Hou Ziwei, Chen Chen, Liu Hong, Wang Yunpeng, Li Zongxuan
Academy of Medical Sciences, Shanxi Medical University, Taiyuan, People's Republic of China.
Neurology Department, The Affiliated Cardiovascular Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
Nat Sci Sleep. 2025 Aug 6;17:1777-1787. doi: 10.2147/NSS.S536799. eCollection 2025.
Obstructive sleep apnea (OSA) is associated with cerebral infarction (CIF) through inflammatory pathways. The neutrophil-to-lymphocyte ratio (NLR) serves as an inflammation biomarker, but its relationship with CIF in OSA patients remains unclear.
A total of 188 OSA patients from The Affiliated Cardiovascular Hospital of Shanxi Medical University (January 2022 to December 2023) were included, consisting of 68 patients with CIF (case group) and 120 without CIF (control group). Data on admission, biochemical tests, and clinical characteristics were collected and compared. Multivariate logistic regression and a nomogram model were employed to identify risk factors, evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA).
Elevated log-transformed NLR (LnNLR), CRP, age, and reduced albumin levels were independently associated with increased CIF risk. The developed nomogram demonstrated excellent discriminative performance (AUC = 0.9372), superior to LnNLR alone (AUC = 0.665). At the optimal cutoff, the model achieved a sensitivity of 82.35% and specificity of 92.50%. Calibration plots showed good agreement between predicted and observed outcomes, and DCA confirmed the model's potential clinical utility.
High NLR can be used as an emerging criterion for evaluating CIF risk in OSA. The nomogram model is capable of estimating CIF risk accurately, providing useful aid to clinical decision-making. The developed nomogram can be implemented in practice as an aid to help healthcare personnel identify high-risk OSA participants who would be offered early intervention in terms of increased monitoring and prophylaxis. External validation in larger, multi-center cohorts is warranted.
阻塞性睡眠呼吸暂停（OSA）通过炎症途径与脑梗死（CIF）相关。中性粒细胞与淋巴细胞比值（NLR）作为一种炎症生物标志物，但其与OSA患者CIF的关系尚不清楚。
纳入山西医科大学附属心血管病医院2022年1月至2023年12月的188例OSA患者，其中68例患有CIF（病例组），120例未患CIF（对照组）。收集并比较入院数据、生化检查和临床特征。采用多因素logistic回归和列线图模型识别危险因素，并通过受试者操作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）进行评估。
经对数转换的NLR（LnNLR）、CRP升高、年龄增加以及白蛋白水平降低与CIF风险增加独立相关。所构建的列线图显示出优异的判别性能（AUC = 0.9372），优于单独的LnNLR（AUC = 0.665）。在最佳截断值时，该模型的灵敏度为82.35%，特异度为92.50%。校准图显示预测结果与观察结果之间具有良好的一致性，DCA证实了该模型的潜在临床应用价值。
高NLR可作为评估OSA患者CIF风险的新指标。列线图模型能够准确估计CIF风险，为临床决策提供有用帮助。所构建的列线图可在实践中应用，以帮助医护人员识别OSA高危参与者，从而对其进行加强监测和预防等早期干预。有必要在更大规模的多中心队列中进行外部验证。
