Association of nocturnal hypoxemia and white blood cell count in a multicenter cohort

Aditi Shah^{1

2}, Mohammadreza Hajipour³, A J Hirsch Allen³, Najib Ayas^{1

2

4}, Tetyana Kendzerska⁵, Patrick Hanly^{6

7

8}, John Kimoff⁹, Frederic Series¹⁰, Annie Lajoie^{10

11}, Rebecca Robillard¹², Rachel Jen^{1

2}, Andrew E Beaudin^{6

13}, Jill Raneri⁷, Robert Skomro¹⁴

Affiliations

¹ Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
² Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Brititsh Columbia, Canada.
³ Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
⁴ Critical Care Division, Department of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
⁵ Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁶ Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada.
⁸ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁰ Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ-UL), Quebec City, Quebec, Canada.
¹¹ Multidisciplinary Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada.
¹² School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁴ Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

PMID: 40575620
PMCID: PMC12198955
DOI: 10.1093/sleepadvances/zpaf028

Association of nocturnal hypoxemia and white blood cell count in a multicenter cohort

Aditi Shah et al. Sleep Adv. 2025.

. 2025 Jun 9;6(2):zpaf028.

doi: 10.1093/sleepadvances/zpaf028. eCollection 2025 Apr.

Authors

Affiliations

¹ Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
² Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Brititsh Columbia, Canada.
³ Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
⁴ Critical Care Division, Department of Medicine, University of British Columbia, Vancouver, Brititsh Columbia, Canada.
⁵ Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁶ Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada.
⁸ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁰ Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ-UL), Quebec City, Quebec, Canada.
¹¹ Multidisciplinary Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada.
¹² School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁴ Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

PMID: 40575620
PMCID: PMC12198955
DOI: 10.1093/sleepadvances/zpaf028

Abstract

Study objectives: There is a higher risk of cardiovascular disease (CVD) in patients with obstructive sleep apnea (OSA) and innate immunity is a potential pathophysiologic pathway. The objective of this study was to determine whether nocturnal hypoxemia is associated with circulating markers of innate immunity in OSA.

Methods: This was a cross-sectional study of an observational cohort from the multicentre, clinic-based, Canadian Sleep and Circadian Network. Oxygen desaturation index 4% (ODI4%) was used to diagnose and determine the severity of OSA. The percentage of time spent below SpO₂ <90% (T90) and minimum SpO₂ we considered as other measures of nocturnal hypoxemia. Multiple linear regressions were used to assess associations between total white blood cell (WBC) and subsets and ODI and hypoxemia indices.

Results: A total of 1296 patients were included in the analysis. There was a positive association between ODI4% and lymphocyte count, adjusting for confounders. For every 1-SD increase in ODI4%, lymphocyte counts increased by 0.08 × 10⁹ L (95% CI 0.01 to 0.15) SD. Patients with severe OSA (ODI4% ≥ 30 events/hour) had significantly higher total WBC and lymphocyte count than non-OSA cohort, in the adjusted model, p-value <.02, for both. There was a positive association between T90 and total WBC, neutrophil, lymphocyte, and monocyte count, adjusting for confounders. Minimum SpO₂ was independently associated with total WBC, neutrophil, and monocyte counts.

Conclusions: In this pan-Canadian clinic-based cohort of individuals with suspected OSA, nocturnal hypoxemia indices were associated with an increase in total WBC and subset counts.

Keywords: biomarkers; hypoxia; sleep-disordered breathing.

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Figures

**Figure 1.**
Total WBC and subsets categorized according to OSA severity. Total WBC, neutrophil, lymphocyte, and monocyte counts are expressed in units, (× 10⁹/L). The error bars represent confidence interval and open circles represent outlier.

See this image and copyright information in PMC

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Association of nocturnal hypoxemia and white blood cell count in a multicenter cohort

Affiliations

Association of nocturnal hypoxemia and white blood cell count in a multicenter cohort

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources