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Background <p>Hypoxemia-driven conditions such as chronic lung disease and highaltitude exposure are recognized causes of erythrocytosis. Obstructive sleep apnea (OSA) produces recurrent nocturnal hypoxemia and could theoretically induce polycythemia; however, prior studies using older hemoglobin thresholds reported very low prevalence. Following the 2016 WHO revision lowering diagnostic cut-offs, the true burden of polycythemia in OSA requires reassessment.</p> Objectives <p>To determine the prevalence of polycythemia in treatment-naïve OSA using WHO-2016 criteria and evaluate its association with polysomnographic severity markers.</p> Methods <p>We conducted a retrospective study of consecutive patients diagnosed with OSA diagnosed using AASM 2012 criteria. OSA was defined as AHI &gt; 5/h. Severity indices included AHI, lowest oxygen saturation, and percentage of total sleep time with SpO<sub>2</sub> ≤ 90% (T90). Hemoglobin and hematocrit were retrieved from laboratory records (Mindray BC-6800). Polycythemia was defined by WHO-2016 criteria (Hb &gt; 16&#xa0;g/dL females, &gt; 16.5&#xa0;g/dL males and/or hematocrit &gt; 48% females, &gt; 49% males). Patients with obstructive airway disease (FEV<sub>1</sub>/FVC &lt; 0.7) were excluded.</p> Results <p>Among 925 participants, 105 (11.4%) had polycythemia. Affected patients were predominantly male (87.6%), younger, more frequently smokers, and exhibited greater hypoxemia (lower nadir SpO₂ and higher T90). AHI did not differ between groups. On univariate analysis, age, male sex, smoking, lowest SpO₂, and T90 predicted polycythemia. Multivariable analysis identified male sex and T90 as independent predictors; each 1% increase in T90 increased odds by 2%. Smoking lost significance after adjustment.</p> Conclusions <p>Using WHO-2016 thresholds, polycythemia is relatively common in OSA and is driven by nocturnal hypoxemia burden rather than AHI severity. T90 may be a clinically relevant marker for identifying OSA patients at risk of erythrocytosis.</p>

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Polycythemia in Obstructive Sleep Apnea: Prevalence, Predictors, and Clinical Implications Using WHO 2016 Criteria

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • Abhishek Goyal,
  • Prakhar Agarwal,
  • Alkesh Khurana,
  • Abhijit Pakhare

摘要

Background

Hypoxemia-driven conditions such as chronic lung disease and highaltitude exposure are recognized causes of erythrocytosis. Obstructive sleep apnea (OSA) produces recurrent nocturnal hypoxemia and could theoretically induce polycythemia; however, prior studies using older hemoglobin thresholds reported very low prevalence. Following the 2016 WHO revision lowering diagnostic cut-offs, the true burden of polycythemia in OSA requires reassessment.

Objectives

To determine the prevalence of polycythemia in treatment-naïve OSA using WHO-2016 criteria and evaluate its association with polysomnographic severity markers.

Methods

We conducted a retrospective study of consecutive patients diagnosed with OSA diagnosed using AASM 2012 criteria. OSA was defined as AHI > 5/h. Severity indices included AHI, lowest oxygen saturation, and percentage of total sleep time with SpO2 ≤ 90% (T90). Hemoglobin and hematocrit were retrieved from laboratory records (Mindray BC-6800). Polycythemia was defined by WHO-2016 criteria (Hb > 16 g/dL females, > 16.5 g/dL males and/or hematocrit > 48% females, > 49% males). Patients with obstructive airway disease (FEV1/FVC < 0.7) were excluded.

Results

Among 925 participants, 105 (11.4%) had polycythemia. Affected patients were predominantly male (87.6%), younger, more frequently smokers, and exhibited greater hypoxemia (lower nadir SpO₂ and higher T90). AHI did not differ between groups. On univariate analysis, age, male sex, smoking, lowest SpO₂, and T90 predicted polycythemia. Multivariable analysis identified male sex and T90 as independent predictors; each 1% increase in T90 increased odds by 2%. Smoking lost significance after adjustment.

Conclusions

Using WHO-2016 thresholds, polycythemia is relatively common in OSA and is driven by nocturnal hypoxemia burden rather than AHI severity. T90 may be a clinically relevant marker for identifying OSA patients at risk of erythrocytosis.