Poor sleep quality increases risk for AF

Patients with frequent sleep disruption have an increased risk for atrial fibrillation after adjusting for obstructive sleep apnea and other potential confounders, according to a study published in HeartRhythm.

“While a relationship between sleep apnea and AF has previously been demonstrated, the effect of sleep itself on AF risk has remained unknown,” Gregory M. Marcus, MD, MAS, professor in the division of cardiology at University of California, San Francisco, said in a press release. “Strategies to enhance sleep quality are different from those that focus on relieving airway obstruction, so it is important to understand the relationship between sleep itself and AF.”

Matthew A. Christensen, MD, internal medicine resident at University of Utah School of Medicine in Salt Lake City, and colleagues analyzed data from 4,553 participants from the Health eHeart Study (mean age, 51 years; 55% women) and 5,703 participants from the Cardiovascular Health Study (mean age, 73 years; 58% women). Findings were validated using a subset of 1,127 participants from the Cardiovascular Health Study who had available polysomnography data.

Researchers also utilized data from the 2005-2009 California Healthcare Cost and Utilization Project (n = 14,330,651; mean age, 49 years; 57% women; median follow-up, 3.9 years) to determine if any relationships identified in the other cohorts might translate to clinical practice.

All data featured in the study included demographics, medical information, sleep quality, ECG, vital sign measurements, obstructive sleep apnea and AF status.

AF was observed in 12% of participants from the Heart eHealth Study. These participants were more likely to have frequent nighttime awakening compared with those without AF (OR = 1.47; 95% CI, 1.14-1.89).

During follow-up in the Cardiovascular Health Study, frequent nighttime awakening increased the risk for AF by 33% (HR = 1.33; 95% CI, 1.17-1.51). In the cohort that had available polysomnography data, each standard deviation percentage decrease in REM sleep was linked to an increased risk for AF (HR = 1.18; 95% CI, 1-1.38).

An insomnia diagnosis in participants from the California Healthcare Cost and Utilization Project was associated with an increased risk for new AF (HR = 1.36; 95% CI, 1.3-1.42).

“This effect may be explained by a reduction in REM sleep,” Christensen and colleagues wrote. “Given the high prevalence of sleep problems and the substantial negative impacts of AF, research examining interventions to improve sleep quality may prove valuable in preventing AF.” – by Darlene Dobkowski

Disclosures: Christensen reports no relevant financial disclosures. Marcus reports he received research support from Cardiogram, Medtronic and Rhythm Diagnostic Systems, and he is a consultant and equity holder in InCarda. Please see the study for all other authors’ relevant financial disclosures.

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Source:

Christensen MA, et al. HeartRhythm. 2018;doi:10.1016/j.hrthm.2018.05.008.