milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2026.4.24milmed-768Research ArticleОРИГИНАЛЬНЫЕ НАУЧНЫЕ ПУБЛИКАЦИИ. Лечебно-профилактические вопросыORIGINAL SCIENTIFIC PUBLICATIONS. Medical and preventive questionsДиагностическая значимость индекса системного воспаления у пациентов с фибрилляцией предсердий и синдромом обструктивного апноэ во снеDiagnostic value of systemic inflammatory index in atrial fibrillation patients with concomitant obstructive sleep apneaМакарцоваТ. И.MakartsovaT. I.

Гродно

Grodno

ШишкоВ. И.ShyshkoV. I.

Гродно

Grodno

УО «Гродненский государственный медицинский университет»БеларусьEducational Establishment «Grodno State Medical University»Belarus202627102026042430Copyright © Макарцова Т.И., Шишко В.И., 20262026Макарцова Т.И., Шишко В.И.Makartsova T.I., Shyshko V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/768

Синдром обструктивного апноэ во сне (СОАС) относится не только к одному из факторов риска фибрилляции предсердий (ФП), но и к одной из причин непосредственного прогрессирования данной аритмии, приводящей нередко к летальному исходу. Воспалению отводится существенная роль в патогенезе как ФП так и СОАС. Исследование прогностического потенциала некоторых лабораторно-гематологических индексов воспаления у пациентов с фенотипом ФП и СОАС остается предметом дискуссий.  В настоящей статье на основании регрессионного анализа клинических, инструментальных показателей и лабораторных биомаркеров, отражающих патофизиологические механизмы развития и прогрессирования ФП при СОАС, выявлена совокупность независимых детерминант рецидивирования ФП (индекс системного воспаления, размер левого предсердия, фракция выброса левого желудочка, индекс апноэ/гипопноэ) и разработана математическая модель для прогнозирования возврата аритмии в однолетний срок после электроимпульсой терапии у данной категории пациентов: при расчетном значении уравнения 0,499 и более прогнозируется высокая вероятность наступления рецидива ФП с чувствительностью 82,35 %, специфичностью 86,21 %. Этот персонифицированный подход способствует решению задачи прогнозирования течения ФП у конкретного пациента (выделению тех лиц, которым угрожает дальнейшее прогрессирование аритмии) и дает возможность ориентировать клинициста на выбор оптимальной обоснованной терапии ФП при сопутствующем СОАС. 

It is a firmly established fact that obstructive sleep apnea syndrome (OSAS) is the etiologic factor of atrial fibrillation (AF). Inflammation plays a significant role in the pathogenesis and progression of AF. The prognostic potential of some laboratory-hematologic indices of inflammation in patients with AF and OSAS phenotype remains a matter of debate. In the present article, based on regression analysis of clinical, instrumental indices and laboratory biomarkers, the authors have been performed on the prediction of AF progression in particular group of patients with concomitant OSAS by developing composite risk mathematical model. The calculated  value of 0,499 and more predicts a high probability of АF recurrence with sensitivity of 82,35 % and specificity  of 86,21 %. This personalized approach helps to solve the problem of predicting AF recurrence in a particular patient and makes it possible to guide the doctor to choose the optimal reasonable therapy to maintain the sinus rhythm in AF patients with concomitant OSAS.

