Prediction model and scoring system for the risk of atrial fibrillation recurrence in patients with atrial fibrillation and obstructive sleep apnoea syndrome: a retrospective case-control study

Abstract

Abstract Background The high prevalence of atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) imposes a substantial disease burden on public healthcare, making it a significant health concern in the current era. However, there is currently a lack of risk assessment tools for AF recurrence in patients with AF and OSAS. Therefore, this study aims to explore the factors influencing AF recurrence in patients with AF and OSAS, and to establish a predictive model and scoring system for AF recurrence rates. Methods The study included a total of 423 patients with AF and OSAS, who were randomly divided into train set (n = 296) and test set (n = 127) in a ratio of 7:3. Afterwards, the train set was split into a recurrence group and a non-recurrence group for further analysis of indicators while in hospital. Results Following Lasso regression screening, 8 variables were selected from a pool of 62 variables from patients with AF and OSAS. Additionally, the study incorporated the CHA2DS2-VASc score and its components of interest, the severity of OSAS and hypoxemia, and whether patients received catheter ablation (CA). Multivariable Cox regression analysis revealed: Hb 1.51mmol/L (HR = 3.77), PCT > 2ng/ml (HR = 15.72) as independent risk factors. Hb > 150 g/L (HR = 0.66), TT4 < 66 nmol/L (HR = 0.16) were identified as independent protective factors. The train set showed AUC values of 0.65, 0.71, and 0.71 at the 1st, 3rd, and 5th year, respectively, while the validation set displayed AUC values of 0.60, 0.59, and 0.64 at the 1st, 3rd, and 5th year, respectively, indicating good predictive performance of the model. The AF recurrence rate scoring system categorized patients in the train and test sets into low-risk, medium-risk, and high-risk groups, with HR values of 2.36 and 6.79 for AF recurrence rates in the medium-risk and high-risk groups of the train set, and an HR value of 2.77 for the medium-risk group in the test set. Conclusion The predictive models and scoring systems developed in this study demonstrate good predictive ability in assessing the recurrence of AF in patients with OSAS, offering invaluable clinical guidance and references. Clinical trial number Not applicable.

Keywords

• Atrial fibrillation
• Obstructive sleep apnea syndrome
• Recurrence
• Prediction model