Differences and Risk Factors of Peripheral Blood Immune Cells in Patients with Obstructive Sleep Apnea

Figures & data

Figure 1 The screening process of 277 patients.

Table 1 Clinical Characteristics of Snoring Patients

	Total (N=277)	Simple Snoring (N=81)	OSA (N= 196)	Mild (N= 80)	Moderate (N=46)	Severe (N=70)	P^a	P*
Sex							<0.001	<0.001^b,c,d
Male	141 (50.9)	24 (29.6)	117 (59.7)	41 (51.2)	27 (58.7)	49 (70)
Female	136 (49.1)	57 (70.4)	79 (40.3)	39 (48.8)	19 (41.3)	21 (30)
Age (years)	44 (32–59)	35 (28.5–47)	45 (34–61)	45 (31–60)	54 (39.25–66.25)	51.5 (38.75–61.75)	<0.001	<0.001^b,c,d
BMI (kg/m^2)	30 (26–33.9)	32.8 (27–34.6)	29 (25.4–33.2)	29.1 (25–34.3)	29 (26–33.08)	28.2 (26.0–32.13)	0.009	0.063
Comorbidities
Hypertension	87 (31.4)	9 (11.1)	78 (39.8)	23 (28.7)	22 (47.8)	33 (47.1)	<0.001	<0.001^b,c
Coronary disease	16 (5.8)	5 (6.2)	11 (5.6)	3 (3.8)	4 (8.7)	4 (5.7)	1	0.702
Diabetes	44 (15.9)	13 (16)	31 (15.8)	15 (18.8)	10 (21.7)	6 (8.6)	0.962	0.215
COPD	20 (7.2)	4 (4.9)	16 (8.2)	8 (10)	4 (8.7)	4 (5.7)	0.346	0.597
Asthma	16 (5.8)	1 (1.2)	15 (7.7)	9 (11.3)	3 (6.5)	3 (4.3)	0.072	0.045
Smoking	49 (17.7)	6 (7.4)	43 (21.3)	17 (28.3)	13 (26.92)	13 (21.21)	0.004	0.017^c

Notes: Data are presented as median (IQR) or n (%). P^a indicates differences between simple snoring and OSA groups. *The Kruskal–Wallis H-test or Chi-square test (post hoc: Bonferroni). ^bComparison between simple snoring and severe OSA group. ^cComparison between simple snoring and moderate OSA. ^dComparison between simple snoring and mild OSA. Bold values indicate statistical differences. The criteria for hypertension: without the use of antihypertensive drugs, the systolic blood pressure (SBP) in the examination room is ≥ 140 mmHg and/or the diastolic blood pressure (DBP) is ≥ 90 mmHg. The criteria for coronary disease: coronary atherosclerotic heart disease, refers to the heart disease caused by myocardial ischemia, hypoxia or necrosis due to stenosis or occlusion of the lumen caused by coronary atherosclerosis. The criteria for diabetes: fasting plasma glucose ≥ 7.0 mmol/L or 2-h plasma glucose ≥ 11.1 mmol/L during oral glucose tolerance test or glycohemoglobin A1C ≥ 6.5% or in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥ 11.1 mmol/L.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease.

