Association between Advanced Lung Cancer Inflammation Index and mortality in US adults with obstructive sleep apnea

Reliable prognostic markers are needed to improve risk assessment in obstructive sleep apnea (OSA). The Advanced Lung Cancer Inflammation Index (ALI), which integrates inflammatory and nutritional status, may offer additional prognostic insight, yet evidence in OSA remains scarce. This study investigated the association between ALI and mortality in U.S. adults with OSA. We analyzed 4 cycles of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 and 2015 to 2018, linked to the National Death Index, and included 7591 adults aged ≥ 20 years with questionnaire-defined OSA. Examination weights were applied to account for the complex sampling design. Natural log-transformed Advanced Lung Cancer Inflammation Index (lnALI) was evaluated both continuously and by quartiles. Associations with all-cause and cardiovascular mortality were estimated using Cox proportional hazards models, accompanied by dose-response, subgroup, and sensitivity analyses to assess the pattern and robustness of associations. Higher lnALI was consistently associated with lower mortality. Fully adjusted models showed reduced risks of all-cause mortality (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.55-0.78) and cardiovascular mortality (HR = 0.44; 95% CI: 0.31-0.64). Mortality was generally lower in higher lnALI quartiles, with significant trends across quartiles (P for trend < .001). Dose-response analyses revealed a nonlinear inverse pattern for all-cause mortality and a steadier decline for cardiovascular mortality. Findings were stable across subgroups and sensitivity analyses. Higher lnALI values were significantly associated with lower all-cause and cardiovascular mortality in adults with OSA.