title: Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study.
abstract: BACKGROUND
  Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Although monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality, no study has attempted to determine the role of MHR in cardiovascular morbidity of patients with OSAS. We aimed to investigate the association between MHR and CVD in patients with OSAS and the relationship between severity of OSAS, polysomnographic parameters, and MHR.
  
  
  METHODS
  In this cohort study, patients who had undergone a full-night polysomnography for the diagnosis of OSAS were recruited. Included patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-15), moderate (15-30), and severe (>30) OSAS. Patients with AHI < 5 served as the control group. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD.
  
  
  RESULTS
  A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65, and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, P < .001). The MHRs were significantly correlated with AHI, oxygen desaturation index, and minimum O2saturation values ( P < .001). Values of MHR were significantly higher in patients with CVD compared with those without ( P < .001). Multiple regression analysis demonstrated that MHR is an independent predictor of CVD.
  
  
  CONCLUSIONS
  The MHR is strongly associated with CVD and the severity of OSAS and might be used as a biomarker to predict CVD in patients with OSAS.
authors.affiliation: 1 Faculty of Medicine, Department of Pulmonary Diseases, Gaziosmanpasa University, Tokat, Turkey.
authors.forename: Handan
authors.initials: H
authors.lastname: Inonu Koseoglu
authors.affiliation: 2 Department of Pulmonary Diseases, Elbistan State Hospital, Kahramanmaras, Turkey.
authors.forename: Ahmet Cemal
authors.initials: AC
authors.lastname: Pazarli
authors.affiliation: 3 Department of Pulmonary Diseases, İstanbul Medeniyet University, İstanbul, Turkey.
authors.forename: Asiye
authors.initials: A
authors.lastname: Kanbay
authors.affiliation: 4 Faculty of Medicine, Department of Biostatistics and Medical Informatics, Gaziosmanpasa University, Tokat, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Demir
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL
keywords: HDL cholesterol; cardiovascular disease; monocyte; monocyte/HDL cholesterol ratio; obstructive sleep apnea syndrome