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.

1. Van 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/ehae176

2. Bizhanov, 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.15759

3. Harada, 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.2020.11.002

4. Yu, 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.2023.08.004

5. Kadhim, 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.2021.09.026

6. Starkey, 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.2020.09.026

7. Zhang, 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.0000000000029443

8. Nadeem, 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.3070

9. Shao, 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.2015.03.011

10. Jin, 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.S283835

11. Sayın, 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.n1986

12. Naser, 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.20230680

13. Zhao, 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.24116

14. Kim, 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.2022.01368

15. Topuz, 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/s00405–021–07227–0

16. Güneş, 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/s11325–023–02913–1

17. Vermeer, 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/s00392–023–02185–5

18. Monahan, 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.2012.03.037

19. Congrete, 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.12313

20. Shukla, 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.2015.02.014

21. Deng, 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.2018.02.013

22. Hunt, 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.2022.06.016

23. Caples, 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.2018.11.100

24. Kuş, 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-2022–0120

25. Gami, 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.2006.08.060

26. Zhao, 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/10.1155/2018/5215868

27. Kawakami, 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