{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:27:44Z","timestamp":1782552464555,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Young people training project from Fujian Province Health Bureau","award":["2022GGA053"],"award-info":[{"award-number":["2022GGA053"]}]},{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"crossref","award":["2022J011474"],"award-info":[{"award-number":["2022J011474"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-00176-2","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T18:17:15Z","timestamp":1751480235000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The neutrophil-to-lymphocyte ratio is associated with increased risk of all-cause mortality in obstructive sleep apnea"],"prefix":"10.1038","volume":"15","author":[{"given":"Xue-Jun","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu-Qiao","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu-Dan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-Qin","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bai-Ling","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-Li","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Ji","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Chao","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Da","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"176_CR1","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","volume":"7","author":"AV Benjafield","year":"2019","unstructured":"Benjafield, A. V. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 7, 687\u2013698. https:\/\/doi.org\/10.1016\/S2213-2600(19)30198-5 (2019).","journal-title":"Lancet Respir Med."},{"key":"176_CR2","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1161\/HYPERTENSIONAHA.111.179788","volume":"58","author":"RP Pedrosa","year":"2011","unstructured":"Pedrosa, R. P. et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 58, 811\u2013817. https:\/\/doi.org\/10.1161\/HYPERTENSIONAHA.111.179788 (2011).","journal-title":"Hypertension"},{"key":"176_CR3","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1056\/NEJM200005113421901","volume":"342","author":"PE Peppard","year":"2000","unstructured":"Peppard, P. E., Young, T., Palta, M. & Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl. J. Med. 342, 1378\u20131384. https:\/\/doi.org\/10.1056\/NEJM200005113421901 (2000).","journal-title":"N Engl. J. Med."},{"key":"176_CR4","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1161\/CIRCRESAHA.118.310783","volume":"122","author":"JS Floras","year":"2018","unstructured":"Floras, J. S. Sleep apnea and cardiovascular disease: an enigmatic risk factor. Circ. Res. 122, 1741\u20131764. https:\/\/doi.org\/10.1161\/CIRCRESAHA.118.310783 (2018).","journal-title":"Circ. Res."},{"key":"176_CR5","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1161\/CIRCULATIONAHA.115.019392","volume":"133","author":"CH Lee","year":"2016","unstructured":"Lee, C. H. et al. Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation 133, 2008\u20132017. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.115.019392 (2016).","journal-title":"Circulation"},{"key":"176_CR6","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.smrv.2018.08.009","volume":"42","author":"J Gaines","year":"2018","unstructured":"Gaines, J., Vgontzas, A. N., Fernandez-Mendoza, J. & Bixler, E. O. Obstructive sleep apnea and the metabolic syndrome: the road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment. Sleep. Med. Rev. 42, 211\u2013219. https:\/\/doi.org\/10.1016\/j.smrv.2018.08.009 (2018).","journal-title":"Sleep. Med. Rev."},{"key":"176_CR7","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1016\/j.chest.2017.05.009","volume":"152","author":"S Reutrakul","year":"2017","unstructured":"Reutrakul, S. & Mokhlesi, B. Obstructive sleep apnea and diabetes: A state of the Art review. Chest 152, 1070\u20131086. https:\/\/doi.org\/10.1016\/j.chest.2017.05.009 (2017).","journal-title":"Chest"},{"key":"176_CR8","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/jamaneurol.2017.2180","volume":"74","author":"Y Leng","year":"2017","unstructured":"Leng, Y., McEvoy, C. T., Allen, I. E. & Yaffe, K. Association of Sleep-Disordered breathing with cognitive function and risk of cognitive impairment: A systematic review and Meta-analysis. JAMA Neurol. 74, 1237\u20131245. https:\/\/doi.org\/10.1001\/jamaneurol.2017.2180 (2017).","journal-title":"JAMA Neurol."},{"key":"176_CR9","doi-asserted-by":"publisher","first-page":"e1000132","DOI":"10.1371\/journal.pmed.1000132","volume":"6","author":"NM Punjabi","year":"2009","unstructured":"Punjabi, N. M. et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 6, e1000132. https:\/\/doi.org\/10.1371\/journal.pmed.1000132 (2009).","journal-title":"PLoS Med."