ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA SYNDROME AND ATRIAL REMODELING IN PATIENTS WITH ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, and its pathophysiology is closely linked to atrial remodeling, characterized by structural and electrophysiological alterations of the left atrium. Obstructive sleep apnea syndrome (OSAS) has been increasingly recognized as an important risk factor and potentially modifiable condition associated with AF. Contemporary guidelines emphasize the relevance of OSAS in the integrated management of atrial fibrillation. The aim of this systematic review was to evaluate the association between obstructive sleep apnea syndrome and atrial remodeling in patients with atrial fibrillation. This systematic review was conducted in accordance with PRISMA 2020 recommendations, with searches performed in PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library. The included studies demonstrated a consistent association between OSAS and alterations in the atrial substrate, particularly evidenced by electroanatomical remodeling, reduced atrial voltage, increased low-voltage areas, and structural and functional changes of the left atrium. In conclusion, OSAS is associated with a greater degree of atrial remodeling in patients with atrial fibrillation, reinforcing its role as a clinically relevant and potentially modifiable factor in arrhythmia management.