Abstract
ImportancePeripheral blood inflammatory indices provide a noninvasive and cost-effective means to assess systemic inflammation. This study highlights the potential of pan-immune-inflammation value (PIV) as a reliable biomarker for obstructive sleep apnea (OSA) severity, with implications for clinical risk stratification.ObjectiveTo evaluate the association between peripheral blood inflammatory markers and OSA severity and identify predictive biomarkers for disease classification.DesignProspective observational study.SettingSingle tertiary academic medical center (Peking University Third Hospital), outpatient sleep clinic.Participants266 adults with snoring (18-70 years) undergoing sleep monitoring, laryngoscopy, and blood tests. Exclusion criteria included recent infection, systemic illness, surgery, or pregnancy.Intervention or ExposuresNo therapeutic intervention was performed. Exposures included varying severities of OSA and soft palate obstruction assessed by the Müller maneuver. Inflammatory indices (PIV, SIRI, SIL, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio [MLR], and platelet-to-lymphocyte ratio) were calculated from routine blood parameters.Main Outcome MeasuresThe primary outcome was the association between inflammatory indices and OSA severity as measured by apnea-hypopnea index (AHI). Secondary outcome was the correlation between inflammatory markers and soft palate-level obstruction.ResultsPIV and SIRI were significantly elevated in severe OSA cases (P = .001 and P = .012, respectively). PIV was independently associated with AHI severity (OR = 1.010, 95% CI [1.003, 1.017]). PIV and SIRI positively correlated with AHI (r = .236 and r = .218, both P < .001). MLR, PIV, and SIRI levels increased with greater soft palate collapse, though not independently predictive in multivariate analysis.ConclusionsPIV is an independent, accessible biomarker for assessing OSA severity. Composite indices (PIV, SIRI) may better reflect systemic inflammation than traditional single markers and could complement clinical phenotyping of OSA.RelevanceThese findings support the use of composite inflammatory indices in OSA phenotyping and prognosis. Future studies should investigate inflammation-targeted strategies and validate these biomarkers in larger, multicenter cohorts.Level of Evidence:3.