синдром обструктивного апноэ во снефибрилляция предсердийиндекс системного воспаленияпрогнозobstructive sleep apneaatrial fibrillationsystemic immune-inflammation indexReferencesVan Gelder, I. C., Rienstra, M., Bunting, K. V. et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–3414. https://doi.org/10.1093/eurheartj/ehae176Van Gelder, I. C., Rienstra, M., Bunting, K. V. et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–3414. https://doi.org/10.1093/eurheartj/ehae176Bizhanov, K. A., Аbzaliyev, K. B., Baimbetov, A. K., Sarsenbayeva, A. B., Lyan, E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). J Cardiovasc Electrophysiol. 2023;34(1):153–165.https://doi.org/10.1111/jce.15759Bizhanov, K. A., Аbzaliyev, K. B., Baimbetov, A. K., Sarsenbayeva, A. B., Lyan, E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). J Cardiovasc Electrophysiol. 2023;34(1):153–165.https://doi.org/10.1111/jce.15759Harada, M., Nattel, S. Implications of Inflammation and Fibrosis in Atrial Fibrillation Pathophysiology. Card Electrophysiol Clin. 2021;13(1):25–35. https://doi.org/10.1016/j.ccep.2020.11.002Harada, M., Nattel, S. Implications of Inflammation and Fibrosis in Atrial Fibrillation Pathophysiology. Card Electrophysiol Clin. 2021;13(1):25–35. https://doi.org/10.1016/j.ccep.2020.11.002Yu, B., Wei, J., Zhao, J., et al. The neutrophil-to-lymphocyte ratio is a potential biomarker for the occurrence of atrial fibrillation in patients with obstructive sleep apnea: A BIOMARKER OF AF IN OSA PATIENTS. Sleep Med. 2023; 110:259–267. https://doi.org/10.1016/j.sleep.2023.08.004Yu, B., Wei, J., Zhao, J., et al. The neutrophil-to-lymphocyte ratio is a potential biomarker for the occurrence of atrial fibrillation in patients with obstructive sleep apnea: A BIOMARKER OF AF IN OSA PATIENTS. Sleep Med. 2023; 110:259–267. https://doi.org/10.1016/j.sleep.2023.08.004Kadhim, K., Middeldorp, M. E., Elliott, A. D., et al. Prevalence and Assessment of Sleep-Disordered Breathing in Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis. Can J Cardiol. 2021;37(11):1846–1856. https://doi.org/10.1016/j.cjca.2021.09.026Kadhim, K., Middeldorp, M. E., Elliott, A. D., et al. Prevalence and Assessment of Sleep-Disordered Breathing in Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis. Can J Cardiol. 2021;37(11):1846–1856. https://doi.org/10.1016/j.cjca.2021.09.026Starkey, S. Y., Jonasson, D. R., Alexis, S. et al. Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What’s the Best Test? CJC Open. 2020;3(4):442–449.https://doi.org/10.1016/j.cjco.2020.09.026Starkey, S. Y., Jonasson, D. R., Alexis, S. et al. Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What’s the Best Test? CJC Open. 2020;3(4):442–449.https://doi.org/10.1016/j.cjco.2020.09.026Zhang, D., Ma, Y., Xu, J., Yi, F. Association between obstructive sleep apnea (OSA) and atrial fibrillation (AF): A dose-response meta-analysis. Medicine (Baltimore). 2022; 101(30):e29443. https://doi.org/10.1097/MD.0000000000029443Zhang, D., Ma, Y., Xu, J., Yi, F. Association between obstructive sleep apnea (OSA) and atrial fibrillation (AF): A dose-response meta-analysis. Medicine (Baltimore). 2022; 101(30):e29443. https://doi.org/10.1097/MD.0000000000029443Nadeem, R., Molnar, J., Madbouly, E. M., Nida, M., Aggarwal S., Sajid, H., Naseem, J., Loomba, R. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med. 2013;9(10):1003–12. https://doi.org/10.5664/jcsm.3070Nadeem, R., Molnar, J., Madbouly, E. M., Nida, M., Aggarwal S., Sajid, H., Naseem, J., Loomba, R. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med. 2013;9(10):1003–12. https://doi.org/10.5664/jcsm.3070Shao, Q., Chen, K., Rha, S. W., Lim, H. E., Li, G., Liu, T. Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Atrial Fibrillation: A Meta-analysis. Arch Med Res. 2015; 46(3):199–206. https://doi.org/10.1016/j.arcmed.2015.03.011Shao, Q., Chen, K., Rha, S. W., Lim, H. E., Li, G., Liu, T. Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Atrial Fibrillation: A Meta-analysis. Arch Med Res. 2015; 46(3):199–206. https://doi.org/10.1016/j.arcmed.2015.03.011Jin, Z., Wu, Q., Chen, S., et al. The Associations of Two Novel Inflammation Indexes, SII and SIRI with the Risks for Cardiovascular Diseases and All-Cause Mortality: A Ten-Year Follow-Up Study in 85,154 Individuals. J Inflamm Res. 2021;14:131–140. https://doi.org/10.2147/JIR.S283835Jin, Z., Wu, Q., Chen, S., et al. The Associations of Two Novel Inflammation Indexes, SII and SIRI with the Risks for Cardiovascular Diseases and All-Cause Mortality: A Ten-Year Follow-Up Study in 85,154 Individuals. J Inflamm Res. 2021;14:131–140. https://doi.org/10.2147/JIR.S283835Sayın, M. R., Özderya, A., Konuş, A. H. et al. The use of systemic immune-inflammation index to predict new onset atrial fibrillation in the context of acute coronary syndrome. Kardiologiia. 2022;62(8):59–64. https://doi.org/10.18087/cardio.2022.8.n1986Sayın, M. R., Özderya, A., Konuş, A. H. et al. The use of systemic immune-inflammation index to predict new onset atrial fibrillation in the context of acute coronary syndrome. Kardiologiia. 2022;62(8):59–64. https://doi.org/10.18087/cardio.2022.8.n1986Naser, A., Sayilan, S., Güven, O., et al. Inflammation Burden and Atrial Fibrillation Burden: A Bidirectional Relationship. Arq Bras Cardiol. 2024;121(6):e20230680. Portuguese, English. https://doi.org/10.36660/abc.20230680Naser, A., Sayilan, S., Güven, O., et al. Inflammation Burden and Atrial Fibrillation Burden: A Bidirectional Relationship. Arq Bras Cardiol. 2024;121(6):e20230680. Portuguese, English. https://doi.org/10.36660/abc.20230680Zhao, Z., Jiang, B., Zhang, F. et al. Association between the systemic immune-inflammation index and outcomes among atrial fibrillation patients with diabetes undergoing radiofrequency catheter ablation. Clin Cardiol. 2023; 46(11):1426–1433. https://doi.org/10.1002/clc.24116Zhao, Z., Jiang, B., Zhang, F. et al. Association between the systemic immune-inflammation index and outcomes among atrial fibrillation patients with diabetes undergoing radiofrequency catheter ablation. Clin Cardiol. 2023; 46(11):1426–1433. https://doi.org/10.1002/clc.24116Kim, M., Cho, S. W., Won, T. B., Rhee, C. S., Kim, J. W. Associations Between Systemic Inflammatory Markers Based on Blood Cells and Polysomnographic Factors in Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol. 2023;16(2):159–164. https://doi.org/10.21053/ceo.2022.01368Kim, M., Cho, S. W., Won, T. B., Rhee, C. S., Kim, J. W. Associations Between Systemic Inflammatory Markers Based on Blood Cells and Polysomnographic Factors in Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol. 2023;16(2):159–164. https://doi.org/10.21053/ceo.2022.01368Topuz, M. F., Ture, N., Akdag, G., Arik, O., Gulhan, P. Y. The importance of systemic immune-inflammation index in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2022;279(10):5033–5038. https://doi.org/10.1007/s00405–021–07227–0Topuz, M. F., Ture, N., Akdag, G., Arik, O., Gulhan, P. Y. The importance of systemic immune-inflammation index in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2022;279(10):5033–5038. https://doi.org/10.1007/s00405–021–07227–0Güneş, Z. Y., Günaydın, F. M. The relationship between the systemic immune-inflammation index and obstructive sleep apnea. Sleep Breath. 2024;28(1):311–317. https://doi.org/10.1007/s11325–023–02913–1Güneş, Z. Y., Günaydın, F. M. The relationship between the systemic immune-inflammation index and obstructive sleep apnea. Sleep Breath. 2024;28(1):311–317. https://doi.org/10.1007/s11325–023–02913–1Vermeer, J., Vinck, T., de Louw, B. et al. Improving outcomes of AF ablation by integrated personalized lifestyle interventions: rationale and design of the prevention to improve outcomes of PVI (POP) trial. Clin Res Cardiol. 2023; 112(6):716–723. https://doi.org/10.1007/s00392–023–02185–5Vermeer, J., Vinck, T., de Louw, B. et al. Improving outcomes of AF ablation by integrated personalized lifestyle interventions: rationale and design of the prevention to improve outcomes of PVI (POP) trial. Clin Res Cardiol. 2023; 112(6):716–723. https://doi.org/10.1007/s00392–023–02185–5Monahan, K., Brewster, J., Wang, L., et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol. 2012;110(3):369–72. https://doi.org/10.1016/j.amjcard.2012.03.037Monahan, K., Brewster, J., Wang, L., et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol. 2012;110(3):369–72. https://doi.org/10.1016/j.amjcard.2012.03.037Congrete, S., Bintvihok, M., Thongprayoon, C. et al. Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta-analysis. J Evid Based Med. 2018;11(3):145–151. https://doi.org/10.1111/jebm.12313Congrete, S., Bintvihok, M., Thongprayoon, C. et al. Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta-analysis. J Evid Based Med. 2018;11(3):145–151. https://doi.org/10.1111/jebm.12313Shukla, A., Aizer, A., Holmes, D. et al. Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis. JACC Clin Electrophysiol. 2015; 1(1–2):41–51. https://doi.org/10.1016/j.jacep.2015.02.014Shukla, A., Aizer, A., Holmes, D. et al. Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis. JACC Clin Electrophysiol. 2015; 1(1–2):41–51. https://doi.org/10.1016/j.jacep.2015.02.014Deng, F., Raza, A., Guo, J. Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation: a meta-analysis. Sleep Med. 2018;46:5–11. https://doi.org/10.1016/j.sleep.2018.02.013Deng, F., Raza, A., Guo, J. Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation: a meta-analysis. Sleep Med. 2018;46:5–11. https://doi.org/10.1016/j.sleep.2018.02.013Hunt, T. E., Traaen, G. M., Aakerøy, L. et al. Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after pulmonary vein isolation in patients with obstructive sleep apnea: A randomized controlledtrial. Heart Rhythm. 2022;19(9):1433–1441. https://doi.org/10.1016/j.hrthm.2022.06.016Hunt, T. E., Traaen, G. M., Aakerøy, L. et al. Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after pulmonary vein isolation in patients with obstructive sleep apnea: A randomized controlledtrial. Heart Rhythm. 2022;19(9):1433–1441. https://doi.org/10.1016/j.hrthm.2022.06.016Caples, S. M., Mansukhani, M. P., Friedman, P. A., Somers, V. K. The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion: A randomized controlled trial. Int J Cardiol. 2019;278:133–136. https://doi.org/10.1016/j.ijcard.2018.11.100Caples, S. M., Mansukhani, M. P., Friedman, P. A., Somers, V. K. The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion: A randomized controlled trial. Int J Cardiol. 2019;278:133–136. https://doi.org/10.1016/j.ijcard.2018.11.100Kuş, G., Çağırcı, G., Bayar, N., Özgünoğlu, E. C., Güven, R., Arslan, Ş. Usefulness of the systemic immune-inflammation index in predicting atrial fibrillation recurrence after direct current cardioversion. Biomark Med. 2022; 16(11):847–855.https://doi.org/10.2217/bmm-2022–0120Kuş, G., Çağırcı, G., Bayar, N., Özgünoğlu, E. C., Güven, R., Arslan, Ş. Usefulness of the systemic immune-inflammation index in predicting atrial fibrillation recurrence after direct current cardioversion. Biomark Med. 2022; 16(11):847–855.https://doi.org/10.2217/bmm-2022–0120Gami, A. S., Hodge, D. O., Herges, R. M. et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71. https://doi.org/10.1016/j.jacc.2006.08.060Gami, A. S., Hodge, D. O., Herges, R. M. et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71. https://doi.org/10.1016/j.jacc.2006.08.060Zhao, E., Chen, S., Du, Y., Zhang, Y. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. Biomed Res Int. 2018;2018:5215868. https://doi.org/10.1155/2018/5215868Zhao, E., Chen, S., Du, Y., Zhang, Y. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. Biomed Res Int. 2018;2018:5215868. https://doi.org/10.1155/2018/5215868Kawakami, H., Nagai, T., Fujii, A. et al. Apnea-hypopnea index as a predictor of atrial fibrillation recurrence following initial pulmonary vein isolation: usefulness of type-3 portable monitor for sleep-disordered breathing. J Interv Card Electrophysiol. 2016;47(2):237–244. https://doi.org/10.1007/s10840–016–0148-zKawakami, H., Nagai, T., Fujii, A. et al. Apnea-hypopnea index as a predictor of atrial fibrillation recurrence following initial pulmonary vein isolation: usefulness of type-3 portable monitor for sleep-disordered breathing. J Interv Card Electrophysiol. 2016;47(2):237–244. https://doi.org/10.1007/s10840–016–0148-z

The authors declare that there are no conflicts of interest present.