{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:40:26Z","timestamp":1773268826933,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the prognostic association of baseline red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and their combined index with 3-year composite cardiovascular events in moderate-to-severe obstructive sleep apnea (OSA) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study enrolled 620 patients with moderate-to-severe OSA (AHI\u202f\u2265\u202f15 events\/h) from 2020\u20132022. Participants were categorized by baseline medians into low-risk (both low), intermediate-risk (one high), and high-risk (both high) groups. The primary outcome was composite cardiovascular events. Cox regression, ROC curves, NRI, and IDI assessed predictive performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During median follow-up of 36.2\u202fmonths, 72 events occurred (11.6% rate). Each 1% increase in RDW (HR\u202f=\u202f1.32, 95% CI: 1.15\u20131.52) and each 1-unit increase in NLR (HR\u202f=\u202f1.41, 95% CI: 1.20\u20131.66) were independently associated with cardiovascular events (both\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The high-risk group showed 2.98-fold higher risk than low-risk group (HR\u202f=\u202f2.98, 95%CI: 1.36\u20136.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006) with significant dose\u2013response relationship (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002). The combined RDW-NLR index showed better discrimination (AUC\u202f=\u202f0.73, 95%CI: 0.65\u20130.81) compared with RDW alone (0.65) or NLR alone (0.67). Adding the combined index to traditional risk factors and OSA parameters significantly improved reclassification (NRI\u202f=\u202f0.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001; IDI\u202f=\u202f0.032,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.009). The association was more pronounced in patients aged \u226560\u202fyears, males, and those with poor CPAP adherence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combined RDW-NLR index is a simple, accessible prognostic marker of cardiovascular events in moderate-to-severe OSA patients, providing additional risk stratification value beyond traditional risk factors for clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1799058","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:52:42Z","timestamp":1773211962000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined red blood cell distribution width and neutrophil-to-lymphocyte ratio and risk of composite cardiovascular events in patients with moderate-to-severe obstructive sleep apnea: a prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Ningzhen","family":"Li","sequence":"first","affiliation":[{"name":"Respiratory and Critical Care Medicine Ward 2, Xinxiang Central Hospital","place":["Xinxiang, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongtao","family":"Liu","sequence":"additional","affiliation":[{"name":"Respiratory and Critical Care Medicine Ward 2, Xinxiang Central Hospital","place":["Xinxiang, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linlin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Respiratory and Critical Care Medicine Ward 2, Xinxiang Central Hospital","place":["Xinxiang, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingjing","family":"Chang","sequence":"additional","affiliation":[{"name":"Respiratory and Critical Care Medicine Ward 2, Xinxiang Central Hospital","place":["Xinxiang, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhong","family":"Xia","sequence":"additional","affiliation":[{"name":"Respiratory and Critical Care Medicine Ward 2, Xinxiang Central Hospital","place":["Xinxiang, Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"387","DOI":"10.3390\/life13020387","article-title":"A scoping review of sleep Apnea: where do we 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