Table 2 Peripheral Blood Immune Cells Expression in Snoring Patients

	Total (N=277)	Simple Snoring (N=81)	OSA (N= 196)	Mild (N= 80)	Moderate (N=46)	Severe (N=70)	P^a	P*
WBC (× 10^9/L)	6.5 (5.3–7.84)	6.49 (5.32–7.75)	6.5 (5.28–7.9)	6.1 (5.1–7.45)	6.4 (5–8.64)	6.56 (5.86–8.07)	0.819	0.459
Neutrophils (× 10^9/L)	3.8 (3.02–4.8)	3.8 (3.15–4.63)	3.8 (2.9–4.81)	3.73 (2.9–4.4)	3.84 (2.8–5.32)	3.97 (3.02–5)	0.777	0.504
Lymphocytes (× 10^9/L)	1.9 (1.43–2.3)	1.92 (1.6–2.43)	1.9 (1.4–2.3)	1.91 (1.4–2.23)	1.88 (1.38–2.23)	1.8 (1.4–2.24)	0.267	0.667
Monocytes (× 10^9/L)	0.47 (0.4–0.6)	0.4 (0.31–0.5)	0.5 (0.4–0.62)	0.47 (0.4–0.6)	0.5 (0.38–0.64)	0.5 (0.4–0.69)	<0.001	0.001^b
Eosinophils (× 10^9/L)	0.125 (0.1–0.2)	0.1 (0.009–0.2)	0.14 (0.1–0.21)	0.1 (0.1–0.2)	0.175 (0.1–0.26)	0.16 (0.1–0.3)	0.127	0.087
Basophils (× 10^9/L)	0.01 (0–0.0475)	0 (0–0.03)	0.02 (0–0.05)	0.01 (0–0.05)	0.02 (0–0.053)	0.02 (0–0.05)	0.012	0.036^c
RBC (× 10^12/L)	4.59 (4.19–4.89)	4.7 (4.3–4.89)	4.55 (4.16–4.89)	4.47 (4.13–4.87)	4.46 (4.05–4.76)	4.67 (4.3–5.1)	0.145	0.029
Hemoglobin (g/L)	137 (127–148)	137 (124.5–147.5)	137.7 (128–149)	136.1 (129.1–145.8)	134.6 (124–146.8)	141 (130–154.6)	0.397	0.102
Platelets (× 10^9/L)	228.5 (188.25–276)	238 (203–283.5)	226 (184–274.5)	238 (190–278)	227.5 (175.75–271)	217.5 (182.75–272.25)	0.175	0.337
NLR	2 (1.54–2.68)	2.06 (1.5–2.49)	2 (1.557–2.7)	1.94 (1.53–2.69)	2.05 (1.47–2.71)	2.05 (1.62–3)	0.375	0.669
PLR	126.78 (100–160.87)	125.52 (101.78–160.45)	127.35 (99.05–160.8)	129.6 (105–169.5)	128.22 (86.5–165.42)	125.12 (93.83–156.12)	0.889	0.649
SII	456.91 (357.75–635.67)	499.38 (359.87–620.52)	456.73 (353.77–666.58)	473.59 (366.36–625.45)	442.1 (332.78–695.04)	451.47 (348.7–667)	0.968	0.992

Notes: Data are presented as median (IQR). P^a indicates differences between simple snoring and OSA groups. *The Kruskal–Wallis H-test (post hoc: Bonferroni). ^bComparison between simple snoring and severe OSA group. ^cComparison between simple snoring and moderate OSA. Bold values indicate statistical differences.

Abbreviations: WBC, white blood cells; RBC, red blood cells; NLR, neutrophils to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic inflammatory index.

