New study links poor sleep quality to atrial fibrillation

Sleep quality independent of obstructive sleep apnea is an important risk factor for atrial fibrillation, report scientists in HeartRhythm


Philadelphia, June 26, 2018

Poor sleep quality appears to be an important risk factor for atrial fibrillation, report scientists in the first study of its kind to demonstrate a relationship between poor sleep quality independent of sleep apnea and a higher risk of atrial fibrillation (AF). Their findings are published in HeartRhythm.

AF is an irregular, rapid heart rate that may cause symptoms such as heart palpitations, fatigue, and shortness of breath. It can substantially reduce quality of life and is associated with heightened risks of stroke, dementia, heart attack, kidney disease, and death. Obstructive sleep apnea has been established as a risk factor for AF, but the mechanism is unclear. While episodes of abnormally slow or shallow breathing (hypopnea) and apnea may cause cardiopulmonary stress, induce inflammation, and contribute to cardiovascular disease, obstructive sleep apnea also results in poor sleep. Aspects of poor sleep such as altered sleep duration, efficiency, and architecture have been linked to other cardiovascular diseases.

“While a relationship between sleep apnea and AF has previously been demonstrated, the effect of sleep itself on AF risk has remained unknown,” explained lead investigator Gregory M. Marcus, MD, MAS, Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA. “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.”

Investigators drew on four different studies to determine whether poor sleep itself is a risk factor for AF. First, they used the global, internet-based Health eHeart Study and determined that individuals with more frequent nighttime awakenings while trying to sleep more often carried a diagnosis of AF. They then validated these findings by using the NIH-funded Cardiovascular Health Study, a prospective cohort study, in which they found that individuals who reported more frequent nighttime awakenings at baseline exhibited a higher risk of developing AF both before and after adjustment for potential confounders.

Within a subset of these individuals who had undergone formal sleep studies, they found that less REM sleep in particular predicted future AF. Finally, in order to see if these findings were readily translatable to patients already seen in healthcare settings and recognized by their providers as having sleeping difficulty, they drew on the California Healthcare Cost and Utilization Project (HCUP), a set of medical records databases of all California residents aged 21 or older who received care in a California ambulatory surgery unit, emergency department, or inpatient hospital unit between January 2005 and December 2009. Among several million people, the HCUP data confirmed that a diagnosis of insomnia predicted a diagnosis of AF both before and after adjustment for potential confounding effects.

These results provide more evidence that sleep quality is important to cardiovascular health and specifically to AF. Investigators determined that there was no evidence that sleep duration per se was a risk factor for AF. Instead, they consistently found sleep disruption to be an important risk factor. While the underlying mechanisms are still unknown, these findings may motivate novel ways to think about, and hence future research into, factors that influence AF risk.

This is the first study to demonstrate a relationship between worse sleep quality independent of sleep apnea and a higher risk of AF. “These data provide compelling evidence that sleep quality itself, even independent of sleep apnea, is an important determinant of AF risk,” noted Dr. Marcus. “While there are several available treatments for AF, prevention of the disease would be ideal. The good news is that sleep quality can be modifiable and is something that at least to some degree is under the control of the individual. It’s possible that improving sleep hygiene, such as performing regular exercise, getting to bed at a reasonable hour on a regular basis, and avoiding viewing screens before bed as well as caffeine later in the day, might help stave off AF.”

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Notes for editors
The article is “Sleep characteristics that predict atrial fibrillation,” by Matthew A. Christensen, MD, Shalini Dixit, MD, Thomas A. Dewland, MD, Isaac R. Whitman, MD, Gregory Nah, MA, Eric Vittinghoff, PhD, Kenneth J. Mukamal, MD, MPH, Susan Redline, MD, MPH, John A. Robbins, MD, MHS, Anne B. Newman, MD, MPH, Sanjay R. Patel, MD, MS, Jared W. Magnani, MD, MSc, Bruce M. Psaty, MD, PhD, Jeffrey E. Olgin, MD, FHRS,  Mark J. Pletcher, MD, MPH, Susan R. Heckbert, MD, PhD, and Gregory M. Marcus, MD, MAS, FHRS (https://doi.org/10.1016/j.hrthm.2018.05.008). It will appear in HeartRhythm, volume 15, issue 9 (September 2018) published by Elsevier.

Matt Christensen was funded by the Sarnoff Cardiovascular Research Foundation. The Health eHeart Study is supported by the Patient Centered Outcomes Research Network and NIH. The Cardiovascular Health Study is supported by the NIH. The Healthcare Cost and Utilization Project is supported by AHRQ.

Full text of this study is available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists wishing to reach the study authors should contact Dr. Gregory Marcus at +1 415 608 7565 or greg.marcus@ucsf.edu.

About HeartRhythm
Heart
Rhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.com

About the Heart Rhythm Society
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 5,100 specialists in cardiac pacing and electrophysiology from more than 70 countries. www.HRSonline.org

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 38,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jane Grochowski
Elsevier
+1 406 542 8397
hmsmedia@elsevier.com