Clinical Indicators and Neutrophil-to-Lymphocyte Ratio Associated with Moderate-to-Severe Obstructive Sleep Apnea in Patients with Acute Ischemic Stroke: A Single-Center Retrospective Study.

OBJECTIVE

To examine the associations of readily available clinical indicators and the neutrophil-to-lymphocyte ratio (NLR) with moderate-to-severe obstructive sleep apnea (OSA) in patients with acute ischemic stroke and to explore the discriminatory performance of BMI, NLR, and a combination of BMI, snoring, and NLR.

METHODS

This single-center retrospective study included 220 patients with acute ischemic stroke who completed overnight polysomnography during hospitalization between October 2024 and April 2026. Moderate-to-severe OSA was defined as an apnea-hypopnea index ≥15 events/h. Clinical characteristics, laboratory indicators, and polysomnographic parameters were compared between groups. Multivariable logistic regression was used to evaluate factors associated with moderate-to-severe OSA, and receiver operating characteristic analysis assessed discriminatory performance. Spearman correlation and NLR tertile analyses explored the relationships between NLR and sleep-disordered breathing and nocturnal hypoxia.

RESULTS

Moderate-to-severe OSA was present in 109 of 220 patients (49.5%). After multivariable adjustment for prespecified clinical covariates, higher BMI (aOR 1.204, 95% CI 1.088-1.332), snoring (aOR 2.910, 95% CI 1.485-5.705), and higher NLR (aOR 2.291, 95% CI 1.449-3.622) remained associated with moderate-to-severe OSA. Modified Poisson sensitivity analyses yielded consistent associations for BMI, snoring, and NLR. The combined model had an AUC of 0.798 (95% CI, 0.736-0.851), indicating moderate discriminatory ability. Higher NLR was also associated with greater sleep-disordered breathing and nocturnal hypoxia burden.

CONCLUSION

BMI, snoring, and NLR were associated with moderate-to-severe OSA in this single-center acute ischemic stroke cohort. Their combined discriminatory performance was moderate. These observational findings are hypothesis-generating and require prospective multicenter validation before clinical application.