Association between Red Blood Cell Distribution Width and Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis

Abstract

Although polysomnography is the gold standard method to diagnose obstructive sleep apnea syndrome (OSAS), there is an ongoing quest for simpler and relatively inexpensive biomarkers of disease presence and severity. To address this issue, we conducted a systematic review of the potential diagnostic role of the red blood cell distribution width (RDW), a routine hematological parameter of red blood cell volume variability, in OSAS. A total of 1478 articles were initially identified in the databases PubMed, Web of Science, Scopus, Embase, and Google Scholar, from their inception to February 2023, and 20 were selected for final analysis. The RDW was significantly higher in OSAS than in non-OSAS subjects (SMD = 0.44, 95% CI 0.20 to 0.67, p < 0.001; low certainty of evidence). In univariate meta-regression, the mean oxygen saturation (SpO2) was significantly associated with the effect size. No significant between-group differences were observed in subgroup analyses. Notably, in OSAS subjects, the RDW SMD progressively increased with disease severity. In conclusion, these results suggest that the RDW is a promising biomarker of OSAS (PROSPERO registration number: CRD42023398047).

Selected routine laboratory tests in the clinical assessment of patients with obstructive sleep apnea

“…On the other hand, Ozsu et al reported that there was no significant difference in haemoglobin levels between OSA and non-OSA patients [21].…”

“…Medical conditions which influence erythropoiesis or haemolysis are responsible for the heterogeneity of RBC and consequent changes in RDW [24]. Gunbatar et al presented that there were no significant differences between OSA patients and the control group in RDW values [25]; however, Ozsu et al presented significantly higher RDW values among OSA patients than in the control group (13.6% vs. 12.9 %) [21], and RDW positively correlated with mean SpO2 [16]. Some data present that the RDW value is correlated with the severity of OSA measured by AHI [18].…”

Utilizing red blood cell distribution width (RDW) as a reliable biomarker to predict treatment effects after chimeric antigen receptor T cell therapy

“…RDW is a readily measurable laboratory parameter of heterogeneity in red blood cell size [ 25 – 27 ]. Both RDW-SD and RDW-CV quantify variation of red blood cell size.…”

Diagnostic value of the creatine kinase-MB/creatine kinase and neutrophil/lymphocyte ratios in acute myocardial infarction

“…Inflammation and oxidative stress are related to its pathogenesis, with atherosclerosis being the pathological basis for the development of the disease. Therefore, the role of inflammatory biomarkers in the occurrence of AMI has received extensive attention from local and international scholars [ 8 – 10 ]. The NLR is an inflammatory marker that combines two subtypes of white blood cells, the NEUTs and LYMs, and has been demonstrated to be associated with the occurrence and prognosis of cardiovascular and cerebrovascular diseases [ 11 – 13 ].…”