The Correlation Between Inflammatory Markers Such As PLR,TNF-α And OSAHS

Background and ObjectiveSleep respiratory disease includes a range of diseases,most of which fall into the category of obstructive sleep apnea hypopnea syndrome(obstructive sleep apnea hypopnea syndrome,OSAHS),central sleep apnea syndrome(central sleep apnea syndrome,CSAS)or sleep-related lack of ventilation.This paper focuses on OSAHS related issues.OSAHS is a common sleep respiratory disorder characterized by recurrent complete or partial obstruction of the upper respiratory tract,accompanied by varying degrees of reduced arterial oxygen saturation and sympathetic nerve activation.It is usually terminated by a brief cortical awakening or an occasional awakening.Apnea hypopnea index(apnea hypopnea index,AHI)refers to the number of apnea or hypopnea during sleep per hour,which can be used to evaluate the severity of the disease.The main clinical manifestations of OSAHS were daytime oversleepiness,habitual snoring,apnea,wheezing or asphyxia arousal,attention loss or memory loss,morning headache,mood disorder or insomnia.In addition to symptoms,OSAHS can lead to adverse health outcomes,including cerebrovascular disease,cardiovascular disease(such as hypertension,ischemic heart disease,arrhythmia,pulmonary hypertension and congestive heart failure),metabolic syndrome,depression,It also increases the risk of traffic accidents[1].OSAHS is a common sleep disorder that can occur at any age [2] and is at higher risk for men,the elderly and obese.Estrogen in women plays a role in the low incidence of OSAHS.But at present,the relevant mechanism is not very clear.OSAHS affects about 26% of adults,about 10% of whom have moderate to severe OSAHS [3].New foreign research shows that at least 17% of men and 9% of women aged 50 to 70 have moderate to severe OSAHS.In addition,African-American,Asian-Americans are at higher risk than their peers [4].Common risk factors for OSAHS include obesity,age,male,female postmenopausal status,ethnic and craniofacial abnormalities.Obesity is one of the main risk factors of OSAHS,especially central obesity,which is the most important risk factor of OSAHS.The increased fat tissue around the upper airway of obese patients increases the volume of upper respiratory tract structure and increases the risk of airway collapse [5].Data show that 4% of middle-aged men and 2% of middle-aged women are affected by OSAHS excessive sleepiness,but this percentage is higher among obese people [6,7].Among obese people who need weight loss surgery,the prevalence of OSAHS is between 40% and 94% [8,9].Aging is an important factor to increase the risk of OSAHS.With the increase of age,the incidence of OSAHS is increasing.A recent large-scale study showed that 50% of elderly men had respiratory disorders index more than 13 times / h,and age was an independent risk factor in multivariate Logistic regression analysis [10,11].Christos et al found that airflow restriction and(OSAHS)-related symptoms of obstructive sleep apnea-hypopnea syndrome were the most common in the elderly,and that the prevalence of airflow restriction was 17.1%(24.2% for men).The prevalence of OSAHS related symptoms such as frequent snoring,apnea and daytime excessive sleepiness were 28.1%,12.9% and 11.6% [12],respectively.According to Ancoli-Israel et al.,OSAHS is one of the reasons for the increase in mortality in the elderly,and the survival time of patients over 70 years of age with severe OSAHS is significantly shorter [13].However,the mechanism of aging increasing the risk of OSAHS is not entirely clear.Adult OSAHS is an independent risk factor for many diseases,such as cerebrovascular disease,coronary heart disease,and so on.Most patients die from complicated cardiovascular and cerebrovascular diseases,and its mechanism may be related to vascular endothelial dysfunction,sympathetic nervous system excitation,chronic hypoxia,and so on.Chronic low-grade inflammation and life habits are related to many factors [14-17],but the exact mechanism has not been well elucidated.Epidemiological studies at home and abroad have pointed out that OSAHS and hypertension are the cause and effect of each other [18].It is pointed out abroad that nearly 50% of patients with OSAHS complicated with hypertension and about 30% of patients with essential hypertension had OSAHS [19,20].In addition to genetic,dietary,weight,age and other factors,OSAHS is also an important factor in the onset and development of hypertension and one of the independent risk factors [21,22].Different from the normal circadian rhythm of blood pressure in non-OSAHS group,the nocturnal blood pressure of OSAHS patients was non-dipper type,and the content of catecholamine in urine during nocturnal sleep was significantly increased,which might be related to the occurrence of hypertension [23,24].Wang Wei [25],a domestic scholar,suggested that OSAHS was associated with increased risk of drug-resistant hypertension,and mild,moderate and severe OSAHS was associated with essential hypertension,and showed a dose-response pattern relationship.Related data showed that the prevalence of OSA in drug-resistant hypertension patients was 70% [26],and the possible mechanism was that OSAHS reduced the efficacy of drugs through pharmacokinetic or time-therapy effects.Thus activating the anti-hypertension drug resistance pathway [27].Some studies have shown that OSAHS is an important predictor of coronary heart disease after correcting age,body mass index(Body Mass Index,BMI),)smoking,hypertension,hyperlipidemia,diabetes and other factors.Peker et al found that nearly 50% of clinical