Neutrophil-to-lymphocyte ratio in obstructive sleep apnea; a multi center, retrospective study.

OBJECTIVE: Systemic inflammation is important in pathophysiology of obstructive sleep apnea (OSA) and its comorbidity. Neutrophil to lymphocyte ratio (N/L ratio) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. In this study, we aimed to evaluate the role of N/L ratio in OSA patients and comparing with other well-known inflammatory marker, C-reactive protein (CRP). PATIENTS AND METHODS: We conducted a retrospective analysis of 481 patients with mild, moderate and severe OSA (163,158 and 160 patients, respectively) and leukocyte profiles of 80 sex-, age- and body mass index- matched healthy controls. Patients were excluded if they had underlying cancer, chronic inflammatory disease, any systemic infection, uncontrolled hypertension and diabetes mellitus, a known acute coronary syndrome, valvular heart disease, a known thyroid, renal or hepatic dysfunction. RESULTS: We found that N/L Ratio in severe OSA patients was significantly higher compared with mild, moderate, OSA patients and healthy controls (p < 0.001). However, there was no difference between mild and moderate OSA patients (p = 0.636). There was also no significant difference between mild-moderate OSA patients and healthy groups (p = 0.150). CRP levels were not different in all OSA stages (p = 0.595). By Spearman correlation, there was no correlation between CRP and N/L ratio. CONCLUSIONS: N/L ratio, which is quick, cheap, easily measurable novel inflammatory marker with routine complete blood count analysis, is a surrogate marker of obstructive sleep apnea severity.

Does early enteral feeding of very low birth weight infants increase the risk of necrotizing enterocolitis?

BACKGROUND/OBJECTIVE: In this retrospective study, we intended to test whether early enteral feeding (EEF) of very low birth weight (VLBW) preterm babies increases the risk of necrotizing enterocolitis (NEC) or not. SUBJECTS AND METHODS: Overall, 297 VLBW preterm babies admitted to the neonatal intensive care unit (NICU) between April 2003 and April 2006 were included. The study consisted of two periods: the first period was between April 2003 and October 2004, when babies were not fed enterally until they were extubated (167 preterm VLBWs). The second period was between November 2004 and April 2006, when babies were fed even when they were intubated, starting preferably on the first day of life (130 preterm VLBWs). Criteria for withholding enteral feeding in both periods were hypotension necessitating vasopressor agent use, abdominal distention, abdominal tenderness and suspected or proven NEC. Possible risk factors for NEC were also recorded. RESULTS: The overall incidence of NEC in VLBW preterm babies was 6.7% and did not differ between the two study periods: 7.2% in the late and 6.2% in the EEF regimens. On logistic regression analysis, the most important risk factors associated with NEC were sepsis (P<0.001) and blood culture positivity (P<0.001). The average daily weight gain was significantly higher in the early fed babies (P=0.011). CONCLUSIONS: The EEF of VLBW preterm babies does not increase the risk of NEC. Increased daily weight gain is an important reason to feed these babies earlier.