Assessment Of The Predictive Value Of Neutrophil And High-density Lipoprotein Cholesterol Ratio For Combined Hypertension In Patients With Obstructive Sleep Apnea

BackgroundObstructive sleep apnea hypopnea syndrome（OSAHS）is a chronic disease characterized by recurrent apnea or hypoventilation during sleep.OSAHS is widely considered to be a systemic disease that causes or exacerbates cardiovascular and cerebrovascular diseases and metabolic disorders.OSAHS is closely related to hypertension and has a high complication rate.The prevalence of hypertension in OSAHS is approximately 50-60%,approximately 30-50%of hypertensive patients with OSAHS,and up to 80%of patients with refractory hypertension.Hypertension is the most prevalent chronic disease in China and is the leading factor in the increase of cardiovascular morbidity and mortality.OSAHS is also a common cause of secondary hypertension.However,no clear biological markers and predictive models have been identified to predict the risk of hypertension in patients with OSAHS.OSAHS is characterized by intermittent hypoxia,which can lead to an increase in neutrophils and overactivation,neutrophils can lead to hypertension through oxidative stress,induce inflammation,vascular endothelial dysfunction and other mechanisms,while high-density lipoprotein cholesterol has the effect of inhibiting neutrophils as antioxidants,anti-inflammatories,and improving endothelial function.Neutrophil to high-density lipoprotein cholesterol ratio（NHR）,as an indicator to evaluate the impact of inflammation and dyslipidemia on the prognosis of cardiovascular disease,mainly predicts coronary heart disease,coronary stenosis and myocardial infarction,but the correlation with OSAHS severity and hypertension remains to be studied.Therefore,this study intends to analyze the correlation between NHR and hypertension in OSAHS patients,and evaluate the diagnostic value of NHR in predicting hypertension in OSAHS patients.ObjectiveTo compare the differences in NHR between OSAHS patients with and without comorbid hypertension,to analyse whether NHR is a risk factor for comorbid hypertension in OSAHS patients,and to assess the diagnostic value of NHR in predicting comorbid hypertension in OSAHS patients.MethodsOSAHS patients were recruited and diagnosed with OSAHS by polysomnography（PSG）monitoring or portable monitor（PM）at the Sleep Center of the First Affiliated Hospital of Guangzhou Medical University from January 1,2020 to October 31,2022.According to hypertension diagnosis criteria,patients were divided into hypertension group and non-hypertension group.The demographic characteristics,laboratory examination and PSG or PM findings of the two groups of patients were collected respectively.The differences between the two groups were compared,and the correlation between various factors and blood pressure was analysed.Multiple linear regression was used to analyze the factors affecting blood pressure of patients with OSAHS.The risk factors of hypertension in OSAHS patients were screened by univariate and multifactor logistics regression analysis.ROC curve was used to evaluate the diagnostic value of NHR in predicting hypertension in OSAHS patients.Results1.The study included 658 subjects,of whom 566 had a confirmed diagnosis of OSAHS,49.3%of the OSAHS patients were hypertensive in combination,of whom45.5%were hypertensive grade 3.Compared with the group without OSAHS,the OSAHS group had a higher proportion of males,overweight,obesity,history of smoking,history of hypertension,history of coronary heart disease and history of diabetes mellitus,had higher BMI,ESS score,SBP and DBP,higher WBC,NEUT,LYM,MONO,WMR,TG,NHR,MHR,BUN and Scr,and had lower HDL,all with statistically significant differences（P<0.05）.2.With the increase of OSAHS severity,the prevalence of hypertension increased gradually.The prevalence of hypertension in patients with mild,moderate and severe OSAHS was 46.5%,50.0%and 51.1%respectively,and the prevalence of hypertension in patients without OSAHS was 33.7%.With the increase of OSAHS severity,BMI,systolic blood pressure,diastolic blood pressure,WBC,LYM,WHR,TG,NHR,MHR,AHI and ESS scores increased gradually（P<0.05）,while HDL and LSa O₂ decreased gradually（P<0.05）.There were significant differences in age,MONO,RBC,HGB,NLR,PLR,BUN and Scr among the four groups（P<0.05）.3.The clinical characteristics of patients in the hypertensive group and the non-hypertensive group were compared.According to whether accepted antihypertensive treatment,the hypertensive group was divided into two groups and compared with the non-hypertensive group.The results showed that:（1）In terms of demographic indicators,the patients in the hypertensive group were older,with higher systolic and diastolic blood pressure,lower proportion of males,and higher proportion of coronary heart disease and diabetes history（P<0.05）.There was no statistical difference in blood pressure between the untreated hypertension group and the treated hypertension group（P>0.05）.（2）In terms of laboratory test indexes,WBC,NEUT,MONO,NLR,PLR,WMR,TG,NHR,FBG,BUN,Scr and Ca²⁺in the hypertensive group were higher than those in the non-hypertensive group.The RBC,HGB and MPV in the hypertensive group were lower than those in the non-hypertensive group（P<0.05）.There were statistical differences in HGB and TC between the untreated hypertension group and the treated hypertension group（P<0.05）,but there were no significant differences in WBC,NEUT,LYM,MONO,RBC,PLT,MPV,NLR,PLR,WMR,TG,HDL,LDL,NHR,MHR,FBG,BUN,Scr and Ca²⁺（P>0.05）.（3）In terms of PSG or PM results,there were statistically significant differences in AHI between the untreated hypertension group and the non-hypertensive group（P<0.05）,and no statistically significant differences in LSa O₂ between the non-hypertensive group,the untreated hypertension group and the treated hypertension group（P>0.05）.4.Correlation analysis:SBP was positively correlated with BMI,hyperlipidemia,WBC,NEUT,LYM,MONO,RBC,WMR,TC,TG,LDL,NHR,FBG,Ca²⁺and AHI,and negatively correlated with LSa O₂.DBP was positively correlated with BMI,hyperlipidemia,WBC,NEUT,LYM,RBC,HGB,PLT,WMR,TC,LDL,NHR,Ca²⁺and AHI,and negatively correlated with age and sex.All the differences were statistically significant（P<0.05）.The correlation coefficients between NHR and SBP and DBP were0.112 and 0.163（P<0.05）.5.Multiple linear regression analysis showed that SBP is independently correlated with AHI,NEUT and TC;DBP is independently associated with AHI,NEUT,RBC and hyperlipidemia.6.Single factor logistics analysis showed that:age,diabetes history and NHR were risk factors for hypertension in OSAHS patients,and the OR values were 1.042（95%CI,1.025-1.059）,2.215（95%CI,1.385-3.542）and 1.243（95%CI,1.115-1.386）,respectively（P<0.05）.Multivariate logistic regression analysis showed that age,diabetes history and NHR were independent risk factors for hypertension in OSAHS patients,and the OR values were 1.041（95%CI,1.027-1.056）,2.323（95%CI,1.466-3.680）and 1.243（95%CI,1.115-1.386）,respectively（P<0.05）.7.The ROC curve analysis found that the AUC of NHR for diagnosis of hypertension in OSAHS was 0.600[（95%CI,0.5544-0.647）,P<0.001],the maximum Youden index was0.204,the optimal cut-off value was 3.9996,the sensitivity was 55.9%,and the specificity was 64.5%.Conclusions1.49.3%of OSAHS patients were combined with hypertension,and the prevalence of hypertension gradually increased with the severity of OSAHS,and the NHR gradually increased;NHR was higher in OSAHS patients with combined hypertension;2.NHR is an independent risk factor for combined hypertension in OSAHS patients;NHR has predictive value for combined hypertension in OSAHS patients.