Skip to main content Accessibility help

Investigation of the relationship between neutrophil-to-lymphocyte ratio and obstructive sleep apnoea syndrome

  • A Yenigun (a1) and H Karamanli (a2)



To investigate the neutrophil-to-lymphocyte ratio and sleep apnoea severity relationship.


Patients (n = 178) were assigned to five groups according to apnoea–hypopnea indices and continuous positive airway pressure use. White blood cell, neutrophil, lymphocyte and neutrophil-to-lymphocyte ratio values were compared for each group.


The neutrophil-to-lymphocyte ratio values of severe obstructive sleep apnoea syndrome patients (group 4) were significantly higher than those of: control patients (group 1), mild obstructive sleep apnoea syndrome patients (group 2) and patients treated with continuous positive airway pressure (group 5) (p = 0.008, p = 0.008 and p = 0.003). Minimum oxygen saturation values of group 4 were significantly lower than those of groups 1, 2 and 5 (p = 0.0005, p = 0.011 and p = 0.001). There was a positive correlation between apnoea–hypopnea index and neutrophil-to-lymphocyte ratio (r = 0.758, p = 0.034), and a negative correlation between apnoea–hypopnea index and minimum oxygen saturation (r = −0.179, p = 0.012).


Neutrophil-to-lymphocyte ratio may be used to determine disease severity, complementing polysomnography.


Corresponding author

Address for correspondence: Dr Alper Yenigun, Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, 34093 Fatih/İstanbul, Turkey Fax: +90 (212) 453 18 70 E-mail:


Hide All
1Garvey, JF, Taylor, CT, McNicholas, WT. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J 2009;33:1195–205
2Andrews, JG, Oei, TP. The roles of depression and anxiety in the understanding and treatment of obstructive sleep apnea syndrome. Clin Psychol Rev 2004;24:1031–49
3Kushida, CA, Littner, MR, Morgenthaler, T, Alessi, CA, Bailey, D, Coleman, J Jr et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005;28:499521
4Marin, JM, Carrizo, SJ, Vicente, E, Agusti, AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046–53
5Kusumanto, YH, Dam, WA, Hospers, GA, Meijer, C, Mulder, NH. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis 2003;6:283–7
6Guthrie, GJ, Charles, KA, Roxburgh, CS, Horgan, PG, McMillan, DC, Clarke, SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013;88:218–30
7Tamhane, UU, Aneja, S, Montgomery, D, Rogers, EK, Eagle, KA, Gurm, HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653– 7
8Rechtschaffen, A, Kales, A. A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages in Human Subjects. Los Angeles: Brain Information Service VCLA, 1968
9Gould, GA, Whyte, KF, Rhind, GB, Airlie, MA, Catterall, JR, Shapiro, CM et al. The sleep hypopnea syndrome. Am Rev Respir Dis 1988;137:895–8
10Mehra, R, Redline, S. Sleep apnea: a proinflammatory disorder that coaggregates with obesity. J Allergy Clin Immunol 2008;121:1096–102
11Nadeem, R, Molnar, J, Madbouly, EM, Nida, M, Aggarwal, S, Sajid, H et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 2013;9:1003–12
12Guven, SF, Turkkani, MH, Ciftci, B, Ciftci, TU, Erdogan, Y. The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath 2012;16:217–21
13Williams, A, Scharf, SM. Obstructive sleep apnea, cardiovascular disease, and inflammation--is NF-kappa B the key? Sleep Breath 2007;11:6976
14Poyton, RO, Ball, KA, Castello, PR. Mitochondrial generation of free radicals and hypoxic signaling. Trends Endocrinol Metab 2009;20:332–40
15Dai, R, Phillips, RA, Ahmed, SA. Despite inhibition of nuclear localization of NF-kappa B p65, c-Rel, and RelB, 17-beta estradiol up-regulates NF-kappa B signaling in mouse splenocytes: the potential role of Bcl-3. J Immunol 2007;179:1776–83
16Dyugovskaya, L, Lavie, P, Lavie, L. Phenotypic and functional characterization of blood γδ T cells in sleep apnea. Am J Respir Crit Care Med 2003;168:242–9
17Yokoe, T, Minoguchi, K, Matsuo, H, Oda, N, Minoguchi, H, Yoshino, G et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003;107:1129–34
18Arruda-Olson, AM, Reeder, GS, Bell, MR, Weston, SA, Roger, VL. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes 2009;2:656–62
19Rudiger, A, Burckhardt, OA, Harpes, P, Muller, SA, Follath, F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med 2006;24:451–4
20Akpek, M, Kaya, MG, Lam, YY, Sahin, O, Elcik, D, Celik, T et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621–7
21Li, MX, Liu, XM, Zhang, XF, Zhang, JF, Wang, WL, Zhu, Y et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 2014;134:2403–13
22Duffy, BK, Gurm, HS, Rajagopal, V, Gupta, R, Ellis, SG, Bhatt, DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006;97:993–6
23Gibson, PH, Croal, BL, Cuthbertson, BH, Small, GR, Ifezulike, AI, Gibson, G et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:9951002
24Turkmen, K, Guney, I, Yerlikaya, FH, Tonbul, HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail 2012;34:155–9



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed