Retrospective Cohort Study of Peripheral Blood miR-486-3p Levels in Patients with Acute Cerebral Infarction and Obstructive Sleep Apnea Syndrome

Acute cerebral infarction (ACI) complicated with obstructive sleep apnea syndrome (OSAS) confers a high risk of stroke recurrence and death, yet effective biomarkers for this comorbid condition remain limited. This retrospective cohort study enrolled 270 patients with ACI between November 2020 and December 2023, who were classified into the ACI group (n = 100, apnea‑hypopnea index [AHI] < 5) and the ACI with OSAS group (n = 170, AHI ≥ 5), with the latter further stratified into mild (5 ≤ AHI < 15, n = 60), moderate (15 ≤ AHI < 30, n = 75), and severe (AHI ≥ 30, n = 35) subgroups. Serum miR‑486‑3p expression was measured by RT‑qPCR, and inflammatory markers, including tumor necrosis factor‑α (TNF‑α), C‑reactive protein (CRP), and hypoxia‑inducible factor‑1α (HIF‑1α), were quantified by ELISA. The diagnostic value of miR‑486‑3p was evaluated using receiver operating characteristic curve analysis, and its prognostic significance was assessed through Kaplan‑Meier survival analysis and Cox regression models. miR-486-3p was markedly lower in the comorbid group and demonstrated strong diagnostic ability (AUC = 0.927). Notably, a clear dose‑dependent trend was observed across OSAS severity subgroups, with miR‑486‑3p decreasing progressively and TNF‑α and CRP increasing stepwise from mild to severe OSAS. Spearman correlation analyses revealed that miR‑486‑3p was negatively correlated with AHI, NIHSS score, TNF‑α, and CRP. At 1‑year follow‑up, patients with low miR‑486‑3p expression had significantly worse functional outcomes compared with those with high expression. Multivariate Cox regression confirmed miR‑486‑3p as an independent protective factor for 1‑year prognosis. These findings suggest that miR‑486‑3p may serve as a novel diagnostic and prognostic biomarker for ACI patients with OSAS, potentially through its regulatory role in systemic inflammation, and warrant further validation in larger prospective cohorts.