},{"key":"176_CR10","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.2147\/NSS.S379252","volume":"14","author":"B Lechat","year":"2022","unstructured":"Lechat, B. et al. All-Cause mortality in people with Co-Occurring insomnia symptoms and sleep apnea: analysis of the Wisconsin sleep cohort. Nat. Sci. Sleep. 14, 1817\u20131828. https:\/\/doi.org\/10.2147\/NSS.S379252 (2022).","journal-title":"Nat. Sci. Sleep."},{"key":"176_CR11","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1186\/s13054-020-03374-8","volume":"24","author":"X Li","year":"2020","unstructured":"Li, X. et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit. Care. 24, 647. https:\/\/doi.org\/10.1186\/s13054-020-03374-8 (2020).","journal-title":"Crit. Care"},{"key":"176_CR12","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.ajem.2020.12.069","volume":"45","author":"M Seyit","year":"2021","unstructured":"Seyit, M. et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. Am. J. Emerg. Med. 45, 569. https:\/\/doi.org\/10.1016\/j.ajem.2020.12.069 (2021).","journal-title":"Am. J. Emerg. Med."},{"key":"176_CR13","doi-asserted-by":"publisher","first-page":"104598","DOI":"10.1016\/j.mvr.2023.104598","volume":"150","author":"A Garcia-Escobar","year":"2023","unstructured":"Garcia-Escobar, A. et al. Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: new insights for a potential predictor of anti-cytokine therapy responsiveness. Microvasc Res. 150, 104598. https:\/\/doi.org\/10.1016\/j.mvr.2023.104598 (2023).","journal-title":"Microvasc Res."},{"key":"176_CR14","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.lungcan.2017.07.024","volume":"111","author":"S Diem","year":"2017","unstructured":"Diem, S. et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 111, 176\u2013181. https:\/\/doi.org\/10.1016\/j.lungcan.2017.07.024 (2017).","journal-title":"Lung Cancer"},{"key":"176_CR15","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1186\/s12885-017-3893-1","volume":"17","author":"D Liu","year":"2017","unstructured":"Liu, D. et al. High neutrophil-to-lymphocyte ratios confer poor prognoses in patients with small cell lung cancer. BMC Cancer. 17, 882. https:\/\/doi.org\/10.1186\/s12885-017-3893-1 (2017).","journal-title":"BMC Cancer"},{"key":"176_CR16","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-024-08729-3","author":"MK Golen","year":"2024","unstructured":"Golen, M. K., Isik, S. M. & Arikan, V. Is there a relationship between the severity of obstructive sleep apnea syndrome and the systemic immune inflammation index? Eur. Arch. Otorhinolaryngol. https:\/\/doi.org\/10.1007\/s00405-024-08729-3 (2024).","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"176_CR17","doi-asserted-by":"publisher","first-page":"251","DOI":"10.5664\/jcsm.8176","volume":"16","author":"M Al-Halawani","year":"2020","unstructured":"Al-Halawani, M. et al. Treatment of obstructive sleep apnea with CPAP improves chronic inflammation measured by neutrophil-to-lymphocyte ratio. J. Clin. Sleep. Med. 16, 251\u2013257. https:\/\/doi.org\/10.5664\/jcsm.8176 (2020).","journal-title":"J. Clin. Sleep. Med."},{"key":"176_CR18","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.5664\/jcsm.9820","volume":"18","author":"D Patel","year":"2022","unstructured":"Patel, D. et al. Validation of the STOP questionnaire as a screening tool for OSA among different populations: a systematic review and meta-regression analysis. J. Clin. Sleep. Med. 18, 1441\u20131453. https:\/\/doi.org\/10.5664\/jcsm.9820 (2022).","journal-title":"J. Clin. Sleep. Med."},{"key":"176_CR19","doi-asserted-by":"publisher","first-page":"263","DOI":"10.5664\/jcsm.27497","volume":"5","author":"LJ Epstein","year":"2009","unstructured":"Epstein, L. J. et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep. Med. 5, 263\u2013276 (2009).","journal-title":"J. Clin. Sleep. Med."},{"key":"176_CR20","doi-asserted-by":"publisher","first-page":"e427","DOI":"10.1016\/j.bja.2022.12.016","volume":"130","author":"N Bhattacharyya","year":"2023","unstructured":"Bhattacharyya, N., Zorrilla-Vaca, A., Schmitt, M. & Lozada, G. Screening for obstructive sleep Apnoea in the USA: a representative cross-sectional study. Br. J. Anaesth. 130, e427\u2013e428. https:\/\/doi.org\/10.1016\/j.bja.2022.12.016 (2023).","journal-title":"Br. J. Anaesth."},{"key":"176_CR21","doi-asserted-by":"publisher","first-page":"355","DOI":"10.5664\/jcsm.3600","volume":"10","author":"NS Marshall","year":"2014","unstructured":"Marshall, N. S., Wong, K. K., Cullen, S. R., Knuiman, M. W. & Grunstein, R. R. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton health study cohort. J. Clin. Sleep. Med. 10, 355\u2013362. https:\/\/doi.org\/10.5664\/jcsm.3600 (2014).","journal-title":"J. Clin. Sleep. Med."