Associations Between Systemic Inflammatory Markers Based on Blood Cells and Polysomnographic Factors in Obstructive Sleep Apnea

Abstract

Objectives. Systemic inflammation plays a key role in the pathogenesis of obstructive sleep apnea (OSA); however, easy-to-use methods to evaluate the severity of systemic inflammation have yet to be developed. This study investigated the association between systemic inflammation markers that could be derived from the complete blood count (CBC) profile and sleep parameters in a large number of patients with OSA.Methods. Patients who visited our hospital’s Otorhinolaryngology Sleep Clinic between January 2017 and April 2022 underwent polysomnography and routine laboratory tests, including a CBC. Associations between three systemic inflammatory markers—the systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR)—and polysomnographic and demographic factors including age, sex, body mass index, the apnea-hypopnea index (AHI), the hypopnea index (HI), lowest oxygen saturation (%), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, and percentages of non-rapid eye movement (REM) sleep stage 3, REM sleep, and snoring time were analyzed. The inflammation markers were compared among OSA subgroups, and associations were also analyzed in subgroups with different OSA severities.Results. In total, 1,102 patients (968 men and 134 women) were included, and their mean AHI was 33.0±24.3. PSQI was significantly associated with SII (<i>P</i>=0.027). No independent significant factors were identified for the NLR or PLR. Within the simple snoring and mild OSA subgroups, no significant association was found between sleep parameters and the SII. In the severe OSA subgroup, the AHI (<i>P</i>=0.004) and PSQI (<i>P</i>=0.012) were independently associated with the SII.Conclusion. Our study analyzed systemic inflammatory markers based on the CBC, a simple, relatively cost-effective test, and showed that the AHI and SII were significantly correlated only in the severe OSA subgroup.

High Monocyte-to-Lymphocyte Ratio is Associated with Obstructive Sleep Apnea Hypopnea Syndrome

“…Both single-factor and Additionally, MLR was positively correlated with AHI scores (r=0.273, P<0.05), with an area under the ROC curve of 0.673, 95% CI (0.601-0.744), indicating a certain predictive value for OSAHS. Our research suggests that elderly patients with higher BMI, NLR, and SII levels are more likely to suffer from OSAHS, which is consistent with the findings of Senaratna et al 4,23,24 Zahide's study found that there was no statistically significant difference in the MLR between OSAHS patients and the normal population. 26 However, in our study, we observed a significant correlation between MLR and the occurrence…”

“…Studies have shown that NLR is associated with the severity of OSAHS. 23 Some research has investigated the relevance of SII and SIRI in the development of OSAHS 24,25 . However, there is currently no reported research on the relationship between MLR, PIV, and the occurrence of OSAHS, nor comparative studies of the association between different inflammatory parameters and the development of OSAHS.…”

Evaluation of Inflammation and Oxidative Stress Markers in Patients with Obstructive Sleep Apnea (OSA)

“…In fact, it has been shown that these indices provide more information about the presence of an inflammatory state when compared with individual blood cell types [ 36 ]. Multivariate analysis showed no significant associations between measures of disease severity, AHI, and simple or combined indices, although NLR and SII were associated with AHI in univariate correlation analysis, in accordance with previous studies [ 34 , 35 ].…”

“…However, only a few reports have evaluated the prognostic capacity of these indexes, primarily NLR and PLR, with conflicting results [ 18 , 22 ]. The investigation of the systemic inflammatory response index (SII) in OSA was performed only in two studies reporting a significant positive correlation between AHI and SII [ 34 , 35 ].…”

Differences and Risk Factors of Peripheral Blood Immune Cells in Patients with Obstructive Sleep Apnea

“…7,8 They often were regarded as easily measurable biomarkers of inflammation and oxidative stress in OSA, such as neutrophils, lymphocytes, monocytes, hemoglobin, and hematocrit, as well as new biomarkers including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic inflammatory index (SII). [9][10][11] In addition, immune cell-driven inflammation also plays a crucial role in the pathogenesis of OSA. Some pro-inflammatory markers released by peripheral blood cells such as C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), erythrocyte sedimentation rate (ESR) were also strongly associated with OSA severity.…”