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Neutrophil-to-lymphocyte ratio decreases in obstructive sleep apnea treated with mandibular advancement devices

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea has been associated with chronic inflammation triggered by nocturnal hypoxemia. The neutrophil-to-lymphocyte ratio (NLR) is a measure of subclinical systemic inflammation. We hypothesize that NLR levels would improve as chronic inflammation diminishes in obstructive sleep apnea (OSA) patients treated with mandibular advancement devices (MADs).

Methods

We studied patients with OSA who were treated with MAD as a first-line treatment or because they could not tolerate CPAP. We obtained pre-treatment and post-treatment complete blood counts. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the CBCs. Patients with other conditions known to affect NLR were excluded from the study.

Results

We compared the values of NLR and oxygen desaturation index (ODI) before and after treatment with MAD in 22 patients who met inclusion criteria and completed the study protocol. There was a significant difference in NLR before and after treatment (p = 0.01). There was also a significant difference in the 3% ODI and 4% ODI before and after treatment with MAD (p = 0.014, 0.007), respectively. A subgroup analysis compared NLR in two groups of patients, the optimally treated and suboptimally treated. There was a significant decrease in the NLR in the optimally treated group (n = 10) (p < 0.01), whereas it did not change in the suboptimally treated group (n = 12) (p = 0.349).

Conclusion

The neutrophil-to-lymphocyte ratio may be useful in documenting improvement in inflammation for OSA patients treated with mandibular advancement devices. Our results specifically suggest that the NLR values are associated with the decrease in the ODI.

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Funding

This research was supported by ResMed, SomnoMed, and Kettenbach LP.

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Authors and Affiliations

  1. Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Moh’d Al-Halawani, Sreelatha Naik, Michael Chan, Iouri Kreinin & Meir Kryger

  2. Veterans Affairs Connecticut Healthcare System, West Haven, CT, 06516, USA

    Moh’d Al-Halawani, Sreelatha Naik, Michael Chan, Iouri Kreinin, Jonathan Meiers & Meir Kryger

  3. Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Sreelatha Naik

Authors
  1. Moh’d Al-Halawani
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  2. Sreelatha Naik
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  3. Michael Chan
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  4. Iouri Kreinin
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  5. Jonathan Meiers
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  6. Meir Kryger
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Corresponding author

Correspondence to Moh’d Al-Halawani.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all participants.

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Comment

At least during the last ten years there is increasing evidence from basic sciences that there are multiple correlations between normal and disturbed sleep (e.g. obstructive sleep apnea syndrome (OSAS) and metabolic, endocrinologic, immunolögic and inflammatory processes. Today, the clinical impact of these correlations is not fully understood. The manuscript of Al-Halawani et coworkers deals with the Impact of optimally versus non optimally treated OSAS on a marker of subclinical inflammation (Neutroph./lymphoc. ratio). If OSAS has a negative influence on this ratio, the question arises, whether sufficient treatment of OSAS has a positive influence.

It can be expected that similar studies will be submitted in the future.

Bernhard Schlueter

Datteln, Germany

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Al-Halawani, M., Naik, S., Chan, M. et al. Neutrophil-to-lymphocyte ratio decreases in obstructive sleep apnea treated with mandibular advancement devices. Sleep Breath 22, 989–995 (2018). https://doi.org/10.1007/s11325-018-1635-5

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  • DOI: https://doi.org/10.1007/s11325-018-1635-5

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