},{"key":"176_CR22","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1001\/jamaoto.2019.0281","volume":"145","author":"Q Lisan","year":"2019","unstructured":"Lisan, Q. et al. Association of positive airway pressure prescription with mortality in patients with obesity and severe obstructive sleep apnea: the sleep heart health study. JAMA Otolaryngol. Head Neck Surg. 145, 509\u2013515. https:\/\/doi.org\/10.1001\/jamaoto.2019.0281 (2019).","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"176_CR23","doi-asserted-by":"publisher","unstructured":"Regolo, M. et al. Neutrophil-to-Lymphocyte ratio (NLR) is a promising predictor of mortality and admission to intensive care unit of COVID-19 patients. J. Clin. Med. 11 https:\/\/doi.org\/10.3390\/jcm11082235 (2022).","DOI":"10.3390\/jcm11082235"},{"key":"176_CR24","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s12933-024-02191-5","volume":"23","author":"X Zhang","year":"2024","unstructured":"Zhang, X. et al. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension. Cardiovasc. Diabetol. 23, 117. https:\/\/doi.org\/10.1186\/s12933-024-02191-5 (2024).","journal-title":"Cardiovasc. Diabetol."},{"key":"176_CR25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.jjcc.2015.06.005","volume":"67","author":"J Oyama","year":"2016","unstructured":"Oyama, J. et al. The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea. J. Cardiol. 67, 295\u2013302. https:\/\/doi.org\/10.1016\/j.jjcc.2015.06.005 (2016).","journal-title":"J. Cardiol."},{"key":"176_CR26","doi-asserted-by":"publisher","first-page":"10862","DOI":"10.1038\/s41598-020-67708-w","volume":"10","author":"MS Rha","year":"2020","unstructured":"Rha, M. S., Kim, C. H., Yoon, J. H. & Cho, H. J. Association between the neutrophil-to-lymphocyte ratio and obstructive sleep apnea: a meta-analysis. Sci. Rep. 10, 10862. https:\/\/doi.org\/10.1038\/s41598-020-67708-w (2020).","journal-title":"Sci. Rep."},{"key":"176_CR27","doi-asserted-by":"publisher","unstructured":"Maniaci, A. et al. Oxidative stress and inflammation biomarker expression in obstructive sleep apnea patients. J. Clin. Med. 10 https:\/\/doi.org\/10.3390\/jcm10020277 (2021).","DOI":"10.3390\/jcm10020277"},{"key":"176_CR28","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.5665\/sleep.3236","volume":"36","author":"LP Israel","year":"2013","unstructured":"Israel, L. P., Benharoch, D., Gopas, J. & Goldbart, A. D. A pro-inflammatory role for nuclear factor kappa B in childhood obstructive sleep apnea syndrome. Sleep 36, 1947\u20131955. https:\/\/doi.org\/10.5665\/sleep.3236 (2013).","journal-title":"Sleep"},{"key":"176_CR29","doi-asserted-by":"publisher","first-page":"647071","DOI":"10.3389\/fcvm.2021.647071","volume":"8","author":"J Chen","year":"2021","unstructured":"Chen, J., Lin, S. & Zeng, Y. An update on obstructive sleep apnea for atherosclerosis: mechanism, diagnosis, and treatment. Front. Cardiovasc. Med. 8, 647071. https:\/\/doi.org\/10.3389\/fcvm.2021.647071 (2021).","journal-title":"Front. Cardiovasc. Med."},{"key":"176_CR30","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12931-018-0727-x","volume":"19","author":"L Li","year":"2018","unstructured":"Li, L. et al. Intermittent hypoxia promotes melanoma lung metastasis via oxidative stress and inflammation responses in a mouse model of obstructive sleep apnea. Respir Res. 19, 28. https:\/\/doi.org\/10.1186\/s12931-018-0727-x (2018).","journal-title":"Respir Res."},{"key":"176_CR31","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.sleep.2023.08.004","volume":"110","author":"B Yu","year":"2023","unstructured":"Yu, B. et al. The neutrophil-to-lymphocyte ratio is a potential biomarker for the occurrence of atrial fibrillation in patients with obstructive sleep apnea: A BIOMARKER OF AF IN OSA PATIENTS. Sleep. Med. 110, 259\u2013267. https:\/\/doi.org\/10.1016\/j.sleep.2023.08.004 (2023).","journal-title":"Sleep. Med."},{"key":"176_CR32","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1152\/physrev.00043.2008","volume":"90","author":"JA Dempsey","year":"2010","unstructured":"Dempsey, J. A., Veasey, S. C. & Morgan, B. J. O\u2019Donnell, C. P. Pathophysiology of sleep apnea. Physiol. Rev. 90, 47\u2013112. https:\/\/doi.org\/10.1152\/physrev.00043.2008 (2010).","journal-title":"Physiol. Rev."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00176-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00176-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00176-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T18:17:15Z","timestamp":1751480235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00176-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,2]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["176"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-00176-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,2]]},"assertion":[{"value":"13 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The National Center for Health Statistics Research Ethics Review Board approved the NHANES protocol and all participants provided informed written consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"23645"}}