{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:03:08Z","timestamp":1777658588511,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats: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 &gt; 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 &lt; 0.001). In unadjusted analyses, high-risk OSA was strongly associated with CAC &gt; 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\u20135.78, p = 0.008). Similar results were observed with the mBQ (adjusted OR 2.62, 95% CI 1.27\u20135.41, p = 0.009). Increased snoring intensity was also independently associated with CAC &gt; 100 (adjusted OR 2.25, 95% CI 1.07\u20134.72, 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.<\/jats:p>","DOI":"10.3390\/jcm15062230","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:41:26Z","timestamp":1773650486000},"page":"2230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography"],"prefix":"10.3390","volume":"15","author":[{"given":"Zeynep","family":"Atceken","sequence":"first","affiliation":[{"name":"Department of Radiology, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sezer","family":"Kula","sequence":"additional","affiliation":[{"name":"Department of Radiology, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8600-7750","authenticated-orcid":false,"given":"Irem Sena","family":"Konakci","sequence":"additional","affiliation":[{"name":"Department of Radiology, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cetin","family":"Atasoy","sequence":"additional","affiliation":[{"name":"Department of Radiology, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8846-048X","authenticated-orcid":false,"given":"Aylin","family":"Pihtili","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, School of Medicine, Istanbul University, 34093 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-6538","authenticated-orcid":false,"given":"Y\u00fcksel","family":"Peker","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden"},{"name":"Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22100 Lund, Sweden"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir. 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