Sleep Disorders

Sleep and Atrial Fibrillation

Sleep Disordered Breathing and Hypoxemia Association With Incident Atrial Fibrillation in a Clinic-Based Cohort (N = 43,634)

AHI = apnea hypopnea index, T90 = percent of sleep time with oxygen saturation < 90%, SaO2 = oxygen saturation

Sleep disordered breathing (SDB) has been implicated in atrial fibrillation (AF) in population-based studies; however, its role remains unclear and inconsistent. A greater risk of 5-year incident AF with SDB and sleep-related hypoxia in a clinic-based cohort is hypothesized. Patients (aged > 8 years) who underwent polysomnogram (PSG) or split studies from Nov. 27, 2004 to Dec. 30, 2015 at Cleveland Clinic with > 3 hours diagnostic time were examined. The sample was comprised of 43,634 patients: aged 51.7 ± 14.5, 51.9% male, 74.5% White, and 7.1% (N = 3090) with AF. Of those without AF, 1176 (2.9%) developed 5-year incident AF. For each 10-unit increase in AHI, incident AF increased by 2% (HR = 1.02, 95% CI, 1.00-1.04). For each 10% increase in T90, incident AF increased by 8% (HR = 1.08, 95% CI, 1.05-1.10). Compared with reference, patients with 25.01% to 50%, 50.01% to 75%, and 75.01% to 100% time T90 had 23% (HR = 1.23, 95% CI, 1.03-1.47), 55% (HR = 1.55, 95% CI, 1.25-1.92), and 72% (HR = 1.72, 95% CI, 1.32-2.25) higher incident AF, respectively. For every 10-unit increase in minSaO2 and meanSaO2, incident AF decreased by 12% (HR = 0.88, 95% CI, 0.82-0.94) and 25% (HR = 0.75, 95% CI, 0.67-0.84), respectively. Increasing SDB severity was associated with 5-year incident AF in this large clinic-based cohort even after consideration of a range of confounding factors.