Sleep characteristics that predict atrial fibrillation

Heart Rhythm. 2018 Sep;15(9):1289-1295. doi: 10.1016/j.hrthm.2018.05.008. Epub 2018 Jun 26.


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.

Keywords: Atrial fibrillation; Insomnia; Obstructive sleep apnea; Rapid eye movement (REM) sleep.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / physiopathology
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Health Surveys / methods*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Polysomnography
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sleep / physiology*
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / physiopathology
  • United States / epidemiology