Neutrophil-to-lymphocyte ratio in obstructive sleep apnea; a multi center, retrospective study

N. Altintas, E. Çetinoğlu, M. Yuceege, A.N. Acet, A. Ursavas, H. Firat, M. Karadag

Department of Pulmonary and Sleep Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. nejataltintas@gmail.com

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• Respiratory Medicine

OBJECTIVE: Systemic inflammation is important in pathophysiology of obstructive sleep apnea (OSA) and its comorbidity. Neutrophil to lymphocyte ratio (N/L ratio) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. In this study, we aimed to evaluate the role of N/L ratio in OSA patients and comparing with other well-known inflammatory marker, C-reactive protein (CRP).

PATIENTS AND METHODS: We conducted a retrospective analysis of 481 patients with mild, moderate and severe OSA (163,158 and 160 patients, respectively) and leukocyte profiles of 80 sex-, age- and body mass index- matched healthy controls. Patients were excluded if they had underlying cancer, chronic inflammatory disease, any systemic infection, uncontrolled hypertension and diabetes mellitus, a known acute coronary syndrome, valvular heart disease, a known thyroid, renal or hepatic dysfunction.

RESULTS: We found that N/L Ratio in severe OSA patients was significantly higher compared with mild, moderate, OSA patients and healthy controls (p < 0.001). However, there was no difference between mild and moderate OSA patients (p = 0.636). There was also no significant difference between mild-moderate OSA patients and healthy groups (p = 0.150). CRP levels were not different in all OSA stages (p = 0.595). By Spearman correlation, there was no correlation between CRP and N/L ratio.

CONCLUSIONS: N/L ratio, which is quick, cheap, easily measurable novel inflammatory marker with routine complete blood count analysis, is a surrogate marker of obstructive sleep apnea severity.

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