Al-Halawani Moh'd, Kyung Christian, Liang Fei, Kaplan Ian, Moon Jane, Clerger Guerrier, Sabin Bruce, Barnes Andrea, Al-Ajam Mohammad
Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York.
J Clin Sleep Med. 2020 Feb 15;16(2):251-257. doi: 10.5664/jcsm.8176. Epub 2020 Jan 13.
Obstructive sleep apnea (OSA) is associated with chronic inflammation likely triggered by nocturnal, intermittent hypoxemia and increased adrenergic tone. The neutrophil-to-lymphocyte ratio (NLR) was recently described as a measure of subclinical systemic inflammation. Studies on the effect of continuous positive airway pressure (CPAP) therapy in OSA on subclinical inflammation measured by NLR are lacking. We hypothesize that NLR levels would improve as chronic inflammation diminishes in patients with OSA treated with CPAP.
We retrospectively reviewed patients in whom OSA was diagnosed and who were treated with CPAP therapy. Complete blood count (CBC) were obtained pretreatment and posttreatment for calculation of NLR, which was calculated by dividing the number of neutrophils by the number of lymphocytes. Patients with conditions known to affect NLR such as chronic infections, inflammatory diseases, active cardiovascular disease, and malignancies were excluded from the study. CPAP adherence downloads were obtained for all patients.
Out of 184 patients in whom OSA was diagnosed and who were treated with CPAP, 109 met our study criteria, including baseline polysomnogram, baseline and posttreatment CBC, and available adherence download. We compared the NLR before and after treatment with CPAP. There was a significant difference in NLR before and after treatment with CPAP (P < .0001). There was also a significant difference in apnea-hypopnea index before and after treatment (P < .0001). We also assessed the relationship between CPAP adherence (percentage of days used for > 4 hours) and the change in NLR. NLR decreased significantly in both the adherent (CPAP use ≥ 70% of days; P = .014) and nonadherent groups (CPAP use < 70% of days; P = .0003). Finally, we noticed a significant direct correlation between CPAP adherence beyond 70% and the change in NLR (ΔNLR) (P = .046) in patients who had ≥ 70% adherence with CPAP, which was not observed in patients with < 70% adherence.
The NLR may be a useful marker for monitoring improvement, as CPAP had a desirable effect on the chronic inflammation induced by OSA when measured by NLR in this study. Our results specifically suggest that the NLR values decrease significantly in patients using CPAP regardless of adherence, but with a more direct relationship in those who use it beyond 70% of days, at least 4 hours a day.
阻塞性睡眠呼吸暂停（OSA）与慢性炎症相关，这种炎症可能由夜间间歇性低氧血症和肾上腺素能张力增加引发。中性粒细胞与淋巴细胞比值（NLR）最近被描述为亚临床全身炎症的一种衡量指标。关于持续气道正压通气（CPAP）治疗OSA对通过NLR测量的亚临床炎症的影响的研究尚缺。我们假设，在接受CPAP治疗的OSA患者中，随着慢性炎症减轻，NLR水平会改善。
我们回顾性分析了已诊断为OSA并接受CPAP治疗的患者。在治疗前和治疗后获取全血细胞计数（CBC）以计算NLR，NLR通过中性粒细胞数量除以淋巴细胞数量得出。已知会影响NLR的疾病患者，如慢性感染、炎症性疾病、活动性心血管疾病和恶性肿瘤患者被排除在研究之外。获取了所有患者的CPAP依从性下载数据。
在184例已诊断为OSA并接受CPAP治疗的患者中，109例符合我们的研究标准，包括基线多导睡眠图、基线和治疗后的CBC以及可用的依从性下载数据。我们比较了CPAP治疗前后的NLR。CPAP治疗前后的NLR有显著差异（P < .0001）。治疗前后的呼吸暂停低通气指数也有显著差异（P < .0001）。我们还评估了CPAP依从性（使用天数超过4小时的百分比）与NLR变化之间的关系。在依从组（CPAP使用天数≥70%；P = .014）和非依从组（CPAP使用天数<70%；P = .0003）中，NLR均显著下降。最后，我们注意到在CPAP依从性≥70%的患者中，CPAP依从性超过70%与NLR变化（ΔNLR）之间存在显著的直接相关性（P = .046），而在依从性<70%的患者中未观察到这种相关性。
NLR可能是监测改善情况的有用标志物，因为在本研究中，通过NLR测量，CPAP对OSA引起的慢性炎症有理想的效果。我们的结果特别表明，使用CPAP的患者，无论依从性如何，NLR值均显著下降，但在每天使用时间至少4小时且使用天数超过70%的患者中，两者的关系更直接。
