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Assessment of Cardiac Sympathetic Function with Iodine-123-MIBG Imaging in Obstructive Sleep Apnea Syndrome

Department of Clinical Physiology, Chest Disease Research Institute, and the Third Department of Internal Medicine, Kyoto University, Kyoto, Japan

Correspondence: For correspondence or reprints contact: Naoki Otsuka, MD, Department of Clinical Physiology, Chest Disease Research Institute, Kyoto University, Shogoin-Kawaharacho 53, Sakyo-ku, Kyoto 606-01, Japan.

ABSTRACT

Iodine-123-MIBG imaging has been used to evaluate myocardial sympathetic function in various cardiac diseases. In patients with obstructive sleep apnea syndrome (OSAS), increased sympathetic activity has been widely recognized, as assessed by measuring the plasma concentration and urinary excretion of catecholamines and by measuring muscle sympathetic nerve activity. However, these measurements are not specific indices of cardiac sympathetic function. Therefore, this study was undertaken to assess cardiac sympathetic function in patients with OSAS using MIBG cardiac scintigraphy. Methods: This study consisted of 11 patients (10 men, 1 woman; mean age 43 ± 16 yr) with a diagnosis of OSAS established by polysomnography, and 8 age-matched normal control subjects (7 men, 1 woman; mean age 45 ± 18 yr). Early (15 min) and delayed (3 hr) planar images were taken after the injection of 111 MBq of [¹²³I]MIBG. The mean counts of the whole heart and the mediastinum were obtained to calculate heart-to-mediastinum count ratios from the early images (H/Me) and from the delayed images (H/Md) and the myocardial washout rate (WR). Eight patients were restudied after 1 mo of nasal continuous positive airway pressure treatment. Results: The H/Me and H/Md ratios were significantly lower in the patients than in the control subjects (H/Me, 2.49 ± 0.32 versus 2.84 ± 0.34, p = 0.0207; and H/Md, 2.33 ± 0.30 versus 3.02 ± 0.36, p = 0.0013). The WR was higher in the patients than in the control subjects (36.2 ± 9.0% versus 23.6 ± 4.9%, p = 0.0022). The H/Me and H/Md ratios in the patients were significantly correlated with the apnea-hypopnea index and the degree of hypoxemia during sleep. After treatment, H/Me and H/Md remained unchanged, but WR significantly recovered (from 34.9 ± 10.4% to 26.3 ± 7.7%, p = 0.0357). Conclusion: Cardiac sympathetic function and integrity are impaired in subjects with OSAS when compared with age-matched control subjects. MIBG cardiac imaging can be helpful in evaluating cardiac involvement and efficacy of therapy in OSAS.

Key Words: obstructive sleep apnea syndrome • iodine-123-MIBG • cardiac sympathetic function

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