Establishment of a nomogram prediction model for the occurrence of acute ischemic stroke in patients with obstructive sleep apnea-hypopnea syndrome based on inflammatory indicators and clinical characteristics

doi:10.11958/20260206

Abstract

Abstract:

Objective To explore the related risk factors of acute ischemic stroke (AIS) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and construct a nomogram prediction model. Methods A total of 278 OSAHS patients were selected and divided into the AIS group (n=53) and the non-AIS group (n=225) based on whether they had concurrent AIS. The patient age, gender, body mass index (BMI), neck circumference, smoking history, drinking history, underlying medical history, apnea-hypopnea index (AHI), blood biochemical indicators and inflammatory indicators were collected and compared between the two groups. Multiple Logistic regression analysis was used to screen independent risk factors for AIS in OSAHS patients, and a nomogram prediction model was constructed based on the screening results. The model performance was evaluated through the receiver operating characteristic (ROC) curve, calibration curve and decision curve. Results The patient age, BMI, AHI, neck circumference, low-density lipoprotein cholesterol (LDL-C), white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) were significantly higher in the AIS group than those in the non-AIS group, while high-density lipoprotein cholesterol (HDL-C) and the lowest peripheral oxygen saturation (LSpO₂) were significantly lower in the AIS group than those in the non-AIS group (all P<0.05). The levels of inflammatory markers C- reactive protein (CRP), interleukin (IL) -6 and tumor necrosis factor (TNF)-α were significantly higher in the AIS group than those in the non-AIS group (all P<0.05). Multivariate Logistic regression analysis showed that BMI, AHI, neck circumference, WBC, CRP, IL-6 and TNF-α were independent risk factors for AIS in OSAHS patients (all P<0.05). The area under the ROC curve (AUC) of the nomogram prediction model constructed based on the above factors was 0.868 (95% CI: 0.822-0.905). At an optimal cutoff value was 3.411, the specificity was 75.47% and the sensitivity was 83.56%. The calibration curve and Hosmer-Lemeshow test showed good consistency between the predicted values of the model (χ²=7.093，P=0.527) and the actual values. When the decision curve indicated a high-risk threshold>0.08 and intervention was carried out, patients can obtain clinical benefits. Conclusion A nomogram constructed on the basis of inflammatory markers and clinical characteristics demonstrates good predictive performance for AIS in patients with OSAHS, and can serve as a reference for the early clinical identification of high-risk patients and the formulation of intervention strategies.

Key words: sleep apnea, obstructive, ischemic stroke, inflammatory markers, clinical features, predictive model

CLC Number:

R562.1，R743.3

Figures/Tables 7

References 25

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组别	n				年龄/ 岁			性别（男/女）				BMI/ （kg/m²）			吸烟史				饮酒史
非AIS组	225				58.54±7.59			135/90				26.19±2.61			91（40.44）				62（27.56）
AIS组	53				62.26±8.31			38/15				28.65±2.35			28（52.83）				19（35.85）
t或χ²					2.979^＊＊			2.497				6.708^＊＊			2.688				1.429
组别			高血压史				糖尿病史			冠心病史				房颤			AHI/（次/h）
非AIS组			146（64.89）				79（35.11）			81（36.00）				59（26.22）			12.09±3.34
AIS组			41（77.36）				25（47.17）			26（49.06）				13（24.53）			22.15±4.81
χ²或t			3.029				2.664			3.089				0.064			15.949^＊＊
组别		颈围/cm				TC/（mmol/L）					TG/（mmol/L）					HDL-C/（mmol/L）
非AIS组		39.78±1.99				5.23±0.98					1.92±0.64					3.62±0.84
AIS组		42.36±2.57				5.43±1.12					2.11±0.80					3.24±0.71
t		6.841^＊＊				1.300					1.849					3.046^＊＊
组别				LDL-C/（mmol/L）					LSpO₂/%				WBC/（×10⁹/L）					NLR
非AIS组				1.09±0.33					78.65±5.92				6.56±1.82					2.34±0.92
AIS组				1.25±0.24					70.26±6.53				8.72±2.17					3.83±1.28
t				3.327^＊＊					9.098^＊＊				7.482^＊＊					10.558^＊＊

组别	n				年龄/ 岁			性别（男/女）				BMI/ （kg/m²）			吸烟史				饮酒史
非AIS组	225				58.54±7.59			135/90				26.19±2.61			91（40.44）				62（27.56）
AIS组	53				62.26±8.31			38/15				28.65±2.35			28（52.83）				19（35.85）
t或χ²					2.979^＊＊			2.497				6.708^＊＊			2.688				1.429
组别			高血压史				糖尿病史			冠心病史				房颤			AHI/（次/h）
非AIS组			146（64.89）				79（35.11）			81（36.00）				59（26.22）			12.09±3.34
AIS组			41（77.36）				25（47.17）			26（49.06）				13（24.53）			22.15±4.81
χ²或t			3.029				2.664			3.089				0.064			15.949^＊＊
组别		颈围/cm				TC/（mmol/L）					TG/（mmol/L）					HDL-C/（mmol/L）
非AIS组		39.78±1.99				5.23±0.98					1.92±0.64					3.62±0.84
AIS组		42.36±2.57				5.43±1.12					2.11±0.80					3.24±0.71
t		6.841^＊＊				1.300					1.849					3.046^＊＊
组别				LDL-C/（mmol/L）					LSpO₂/%				WBC/（×10⁹/L）					NLR
非AIS组				1.09±0.33					78.65±5.92				6.56±1.82					2.34±0.92
AIS组				1.25±0.24					70.26±6.53				8.72±2.17					3.83±1.28
t				3.327^＊＊					9.098^＊＊				7.482^＊＊					10.558^＊＊

组别	n	CRP/（mg/L）	IL-6/（ng/L）	TNF-α/（ng/L）
非AIS组	225	9.35±2.65	20.87±6.92	14.58±4.82
AIS组	53	12.74±4.26	27.65±8.48	18.35±5.37
t		7.353^＊＊	6.134^＊＊	5.010^＊＊

组别	n	CRP/（mg/L）	IL-6/（ng/L）	TNF-α/（ng/L）
非AIS组	225	9.35±2.65	20.87±6.92	14.58±4.82
AIS组	53	12.74±4.26	27.65±8.48	18.35±5.37
t		7.353^＊＊	6.134^＊＊	5.010^＊＊

变量	β	SE	Wald χ²	P	OR	OR（95%CI）
年龄	0.019	0.046	0.171	0.680	1.019	0.931~1.115
BMI	0.423	0.185	5.228	0.022	1.527	1.062~2.194
AHI	0.598	0.143	17.488	<0.001	1.818	1.374~2.407
颈围	0.556	0.191	8.474	0.004	1.744	1.199~2.535
HDL-C	0.145	0.578	0.063	0.802	1.156	0.372~3.589
LDL-C	-2.906	1.823	2.541	0.111	0.055	0.002~1.949
LSpO₂	-2.141	1.214	3.110	0.078	0.118	0.011~1.269
WBC	0.915	0.272	11.316	0.001	2.497	1.465~4.255
NLR	0.147	0.311	0.223	0.636	1.158	0.630~2.131
CRP	0.299	0.124	5.814	0.016	1.349	1.058~1.720
IL-6	0.125	0.063	3.937	0.047	1.133	1.002~1.282
TNF-α	0.173	0.072	5.773	0.016	1.189	1.032~1.369
常数项	-30.654	11.541	8.201	0.004	<0.001	-