Association of Short Sleep Duration and Atrial Fibrillation

  • Michael V. Genuardi
    Correspondence
    CORRESPONDENCE TO: Michael V. Genuardi, MD, University of Pittsburgh Heart and Vascular Institute, 200 Lothrop St, Scaife S-553, Pittsburgh, PA 15213
    Affiliations
    Division of Cardiology, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA

    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Rachel P. Ogilvie
    Affiliations
    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA

    Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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  • Aisha Rasool Saand
    Affiliations
    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA

    Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
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  • Rebecca S. DeSensi
    Affiliations
    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Melissa I. Saul
    Affiliations
    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Jared W. Magnani
    Affiliations
    Division of Cardiology, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA

    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Sanjay R. Patel
    Affiliations
    Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA

    Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
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Published:February 27, 2019DOI:https://doi.org/10.1016/j.chest.2019.01.033

      Background

      Short sleep may be a risk factor for atrial fibrillation. However, previous investigations have been limited by lack of objective sleep measurement and small sample size. We sought to determine the association between objectively measured sleep duration and atrial fibrillation.

      Methods

      All 31,079 adult patients undergoing diagnostic polysomnography from 1999 to 2015 at multiple sites within a large hospital network were identified from electronic medical records. Prevalent atrial fibrillation was identified by continuous ECG during polysomnography. Incident atrial fibrillation was identified by diagnostic codes and 12-lead ECGs. Logistic regression and Cox proportional hazards modeling were used to examine the association of sleep duration and atrial fibrillation prevalence and incidence, respectively, adjusting for age, sex, BMI, hypertension, coronary artery disease, cerebrovascular disease, peripheral vascular disease, heart failure, and sleep apnea severity.

      Results

      We identified 404 cases of prevalent atrial fibrillation among 30,061 individuals (mean age ± SD, 51.0 ± 14.5 years; 51.6% women) undergoing polysomnography. After adjustment, each 1-h reduction in sleep duration was associated with a 1.17-fold (95% CI, 1.11-1.30) increased risk of prevalent atrial fibrillation. Among 27,589 patients without atrial fibrillation at baseline, we identified 1,820 cases of incident atrial fibrillation over 4.6 years median follow-up. After adjustment, each 1-h reduction in sleep duration was associated with a 1.09-fold (95% CI, 1.05-1.13) increased risk for incident atrial fibrillation.

      Conclusions

      Short sleep duration is independently associated with prevalent and incident atrial fibrillation. Further research is needed to determine whether interventions to extend sleep can lower atrial fibrillation risk.

      Key Words

      Abbreviations:

      AF ( atrial fibrillation), AHI ( apnea-hypopnea index), MESA ( Multi-Ethnic Study of Atherosclerosis), N1 ( stage 1 nonrapid eye movement), N2 ( stage 2 nonrapid eye movement), N3 ( stage 3 nonrapid eye movement), R ( rapid eye movement sleep stage), TST ( total sleep time)
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