Associations between hematological inflammatory markers, infarct volume, and stroke severity in patients with obstructive sleep apnea and anterior circulation non-large artery occlusion

Abstract

Background: Neuroinflammatory processes are recognized as critical contributors to the pathophysiology of acute ischemic stroke (AIS). Hematological inflammatory markers have demonstrated a strong association with the progression and clinical prognosis of AIS.

Methods: A retrospective review was conducted on the clinical records of patients with AIS involving the anterior circulation without evidence of large artery occlusion (LAO) who received treatment at a single institution between January 2019 and September 2021. Participants were stratified according to the presence or absence of obstructive sleep apnea (OSA) prior to stroke onset. Multiple linear regression models were applied to evaluate the relationships among hematological inflammatory markers, vascular risk factors, infarct volume, and stroke severity.

Results: Infarct volume demonstrated a significantly positive association with both the systemic immune-inflammation index (SII) (p = 0.002) and mean platelet volume (MPV) (p = 0.03). Stroke severity at the time of hospital admission demonstrated a significant negative association with pre-stroke OSA history (p = 0.026) and the monocyte-to-lymphocyte ratio (MLR) (p = 0.002), and a significant positive association with neutrophil count (p < 0.001) and platelet distribution width (PDW) (p = 0.048). No statistically significant relationship was identified between the SII and stroke severity, or between a history of pre-stroke OSA and infarct volume.

Conclusion: Elevated levels of SII and MPV may be independently associated with increased infarct volume in patients with AIS. However, our findings did not reveal an association between pre-stroke OSA with increased infarct volume or greater stroke severity at presentation.