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A retrospective analysis was conducted on 216 patients who underwent polysomnography (PSG) between January 2018 and February 2023. Patients were divided into two groups according to the apnea-hypopnea index (AHI): severe OSAS (<jats:italic>n<\/jats:italic>\u2009= 131) and non-severe OSAS (<jats:italic>n<\/jats:italic>\u2009= 85). Comparisons were performed between the two groups regarding baseline characteristics, AHI, minimum blood oxygen saturation (MinSaO\u2082), and hematological parameters including white blood cell (WBC) count, red blood cell (RBC) count, platelet count (PLT), hemoglobin (Hb), red blood cell distribution width (RDW), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and HRR. Correlation analyses were conducted to assess relationships between AHI, MinSaO\u2082, and HRR in the severe OSAS group. Receiver operating characteristic (ROC) curve analysis revealed that HRR had an area under the curve (AUC) of 0.84 for predicting severe OSAS, with a sensitivity of 81.68%, specificity of 72.94%, and 95% confidence interval (CI) of 0.784\u20130.886. The levels of AHI, MinSaO\u2082, Hb, and HRR were significantly higher in the severe OSAS group. Elevated AHI levels may indicate an increased risk of severe OSAS. HRR may serve as an early predictive biomarker for severe OSAS, facilitating timely intervention and potentially reducing complication risks.<\/jats:p>","DOI":"10.1038\/s41598-025-96693-1","type":"journal-article","created":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T04:54:58Z","timestamp":1744433698000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical significance of the hemoglobin-to-red blood cell distribution width ratio in patients with severe OSAS"],"prefix":"10.1038","volume":"15","author":[{"given":"Ni","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangcai","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peijun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,12]]},"reference":[{"key":"96693_CR1","unstructured":"Fr\u00e9d\u00e9ric, R. et al. 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