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Can the complete blood count be used as a reliable screening tool for obstructive sleep apnea?

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Since hypoxia increases erythropoietin production and inflammation, the complete blood count (CBC) has been proposed as an inexpensive alternative for obstructive sleep apnea (OSA) screening. The objective of this study was to determine whether or not intermittent hypoxia and OSA severity, as measured by the mean oxygen saturation (SpO2) and apnea–hypopnea index (AHI), affect parameters measured by the CBC.

Methods

This retrospective study included a total of 941 surgical patients who had a pre-operative home sleep study. The pre-operative CBC was extracted from the electronic patient records. Patients were stratified according to their AHI scores, into mild (AHI ≥ 5 – < 15), moderate (AHI ≥ 15 – < 30), and severe (AHI ≥ 30) OSA groups.

Results

There were 244 patients without OSA, 294 with mild, 223 with moderate, and 180 with severe OSA. Our analysis showed that hemoglobin (P = 0.010), hematocrit (P = 0.027), and basophils (P = 0.006) showed significant changes among the different severities of OSA. For mean SpO2, there were negative associations with body mass index (r =  − 0.287; P < 0.001), age (r =  − 0.077; P = 0.021), hemoglobin (r =  − 0.208; P < 0.001), hematocrit (r =  − 0.220; P < 0.001), red blood cells (r =  − 0.107; P = 0.001), mean corpuscular volume (MCV) (r =  − 0.159; P < 0.001), mean corpuscular hemoglobin (r =  − 0.142; P < 0.001), and basophils (r =  − 0.091; P = 0.007). All analyzed parameters remained within normal clinical range. Multivariable regression identified hemoglobin, MCV, and basophils to be independent predictors of mean SpO2 and AHI.

Conclusion

Hemoglobin, MCV, and basophils were independently associated with intermittent hypoxia defined by mean SpO2 and AHI. Adding CBC parameters to other screening tools for OSA may have additional value due to its association with changes in mean SpO2.

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Abbreviations

CBC:

Complete blood count

AHI:

Apnea–hypopnea index

OSA:

Obstructive sleep apnea

SpO2 :

Oxygen saturation

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Funding

This work was funded by University Health Network Foundation and the Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Emer Cummins, Rida Waseem, Deween Piyasena, Colin Suen, Jean Wong & Frances Chung

  2. University of Malaya, Kuala Lumpur, Malaysia

    Chew Yin Wang

  3. Centre of Sleep Health and Research, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada

    Clodagh Ryan

  4. Department of Anesthesia and Pain Management, Women’s College Hospital, University of Toronto, Toronto, ON, Canada

    Jean Wong

  5. Yale School of Medicine, New Haven, CT, USA

    Meir Kryger

Authors
  1. Emer Cummins
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  2. Rida Waseem
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Contributions

Emer Cummins – This author contributed to data collection and interpretation, and writing of the manuscript.

Rida Waseem – This author contributed to data analysis and writing of the manuscript.

Deween Piyasena – This author contributed to data collection and interpretation, and writing of the manuscript.

Chew Yin Wang – This author contributed to data collection and writing of the manuscript.

Colin Suen – This author contributed to writing of the manuscript.

Clodagh Ryan – This author contributed to writing of the manuscript.

Jean Wong – This author contributed to writing of the manuscript.

Meir Kryger – This author contributed to writing of the manuscript.

Frances Chung – This author contributed to study concept and design, data acquisition and interpretation, and writing of the manuscript.

All authors have seen and approved this manuscript.

Corresponding author

Correspondence to Frances Chung.

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Conflict of interest

Frances Chung is supported by Up-to-Date royalties, STOP-Bang questionnaire (proprietary to University Health Network). The rest of the authors declare no competing interests.

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This work was performed at University Health Network, University of Toronto, Ontario, Canada and University of Malaya, Kuala Lumpur, Malaysia

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Cummins, E., Waseem, R., Piyasena, D. et al. Can the complete blood count be used as a reliable screening tool for obstructive sleep apnea?. Sleep Breath 26, 613–620 (2022). https://doi.org/10.1007/s11325-021-02383-3

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  • DOI: https://doi.org/10.1007/s11325-021-02383-3

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