Predictors of obstructive sleep apnea syndrome in bronchial asthma patients: investigating the obesity–inflammation interplay through LEP, IL-6, and NLR
Main Article Content
Keywords
bronchial asthma, interleukin-6, leptin, neutrophil-to-lymphocyte ratio, predictors
Abstract
Background: Bronchial asthma (BA) frequently coexists with obstructive sleep apnea syndrome (OSAS). The obesity–inflammation axis may underlie this overlap, but pragmatic predictors and biomarker utility remain incompletely defined.
Objective: To identify clinical predictors of OSAS in BA and evaluate the diagnostic performance of leptin (LEP), interleukin-6 (IL-6), and neutrophil-to-lymphocyte ratio (NLR), individually and in combination.
Materials and Methods: In a prospective study, 263 adults with BA were enrolled and classified into OSAS (n=124) and non-OSAS (n=139) groups by polysomnography. The OSAS group was stratified by apnea–hypopnea index (AHI) into mild (n=59), moderate (n=42), and severe (n=23). Clinical variables were compared with univariate tests. Independent predictors were identified using binary logistic regression. Serum LEP and IL-6 (immunoassays) and NLR (hematology) were measured. Biomarker–AHI relationships were assessed by Spearman’s correlation. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves and DeLong’s test.
Results: On univariate analysis, OSAS cases were older and more often male, with higher rates of obesity, severe BA, neck circumference >40 cm, rhinitis, and gastroesophageal reflux disease (GERD). Logistic regression confirmed obesity, severe BA, neck circumference >40 cm, rhinitis, and GERD as independent predictors. LEP, IL-6, and NLR were significantly higher in OSAS than non-OSAS and increased progressively across AHI strata. LEP correlated strongly with IL-6, IL-6 with NLR, and LEP with NLR to a lesser extent (all P<0.001). For diagnosing BA–OSAS, AUCs were 0.746 (LEP), 0.771 (IL-6), 0.742 (NLR), and 0.826 for their combination, which outperformed individual markers (DeLong, P<0.05).
Conclusion: Obesity, neck circumference >40 cm, severe BA, rhinitis, and GERD independently predict OSAS in BA. LEP, IL-6, and NLR correlate with OSAS severity, and their combined use provides superior diagnostic value for identifying BA–OSAS comorbidity and may aid targeted screening and referral. (≈240 words)
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