Table 3 Polysomnographic Parameters in Snoring Patients

	Total (N=277)	Simple Snoring (N=81)	OSA (N= 196)	Mild (N= 80)	Moderate (N=46)	Severe (N=70)	P^a	P*
AHI	11.8 (3.7–30.75)	1.9 (0.65–3.1)	20.3 (11.05–38.4)	9.75 (7.1–12)	21.75 (18.9–24.43)	45.8 (36.28–61.63)	<0.001	<0.001^e
The longest apnea duration	36.65 (18.28–57)	12.7 (0–24.3)	40.9 (31–62.48)	32 (21.2–40.5)	39.5 (33.6–50.38)	63.55 (48.85–81.18)	<0.001	<0.001^e
The sum of all desaturations	103.5 (46–219.75)	34 (17.5–69.5)	158.5 (84.75–308.25)	85 (63–133)	138.5 (98–200)	329 (216–445.25)	<0.001	<0.001^e
ODI	14.95 (5.88–30.08)	4.8 (2.35–8.35)	21.1 (12.2–42.25)	12.2 (8.5–16)	21.85 (17.63–26.68)	46.35 (30.08–58.43)	<0.001	<0.001^e
Minimum SpO2 (%)	79 (67–86)	85 (73.5–90)	77.5 (65–84.25)	83 (72–88)	78 (71.5–84.25)	68.5 (60–79)	<0.001	<0.001^b
Average SpO2 (%)	95 (93.6–96)	96 (95–97)	94.4 (93–96)	95 (94–96.4)	94 (92.68–95.05)	93 (90.98–95)	<0.001	<0.001^b,c
Maximum heart rate	109 (99–116.75)	110 (100–120)	107 (98–116)	109 (99–117)	109 (104.75–116.5)	103 (95–114)	0.134	0.04^b
Minimum heart rate	51 (43–56)	53 (48–59)	49 (41–54)	50 (43–54)	50.5 (39–56.25)	48 (39.75–52.25)	<0.001	<0.001^b,c,d
Average heart rate	68.25 (63–75.28)	69.2 (62.8–75.1)	67.55 (63–75.3)	67.2 (62.3–74.5)	70 (65.45–77.48)	67.3 (63–75)	0.584	0.164

Notes: Data are presented as median (IQR). P^a indicates differences between simple snoring and OSA groups. *The Kruskal–Wallis H-test (post hoc: Bonferroni). ^bComparison between simple snoring and severe OSA group. ^cComparison between simple snoring and moderate OSA. ^dComparison between simple snoring and mild OSA. ^eComparison between simple snoring, mild, moderate, and severe OSA subgroups. Bold values indicate statistical differences.

Abbreviations: AHI, apnea-hypopnea index; ODI, Oxygen desaturation index.

Table 4 Correlation Between Blood Immune Cells with Clinical and Polysomnographic Parameters in Snoring Patients

