinai Hospital (New York, NY) between August 2015 and September 2016. Participants were ≥ 21 years old with moderate-to-severe OSA who were na{\"i}ve to continuous positive airway pressure (CPAP) therapy or other OSA treatment. Patients meeting the following criteria were excluded: previous or current therapy for OSA, documented history of cerebrovascular or cardiovascular disease, active statin therapy, insulin-dependent diabetes, pre-imaging glucose ≥ 200 mg/dl, glomerular filtration rate (GFR) < 60 mg/ml/1.73 m, pregnancy, or contraindication to gadolinium-enhanced MRI. These exclusion criteria were selected as part of another study evaluating atherosclerotic plaque activity [] to minimize confounding and inability to undergo PET/MRI for research purposes. Institutional review board approval was obtained and all participants provided written informed consent. 2 Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.",
year = "2022",
month = sep,
doi = "10.1007/s11325-021-02480-3",
language = "English",
volume = "26",
pages = "1087--1096",
journal = "Sleep and Breathing",
issn = "1520-9512",
publisher = "Springer Science and Business Media Deutschland GmbH",
number = "3",
}