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Review
. 2024 Oct 28;16(10):e72539.
doi: 10.7759/cureus.72539. eCollection 2024 Oct.

Using the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Markers for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Observational Studies

Mahmoud Mohamed Attia  1   2 , Mohammad Alameen Qasim  3   2 , Hamzeh Samer Alhamwi  4   2 , Mahmoud Ali  1   2 , Ebtihal Abdelhay Alsharief  5   2 , Judy Sobhy Ali  6   2 , Mohamed Elmasry  7   2 , Ahmed Elgebaly  8   2 , Eshak I Bahbah  1   2
Affiliations
Review

Using the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Markers for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Observational Studies

Mahmoud Mohamed Attia et al. Cureus. .

Abstract

Obstructive sleep apnea (OSA) is a chronic condition characterized by the partial or complete collapse of the airways during sleep, leading to hypoxemia (reduced oxygen flow to organs) and disrupted sleep. This study aims to establish robust evidence for the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the severity and prognosis of OSA. A systematic review and meta-analysis were conducted using PubMed, Cochrane Central Register of Controlled Trials, Scopus, Medline, and Web of Science to gather all relevant articles. Twenty-six eligible articles were included in the study. The pooled outcomes indicated that the NLR and PLR were significantly higher in patients with OSA compared to controls. Subgroup analyses based on the severity of OSA showed that differences in the NLR were more pronounced in patients with severe OSA. Moreover, meta-regression analysis revealed that variations in mean age, BMI, and male proportion did not significantly affect the differences in the NLR and PLR. OSA has a significant impact on NLR and PLR levels, making them useful markers for detecting the inflammatory status in OSA patients.

Keywords: diagnostic biomarkers; neutrophil-to-lymphocyte ratio; obstructive sleep apnea; platelet-to-lymphocyte ratio; prognostic biomarkers.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Forest plot of subgroup analysis of the NLR between OSA patients and controls according to disease severity.
OSA: Obstructive sleep apnea, NLR, Neutrophil-to-lymphocyte ratio, SD: Standard deviation, CI: Confidence interval, IV: Inverse variance
Figure 3
Figure 3. Forest plot of the effect of CPAP on the NLR in OSA patients.
OSA: Obstructive sleep apnea, NLR, Neutrophil-to-lymphocyte ratio, SD: Standard deviation, CI: Confidence interval, IV: Inverse variance, CPAP: Continuous positive airway pressure
Figure 4
Figure 4. Forest plot of random-effects model SMD of the PLR between OSA patients and controls.
OSA: Obstructive sleep apnea, NLR, Neutrophil-to-lymphocyte ratio, SD: Standard deviation, CI: Confidence interval, IV: Inverse variance, CPAP: Continuous positive airway pressure, SMD: Standardized mean difference
Figure 5
Figure 5. Forest plot of subgroup analysis of PLR and OSA according to disease severity.
OSA: Obstructive sleep apnea, PLR: Platelet-to-lymphocyte ratio, SD: Standard deviation, CI: Confidence interval, IV: Inverse variance, CPAP: Continuous positive airway pressure
Figure 6
Figure 6. Forest plot of the effect of CPAP on the PLR.
OSA: Obstructive sleep apnea, PLR: Platelet-to-lymphocyte ratio, SD: Standard deviation, CI: Confidence interval, IV: Inverse variance, CPAP: Continuous positive airway pressure
See this image and copyright information in PMC

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