ArticleNature and science of sleep2026
Clinical Indicators and Neutrophil-to-Lymphocyte Ratio Associated with Moderate-to-Severe Obstructive Sleep Apnea in Patients with Acute Ischemic Stroke: A Single-Center Retrospective Study.
Article in Nature and science of sleep, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To examine the associations of readily available clinical indicators and the neutrophil-to-lymphocyte ratio (NLR) with moderate-to-severe obstructive sleep apnea (OSA) in patients with acute ischemic stroke and to explore the discriminatory performance of BMI, NLR, and a combination of BMI, snoring, and NLR. Methods: This single-center retrospective study included 220 patients with acute ischemic stroke who completed overnight polysomnography during hospitalization between October 2024 and April 2026. Moderate-to-severe OSA was defined as an apnea-hypopnea index ≥15 events/h. Clinical characteristics, laboratory indicators, and polysomnographic parameters were compared between groups. Multivariable logistic regression was used to evaluate factors associated with moderate-to-severe OSA, and receiver operating characteristic analysis assessed discriminatory performance. Spearman correlation and NLR tertile analyses explored the relationships between NLR and sleep-disordered breathing and nocturnal hypoxia. Results: Moderate-to-severe OSA was present in 109 of 220 patients (49.5%). After multivariable adjustment for prespecified clinical covariates, higher BMI (aOR 1.204, 95% CI 1.088-1.332), snoring (aOR 2.910, 95% CI 1.485-5.705), and higher NLR (aOR 2.291, 95% CI 1.449-3.622) remained associated with moderate-to-severe OSA. Modified Poisson sensitivity analyses yielded consistent associations for BMI, snoring, and NLR. The combined model had an AUC of 0.798 (95% CI, 0.736-0.851), indicating moderate discriminatory ability. Higher NLR was also associated with greater sleep-disordered breathing and nocturnal hypoxia burden. Conclusion: BMI, snoring, and NLR were associated with moderate-to-severe OSA in this single-center acute ischemic stroke cohort. Their combined discriminatory performance was moderate. These observational findings are hypothesis-generating and require prospective multicenter validation before clinical application.
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