patients with coronary artery disease(CAD)have obstructive sleep apnea hypopnea syndrome,and about 35% of patients with single or multiple coronary artery disease have OSAHS.At the same time,about 50% of OSAHS patients develop coronary artery disease,and the prognosis of these patients is worse than that of CAD patients without OSAHS [29-31].Retrospective and epidemiological studies have shown that the mortality of cardiovascular diseases is related to OSAHS.CPAP therapy for OSAHS can significantly improve the quality of life and prolong the life span of patients [31].OSAHS patients had great variability of heart rate during sleep.Compared with those without OSAHS,the incidence of arrhythmias was higher in OSAHS patients,which was positively correlated with nocturnal hypoxia and apnea [32,33].Neo and others found that the prevalence of central arrhythmias in Asian OSAHS population was 8.0%.Univariate analysis showed older age,higher body mass index(BMI),complications and severity of OSAHS,including apnea-hypopnea index(AHI).The lowest blood oxygen saturation and hypoxia time were correlated with the incidence of arrhythmias [34].Akershus sleep apnea items based on large population studies showed that about 12.2% of patients had ventricular premature beats,about 49.4% had atrial premature beats,and more than 10% developed second-degree atrioventricular block [35].OSAHS patients may also develop right ventricular dysfunction,with chronic obstructive pulmonary disease(chronic obstructive pulmonary disease,COPD)associated with hypoxemia and hypercapnia during sleep,especially in patients with COPD.It has become one of the most important and common causes of chronic pulmonary heart disease [36].With the deepening of the understanding of OSAHS and the development of medical level,many OSAHS patients have been diagnosed and standardized in a timely and accurate manner,which can improve the quality of life of the patients and prevent the occurrence of various complications.It is of great significance to improve the survival rate of patients.However,there are still many patients due to mild symptoms,lack of awareness and other timely diagnosis and treatment.Therefore,finding effective,simple and economical indicators of biological diagnosis and follow-up and clarifying the pathogenesis of OSAHS and complications has become one of the hotspots that researchers pay attention to at present.ObjectiveTo investigate the ratio of neutrophil to lymphocyte(neutrophil-to-lymphocyte ratio,NLR),platelet to lymphocyte ratio(platelet to lymphocyte ratio,PLR),platelet parameters,including mean platelet volume(mean platelet volume,MPV)and platelet distribution width(platelet distribution width,PDW),C-reactive protein(C-reactive protein,CRP),tumor necrosis factor-α(tumor necrosis factor-α,TNF-α)and OSAHS was studied.Materials and MethodsFrom September 2016 to March 2018,104 patients with sleep snoring,somnolence,daytime fatigue and somnolence were enrolled in the Department of Respiratory and critical Care,the second affiliated Hospital of Zhengzhou University.All patients underwent polysomnography(polysommogram,PSG),).According to apnea hypopnea index(apnea hypopnea index,AHI),all patients were divided into control group(AHI < 5 times / h,20 cases),light group(5 ≤ AHI < 15 times / h,27 cases),moderate group(15 ≤ AHI < 30 times / h,26 cases).Severe group(AHI ≥ 30 times / h,31 cases).General data,PSG monitoring,blood routine parameters,CRP,TNF-α,NLR and PLR,were collected.Pearson correlation analysis was used to analyze the correlation between the platelet parameters of NLR,PLR,CRP,TNF-α and the lowest arterial oxygen saturation and AHI during sleep.Results(1)PLR: moderate group(137.90 ±57.90),severe group(153.40 ±71.92)was significantly higher than mild group(103.87 ±18.70)and control group(98.89 ±16.83)(P < 0.05),but the severe group was higher than the moderate group,the mild group was higher than the control group,but there was no significant difference(P > 0.05).PDW: severe group(16.44 ±0.87),moderate group(13.19 ±0.81),mild group(12.83 ±1.16)was higher than the control group(11.10 ±0.86),and severe group was higher than the moderate group(P < 0.05).The moderate group was higher than the mild group,but there was no significant difference(P > 0.05).(2)TNF-α: mild group(1.31 ±0.67),moderate group(1.92 ±0.86),severe group(2.61 ±0.77)was higher than control group(0.82 ±0.39).moderate group,severe group was higher than that in mild group(P < 0.05);CRP: severe group(4.16 ±1.86),moderate group(3.28 ±0.57)was higher than control group(2.42 ±1.02),and severe group was higher than moderate group(P < 0.05).There was no significant difference between the moderate group and the mild group(P > 0.05).(3)NLR,MPV:4 group showed an increasing trend with the disease increasing,but there was no significant difference between the groups(P > 0 05).(4)PLR,PDW was positively correlated with AHI(PLR r = 0.487,P < 0.001;PDW r = 0.803,P < 0.001),and negatively correlated with lowest blood oxygen saturation(PLR r =-0.437,P < 0.001;PDW r =-0.491,P < 0.001);CRP,TNF-α was positively correlated with AHI(CRP r = 0.430,P < 0.001;TNF-α r = 0.676,P < 0.001),and negatively correlated with minimum blood oxygen saturation(CRP r =-0.344,P < 0.001;TNF-α r =-0.446,P < 0.001).Conclusion(1)Platelet parameter PDW,PLR,inflammation index CRP,TNF-α was significantly increased in patients with OSAHS,and the above indexes increased with the severity of the disease.(2)there is a certain correlation between PLR,PDW,CRP,TNF-α and OSAHS,which may be an auxiliary index for OHASA screening,severity assessment and clinical follow-up.