Abstract
Purpose
This study aimed at investigating the association of severity of obstructive sleep apnea with the markers of inflammation as fibrinogen to albumin ratio and C-reactive protein to albumin ratio.
Methods
We included 126 patients admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea–hypopnea index (mild-moderate-severe sleep apnea and control group). We investigated the difference of white blood cell, fibrinogen to albumin ratio, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin among the groups.
Results
Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin did not significantly differ among four groups (p = 0.39, p = 0.06, and p = 0.31, respectively). A significant difference of fibrinogen to albumin ratio and C-reactive protein to albumin ratio was evident among four groups (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the mild sleep apnea and control groups (p = 0.65, and p = 0.85, respectively), but were significantly greater in moderate sleep apnea group compared with the control group (p < 0.001 and p = 0.001, respectively). Also, fibrinogen to albumin ratio and C-reactive protein to albumin ratio were significantly greater in the severe sleep apnea group compared with the control group (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the severe sleep apnea and moderate sleep apnea groups (p = 0.49, and p = 0.58, respectively).
Conclusion
Higher fibrinogen to albumin ratio and C-reactive protein to albumin ratio may be predictive of inflammation in patients with moderate-to-severe sleep apnea.
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References
Tan S, Liu X, Xu Y, Luo L, Zhou S, Gao Y (2017) Serum high-density lipoprotein correlates with serum apolipoprotein M and A5 in obstructive sleep apnea hypopnea syndrome. Sleep Breath 21(1):37–44
DeMartino T, Ghoul RE, Wang L, Bena J, Hazen SL, Tracy R, Patel SR, Auckley D, Mehra R (2016) Oxidative stress and inflammation differentially elevated in objective versus habitual subjective reduced sleep duration in obstructive sleep apnea. Sleep 39(7):1361–1369
Kang J-H, Lin H-C (2012) Obstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study. Sleep Med 13(6):583–588
Zhang X, Wang A, Zhang J, Singh M, Liu D, Zuo Y, Wu L, Song M, Wang W, Feigin VL, Wang Y, Zheng D (2019) Association of plasma C-reactive protein with ischemic stroke: a Mendelian randomization study. Eur J Neurol. https://doi.org/10.1111/ene.14113
Cayir S, Hizli O, Kayabasi S (2019) Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy? Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-019-05691-3
Liu Z, Jin K, Guo M, Long J, Liu L, Liu C, Xu J, Ni Q, Luo G, Yu X (2017) Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol 24(2):561–568. https://doi.org/10.1245/s10434-016-5579-3
He Y, Tang J, Wu B, Yang B, Ou Q, Lin J (2019) Correlation between albumin to fibrinogen ratio, C-reactive protein to albumin ratio and Th17 cells in patients with rheumatoid arthritis. Clin Chim Acta. https://doi.org/10.1016/j.cca.2019.10.009
He D, Jiao Y, Yu T, Song J, Wen Z, Wu J, Duan W, Sun N, Sun Z, Sun Z (2019) Prognostic value of fibrinogen-to-albumin ratio in predicting 1-year clinical progression in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention. Exp Ther Med 18(4):2972–2978. https://doi.org/10.3892/etm.2019.7890
Wang YY, Liu ZZ, Xu D, Liu M, Wang K, Xing BC (2019) Fibrinogen-albumin ratio index (FARI): a more promising inflammation-based prognostic marker for patients undergoing hepatectomy for colorectal liver metastases. Ann Surg Oncol 26(11):3682–3692. https://doi.org/10.1245/s10434-019-07586-3
Bozkus F, Dikmen N, Samur A, Bilal N, Atilla N, Arpag H (2018) Does the neutrophil-to-lymphocyte ratio have any importance between subjects with obstructive sleep apnea syndrome with obesity and without obesity? Tuberk Toraks 66(1):8–15. https://doi.org/10.5578/tt.66535
Korkmaz M, Korkmaz H, Kucuker F, Ayyildiz SN, Cankaya S (2015) Evaluation of the association of sleep apnea-related systemic inflammation with CRP, ESR, and neutrophil-to-lymphocyte ratio. Med Sci Monit 21:477–481. https://doi.org/10.12659/msm.893175
Pafili K, Steiropoulos P, Papanas N (2015) The relationship between obstructive sleep apnoea and coronary heart disease. Curr Opin Cardiol 30(4):439–446
Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290(14):1906–1914
Wu M, Zhou L, Zhu D, Lai T, Chen Z, Shen H (2018) Hematological indices as simple, inexpensive and practical severity markers of obstructive sleep apnea syndrome: a meta-analysis. J Thorac Dis 10(12):6509–6521. https://doi.org/10.21037/jtd.2018.10.105
Koseoglu S, Ozcan KM, Ikinciogullari A, Cetin MA, Yildirim E, Dere H (2015) Relationship between neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and obstructive sleep apnea syndrome. Adv Clin Exp Med 24(4):623–627. https://doi.org/10.17219/acem/47735
Sproston NR, Ashworth JJ (2018) Role of C-reactive protein at sites of inflammation and infection. Front Immunol 9:754. https://doi.org/10.3389/fimmu.2018.00754
Baratta F, Pastori D, Fabiani M, Fabiani V, Ceci F, Lillo R, Lolli V, Brunori M, Pannitteri G, Cravotto E, De Vito C, Angelico F, Del Ben M (2018) Severity of OSAS, CPAP and cardiovascular events: a follow-up study. Eur J Clin Investig 48(5):e12908. https://doi.org/10.1111/eci.12908
Zhang W-J, Frei B (2002) Albumin selectively inhibits TNFα-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells. Cardiovasc Res 55(4):820–829
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All procedures performed in this study were in accordance with the ethical standards of local ethical committee of Giresun University (IRB Number: 90139838-000-E.44913).
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This article is part of the Topical Collection on sleep apnea syndrome. Guest Editors: Manuele Casale, Rinaldi Vittorio.
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Hizli, O., Cayir, S., Coluk, Y. et al. The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio. Eur Arch Otorhinolaryngol 278, 851–855 (2021). https://doi.org/10.1007/s00405-019-05770-5
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DOI: https://doi.org/10.1007/s00405-019-05770-5