		WBC	Neutrophils	Lymphocytes	Monocytes	Eosinophils	Basophils	RBC	Hemoglobin	Platelets	NLR	PLR	SII
Age	r	−0.306	−0.197	−0.493	0.060	0.034	0.032	−0.406	−0.269	−0.412	0.258	0.223	0.015
	P	<0.001	0.001	<0.001	0.317	0.568	0.593	<0.001	<0.001	<0.001	0.000	0.000	0.800
BMI	r	0.192	0.168	0.219	−0.113	0.064	−0.025	0.238	0.148	0.173	−0.052	−0.107	0.036
	P	0.001	0.005	<0.001	0.060	0.292	0.677	0.000	0.013	0.004	0.391	0.075	0.553
Hypertension	r	−0.122	−0.052	−0.259	0.051	0.032	0.117	−0.142	−0.094	−0.307	0.166	0.070	0.012
	P	0.051	0.403	<0.001	0.415	0.604	0.060	0.023	0.130	<0.001	0.008	0.261	0.842
Diabetes	r	0.014	0.066	−0.036	−0.004	−0.069	0.020	0.030	0.011	0.027	0.087	0.065	0.095
	P	0.825	0.296	0.570	0.950	0.277	0.756	0.630	0.856	0.671	0.165	0.304	0.132
COPD	r	−0.012	0.052	−0.232	0.224	0.047	0.009	−0.059	−0.018	−0.091	0.208	0.149	0.136
	P	0.853	0.415	<0.001	<0.001	0.457	0.885	0.357	0.773	0.152	0.001	0.019	0.032
Asthma	r	−0.074	−0.039	−0.143	0.050	0.081	−0.063	−0.026	−0.046	−0.062	0.133	0.102	0.080
	P	0.243	0.535	0.024	0.433	0.204	0.317	0.686	0.471	0.332	0.035	0.107	0.209
Smoking	r	0.089	0.099	−0.054	0.261	0.034	0.005	0.031	0.176	−0.065	0.126	0.050	0.101
	P	0.159	0.117	0.395	<0.001	0.594	0.942	0.623	0.005	0.306	0.045	0.433	0.109
AHI	r	0.087	0.084	−0.050	0.261	0.149	0.120	0.027	0.120	−0.118	0.079	−0.043	−0.004
	P	0.149	0.163	0.407	<0.001	0.013	0.046	0.650	0.046	0.050	0.190	0.478	0.942
The longest apnea duration	r	0.042	0.020	−00.04	0.181	0.119	0.060	0.039	0.115	−0.125	0.034	−0.067	−0.059
	P	0.483	0.746	0.509	0.002	0.047	0.322	0.517	0.055	0.038	0.573	0.268	0.328
The sum of all desaturations	r	0.172	0.163	0.058	0.169	0.081	0.141	0.162	0.184	−0.021	0.087	−0.071	0.062
	P	0.004	0.006	0.335	0.005	0.178	0.019	0.007	0.002	0.723	0.148	0.236	0.305
ODI	r	0.158	0.154	0.030	0.194	0.104	0.136	0.138	0.170	−0.024	0.102	−0.038	0.072
	P	0.008	0.010	0.614	0.001	0.084	0.024	0.022	0.005	0.697	0.089	0.528	0.233
Minimum SpO2	r	−0.130	−0.139	0.020	−0.045	−0.040	−0.038	−0.092	−0.020	−0.016	−0.118	−0.050	−0.117
	P	0.030	0.021	0.742	0.455	0.507	0.527	0.128	0.744	0.793	0.050	0.403	0.051
Average SpO2	r	−0.153	−0.188	0.021	−0.179	−0.045	−0.084	−0.042	−0.110	0.003	−0.122	−0.018	−0.117
	P	0.011	0.002	0.723	0.003	0.455	0.162	0.488	0.067	0.959	0.042	0.763	0.052
Maximum heart rate	r	0.234	0.200	0.203	0.011	−0.054	0.029	0.190	0.046	0.287	−0.027	0.022	0.141
	P	<0.001	0.001	0.001	0.853	0.371	0.63	0.002	0.447	<0.001	0.658	0.715	0.019
Minimum heart rate	r	0.007	0.035	−0.049	−0.085	−0.016	−0.039	0.030	−0.053	0.097	0.069	0.110	0.092
	P	0.902	0.558	0.415	0.157	0.796	0.514	0.622	0.384	0.109	0.249	0.068	0.128
Average heart rate	r	0.275	0.255	0.142	0.096	0.102	−0.005	0.122	−0.032	0.239	0.076	0.032	0.183
	P	<0.001	<0.001	0.018	0.110	0.090	0.929	0.044	0.598	<0.001	0.210	0.600	0.002

Note: Bold values indicate statistical differences.

Abbreviations: WBC, white blood cells; RBC, red blood cells; NLR, neutrophils to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic inflammatory index; BMI, body mass index; COPD, chronic obstructive pulmonary disease; AHI, apnea-hypopnea index; ODI, Oxygen desaturation index.

Table 5 Peripheral Blood Immune Cell Expression in Snoring Patients with and without Clinical Comorbidities

