Sleep characteristics that predict atrial fibrillation

Matthew A. Christensen, Shalini Dixit, Thomas Dewland, Isaac R. Whitman, Gregory Nah, Eric Vittinghoff, Kenneth J. Mukamal, Susan Redline, John A. Robbins, Anne B. Newman, Sanjay R. Patel, Jared W. Magnani, Bruce M. Psaty, Jeffrey E. Olgin, Mark J. Pletcher, Susan R. Heckbert, Gregory M. Marcus

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. Objective: The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. Methods: We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005–2009 data from the California Healthcare Cost and Utilization Project. Results: Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14–1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17–1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00–1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30–1.42; P <.001). Conclusion: Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Atrial Fibrillation
Sleep
Confidence Intervals
Polysomnography
Health
Obstructive Sleep Apnea
REM Sleep
Sleep Initiation and Maintenance Disorders
Health Care Costs
Odds Ratio
Population

Keywords

  • Atrial fibrillation
  • Insomnia
  • Obstructive sleep apnea
  • Rapid eye movement (REM) sleep

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Christensen, M. A., Dixit, S., Dewland, T., Whitman, I. R., Nah, G., Vittinghoff, E., ... Marcus, G. M. (Accepted/In press). Sleep characteristics that predict atrial fibrillation. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2018.05.008

Sleep characteristics that predict atrial fibrillation. / Christensen, Matthew A.; Dixit, Shalini; Dewland, Thomas; Whitman, Isaac R.; Nah, Gregory; Vittinghoff, Eric; Mukamal, Kenneth J.; Redline, Susan; Robbins, John A.; Newman, Anne B.; Patel, Sanjay R.; Magnani, Jared W.; Psaty, Bruce M.; Olgin, Jeffrey E.; Pletcher, Mark J.; Heckbert, Susan R.; Marcus, Gregory M.

In: Heart Rhythm, 01.01.2018.

Research output: Contribution to journalArticle

Christensen, MA, Dixit, S, Dewland, T, Whitman, IR, Nah, G, Vittinghoff, E, Mukamal, KJ, Redline, S, Robbins, JA, Newman, AB, Patel, SR, Magnani, JW, Psaty, BM, Olgin, JE, Pletcher, MJ, Heckbert, SR & Marcus, GM 2018, 'Sleep characteristics that predict atrial fibrillation', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2018.05.008
Christensen MA, Dixit S, Dewland T, Whitman IR, Nah G, Vittinghoff E et al. Sleep characteristics that predict atrial fibrillation. Heart Rhythm. 2018 Jan 1. https://doi.org/10.1016/j.hrthm.2018.05.008
Christensen, Matthew A. ; Dixit, Shalini ; Dewland, Thomas ; Whitman, Isaac R. ; Nah, Gregory ; Vittinghoff, Eric ; Mukamal, Kenneth J. ; Redline, Susan ; Robbins, John A. ; Newman, Anne B. ; Patel, Sanjay R. ; Magnani, Jared W. ; Psaty, Bruce M. ; Olgin, Jeffrey E. ; Pletcher, Mark J. ; Heckbert, Susan R. ; Marcus, Gregory M. / Sleep characteristics that predict atrial fibrillation. In: Heart Rhythm. 2018.
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abstract = "Background: The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. Objective: The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. Methods: We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005–2009 data from the California Healthcare Cost and Utilization Project. Results: Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95{\%} confidence interval [CI] 1.14–1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33{\%} greater risk of AF (hazard ratio [HR] 1.33; 95{\%} CI 1.17–1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18{\%} higher risk of developing AF (HR 1.18; 95{\%} CI 1.00–1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36{\%} increased risk of new AF (HR 1.36; 95{\%} CI 1.30–1.42; P <.001). Conclusion: Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.",
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AU - Whitman, Isaac R.

AU - Nah, Gregory

AU - Vittinghoff, Eric

AU - Mukamal, Kenneth J.

AU - Redline, Susan

AU - Robbins, John A.

AU - Newman, Anne B.

AU - Patel, Sanjay R.

AU - Magnani, Jared W.

AU - Psaty, Bruce M.

AU - Olgin, Jeffrey E.

AU - Pletcher, Mark J.

AU - Heckbert, Susan R.

AU - Marcus, Gregory M.

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N2 - Background: The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. Objective: The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. Methods: We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005–2009 data from the California Healthcare Cost and Utilization Project. Results: Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14–1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17–1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00–1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30–1.42; P <.001). Conclusion: Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.

AB - Background: The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. Objective: The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. Methods: We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005–2009 data from the California Healthcare Cost and Utilization Project. Results: Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14–1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17–1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00–1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30–1.42; P <.001). Conclusion: Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.

KW - Atrial fibrillation

KW - Insomnia

KW - Obstructive sleep apnea

KW - Rapid eye movement (REM) sleep

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