Hemoglobin–albumin–lymphocyte–platelet score as a marker of systemic inflammatory burden and disease severity in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a condition characterized by hypoxemia or arousal associated with apnea or hypopnea due to partial or complete collapse of the upper airway. OSA also induces endothelial dysfunction through hypoxic stress and enhances systemic inflammation. HALP (Hemoglobin-Albumin-Lymphocyte-Platelet) score has recently gained prominence as a biomarker for endothelial dysfunction and inflammation. Therefore, this study aimed to evaluate the relationship between HALP score and the diagnosis and severity of OSA. This retrospective, single-center study included 116 patients with OSA, classified as mild, moderate, or severe OSA, and 66 age- and sex-matched controls. Participants underwent overnight polysomnography, and OSA severity was defined using the apnea–hypopnea index (AHI). Laboratory parameters were obtained from routine blood tests, and HALP score was calculated accordingly. Group comparisons were performed, and univariable/multivariable logistic regression analyses were used to identify independent predictors of OSA. Receiver operating characteristic (ROC) analysis assessed the ability of HALP score to discriminate severe OSA. Compared with controls, patients with OSA had significantly higher BMI, systolic blood pressure, hs-CRP, WBC, neutrophil count, platelet count, and neutrophil-to-lymphocyte ratio (NLR). In contrast, albumin, lymphocyte count, and HALP score were significantly lower (all p < 0.05). In multivariable analysis, the HALP score was independently associated with OSA (OR 0.76, p = 0.02) in a model that also included clinical covariates, and NLR was independently associated with OSA (OR 1.99, p = 0.03) in a separate model. For severe OSA, the HALP score (OR 0.74, p = 0.02) and NLR (OR 1.91, p = 0.02) likewise remained independent predictors in their respective models. The HALP score showed good discriminative performance for severe OSA in this cohort (AUC = 0.84), with an exploratory cut-off of <22.2 (sensitivity 82.5%, specificity 78%) that requires external validation. HALP score is independently associated with OSA and severity. HALP score may provide clinically useful discrimination for severe OSA and warrants further validation in prospective studies.