	Hypertension		P	COPD		P	Smoking		P
	With (N=87)	Without		With (N=20)	Without		With (N=49)	Without
WBC (× 10^9/L)	6.12 (4.78–7.39)	6.70 (5.60–7.90)	0.051	6.04 (4.79–8.40)	6.50 (5.30–7.80)	0.852	6.85 (5.60–8.49)	6.35 (5.28–7.70)	0.159
Neutrophils (× 10^9/L)	3.73 (2.80–4.43)	3.80 (3.10–4.80)	0.402	4.14 (2.88–5.61)	3.79 (3.01–4.68)	0.414	3.84 (3.29–5.25)	3.78 (2.90–4.57)	0.117
Lymphocytes (× 10^9/L)	1.65 (1.24–2.11)	2.00 (1.65–2.45)	<0.001	1.43 (1.08–1.69)	1.91 (1.50–2.40)	<0.001	1.90 (1.16–2.30)	1.90 (1.50–2.31)	0.394
Monocytes (× 10^9/L)	0.46 (0.39–0.63)	0.43 (0.40–0.60)	0.414	0.65 (0.45–0.83)	0.41 (0.39–0.60)	<0.001	0.50 (0.43–0.73)	0.41 (0.37–0.58)	<0.001
Eosinophils (× 10^9/L)	0.14 (0.10–0.25)	0.11 (0.10–0.20)	0.603	0.20 (0.10–0.23)	0.12 (0.10–0.20)	0.456	0.15 (0.10–0.27)	0.14 (0.10–0.20)	0.593
Basophils (× 10^9/L)	0.02 (0.00–0.05)	0.00 (0.00–0.04)	0.060	0.01 (0.00–0.05)	0.00 (0.00–0.04)	0.885	0.00 (0.00–0.05)	0.00 (0.00–0.04)	0.942
RBC (× 10^12/L)	4.39 (4.00–4.83)	4.59 (4.32–4.88)	0.023	4.26 (3.86–4.98)	4.56 (4.2–4.85)	0.356	4.55 (4.18–4.87)	4.57 (4.16–4.84)	0.622
Hemoglobin (g/L)	133.00 (123.98–147.33)	137.70 (129.30–147.00)	0.130	133.70 (124.80–148.75)	137.00 (126.63–146.88)	0.772	143.00 (133.70–152.70)	135.00 (125.00–145.05)	0.005
Platelets (× 10^9/L)	201.00 (170.00–242.75)	246.00 (207.00–286.00)	<0.001	215.50 (177.25–233.25)	230.50 (188.00–277.00)	0.152	219.00 (191.50–260.50)	231.00 (187.75–279.00)	0.305
NLR	2.22 (1.57–3.30)	1.94 (1.53–2.41)	0.008	2.86 (2.25–4.55)	1.97 (1.52–2.47)	0.001	2.26 (1.62–3.02)	1.97 (1.52–2.47)	0.045
PLR	131.33 (98–171.25)	125.52 (99.64–158.50)	0.259	173.79 (107.86–211.01)	125.62 (98.69–158.55)	0.019	129.60 (95.70–181.11)	126.64 (99.18–158.75)	0.432
SII	463.79 (313.86–680.79)	465.95 (364.00–612.89)	0.841	609.72 (436.03–1076.48)	453.43 (351.28–622.41)	0.032	522.84 (356.97–697.59)	453.36 (349.81–617.13)	0.109

Notes: Data are presented as median (IQR). Bold values indicate statistical differences.

Abbreviations: WBC, white blood cells; RBC, red blood cells; NLR, neutrophils to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic inflammatory index; COPD, chronic obstructive pulmonary disease.

Table 6 Multiple Linear Regression Analysis for Peripheral Blood Monocyte Count in Snoring Patients

Variables	β	P	R^2	P-value of Model
Age	−0.011	0.882	0.139	<0.001
BMI	−0.034	0.611
AHI	0.314	0.005
COPD	0.150	0.029
Smoking	0.189	0.004
The longest apnea duration	0.018	0.814
ODI	−0.157	0.137
Minimum SPO2	0.093	0.196
Average SPO2	−0.131	0.096
Maximum heart rate	0.161	0.015
Minimum heart rate	0.022	0.724

Note: Bold values indicate statistical differences.

Abbreviations: BMI, body mass index; AHI, apnea-hypopnea index; COPD, chronic obstructive pulmonary disease; ODI, Oxygen desaturation index.

Table 7 Multiple Linear Regression Analysis for Peripheral Blood Basophil Count in Snoring Patients

Variables	β	P	R^2	P-value of Model
AHI	−0.058	0.581	0.002	0.053
Asthma	−0. 082	0.198
Smoking	0.044	0.493
The longest apnea duration	−0.039	0.631
ODI	0.163	0.105

Abbreviations: AHI, apnea-hypopnea index; ODI, Oxygen desaturation index.