Europace Advance Access originally published online on May 14, 2009
Europace 2009 11(7):902-909; doi:10.1093/europace/eup107
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Obstructive Sleep Apnoea and Recurrence of Atrial Fibrillation
Baseline apnoea/hypopnoea index and high-sensitivity C-reactive protein for the risk of recurrence of atrial fibrillation after successful electrical cardioversion: a predictive model based upon the multiple effects of significant variables
1 Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy; 2 Epidemiologic and Bio-Statistics Unit, AUSL Terni 4, Italy; 3 Cardiology Division, Santa Maria Hospital, Terni, Italy; 4 Cardiovascular Department, Cardiac Rehabilitation Operative Unit (S.I.), San Filippo Neri Hospital, Via della Lucchina 41, 00135 Rome, Italy; 5 Nephrology Unit, Santa Maria della Stella Hospital, Orvieto, Italy; 6 Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan, San Donato Milanese, Milan, Italy
Aims: We tested apnoea/hypopnoea index (AHI), high-sensitivity (hs) C-reactive protein and clinical/instrumental variables as predictors of atrial fibrillation (AF) recurrence over 1-year follow-up after successful electrical cardioversion.
Methods and results: We enrolled 158 consecutive patients. Apnoea/hypopnoea index was assessed with standard overnight polysomnography and hs-C-reactive protein with immunonephelometry assay the day before electrical cardioversion. Atrial fibrillation recurrences occurred in 81 patients (51%). Predictors at univariate analysis were: AHI 
15 events/h (P = 0.001), hs-C-reactive protein >0.30 mg/dL (P = 0.009), AF duration >3 days (P = 0.008), diabetes (P = 0.03), and ongoing anti-arrhythmic therapy at the time of electrical cardioversion (P = 0.03). Survival analysis confirmed that patients with AHI 15 events/h and hs-C-reactive protein > 0.30 mg/dL had a higher recurrence rate of AF (log rank P = 0.0006 and P = 0.01, respectively). Predictors at multivariate analysis were: AHI 15 events/h (P = 0.003), hs-C-reactive protein > 0.30 mg/dL (P = 0.01) and ongoing anti-arrhythmic therapy (P = 0.04). A predictive model based upon the multiple effects of significant variables plus age as a continuous variable stratified the risk of AF recurrence, more than tripled with all dichotomized variables altered with respect to normal variables (85 vs. 27%).
Conclusion: AHI 15 events/h and hs-C-reactive protein > 0.30 mg/dL are the strongest predictors of the predictors chosen of AF recurrence after successful electrical cardioversion over 1-year follow-up.
Key Words: Atrial fibrillation, Sleep apnoea, Inflammation, Cardioversion
* Corresponding author. Tel: +39 06302511, Fax: +39 0630811972, Email: mleggio{at}libero.it
Manuscript submitted 24 January 2009. Accepted after revision 9 April 2009.
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