Variability of Sleep Apnea Severity and Risk of Atrial Fibrillation: The VARIOSA-AF Study

Dominik Linz; Anthony G Brooks; Adrian D Elliott; Chrishan J Nalliah; Jeroen M L Hendriks; Melissa E Middeldorp; Celine Gallagher; Rajiv Mahajan; Jonathan M Kalman; R Doug McEvoy; Dennis H Lau; Prashanthan Sanders

doi:10.1016/j.jacep.2019.03.005

Variability of Sleep Apnea Severity and Risk of Atrial Fibrillation: The VARIOSA-AF Study

JACC Clin Electrophysiol. 2019 Jun;5(6):692-701. doi: 10.1016/j.jacep.2019.03.005. Epub 2019 May 1.

Affiliations

¹ Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Cardiac Rhythm Management, MicroPort, Scoresby, Victoria, Australia.
³ Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁵ Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia. Electronic address: prash.sanders@adelaide.edu.au.

PMID: 31221356
DOI: 10.1016/j.jacep.2019.03.005

Abstract

Objectives: This study sought to determine night-to-night variability in the severity of sleep-disordered breathing (SDB) and the dynamic intraindividual relationship to daily risk of incident atrial fibrillation (AF) by using simultaneous long-term day-by-day SDB and AF monitoring.

Background: Night-to-night variability in SDB severity may result in a dynamic exposure to SDB related conditions impacting the timing and extent of cardiovascular responses.

Methods: This study was an observational cohort study. Daily data for AF burden and average respiratory disturbance index (RDI) were extracted from pacemakers capable of monitoring nightly SDB and daily AF burden in 72 patients. Nightly RDI values were grouped into quartiles of severity within each patient. AF burdens of >5 min, >1 h, and >12 h were the outcome variables.

Results: A total of 32% of patients had a mean RDI of ≥20/h, indicative of overall severe SDB. There was significant night-to-night variation in RDI reflected by an absolute SD of ±6.3 events/h (range 2 to 14 events/h) within any given patient. Within each patient, the nights with the highest RDI (in their highest quartile) conferred a 1.7-fold (1.2 to 2.2; p < 0.001), 2.3-fold (1.6 to 3.5; p < 0.001), and 10.2-fold (3.5 to 29.9; p < 0.001) increase risk of having at least 5 min, 1 h, and 12 h, respectively, of AF during the same day compared with the best sleep nights (in their lowest quartiles).

Conclusions: There is considerable night-to-night variability in SDB severity which cannot be detected by 1 single overnight sleep study. SDB burden may be a better metric with which to assess the extent of dynamic SDB related cardiovascular responses such as daily AF risk than the categorical diagnosis of SDB. (Night-to-Night Variability in Severity of Sleep Apnea and Daily Dynamic Atrial Fibrillation Risk [VARIOSA-AF]; ACTRN 12618000757213).

Keywords: atrial fibrillation; burden; dynamic substrate; night-to-night variability; pacemaker; sleep-disordered breathing.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation / epidemiology*
Cardiac Resynchronization Therapy Devices*
Cohort Studies
Humans
Incidence
Logistic Models
Monitoring, Physiologic*
Severity of Illness Index
Sleep Apnea Syndromes / epidemiology
Sleep Apnea Syndromes / physiopathology*

Associated data

ANZCTR/ACTRN12618000757213