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Association of sleep characteristics with atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis
  1. Younghoon Kwon1,
  2. Sina A Gharib2,
  3. Mary L Biggs3,
  4. David R Jacobs Jr4,
  5. Alvaro Alonso4,
  6. Daniel Duprez1,4,
  7. Joao Lima5,
  8. Gen-Min Lin6,7,
  9. Elsayed Z Soliman8,
  10. Reena Mehra9,
  11. Susan Redline10,
  12. Susan R Heckbert11
  1. 1Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Department of Medicine, University of Washington, Seattle, Washington, USA
  3. 3Department of Biostatistics, University of Washington, Seattle, Washington, USA
  4. 4Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
  7. 7Department of Medicine, Hualien-Armed Forces General Hospital, Hualien, Taiwan
  8. 8Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
  9. 9Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  10. 10Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, Massachusetts, USA
  11. 11Department of Epidemiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Younghoon Kwon, Department of Medicine, University of Minnesota, Mayo Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA; kwonx208{at}


Background Population-based studies have linked measures of sleep disordered breathing to nocturnally occurring atrial fibrillation (AF) episodes. Whether measures of sleep disordered breathing and sleep quality are associated with prevalent AF has not been studied in an unselected population. We investigated the cross-sectional association with prevalent AF of objectively collected prespecified measures of overnight sleep breathing disturbances, sleep stage distributions, arousal and sleep duration.

Methods AF prevalence, defined by diagnosis codes, study electrocardiography and sleep study were examined among Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent polysomnography in the MESA Sleep Study (n=2048).

Measurements and main results Higher apnoea hypopnoea index (AHI) was associated with increased odds of AF, although the significance was attenuated after full adjustment for covariates including prevalent cardiovascular disease (OR: 1.22 (0.99 to 1.49) per SD (17/h), p=0.06). Analyses of sleep architecture measures and AF revealed significantly lower odds of AF associated with longer duration of slow wave sleep (OR: 0.66 (0.5 to 0.89) per SD (34 min), p=0.01) which persisted after additionally adjusting for AHI (OR: 0.68 (0.51 to 0.92), p=0.01). Higher sleep efficiency was significantly associated with lower likelihood of AF but the significance was lost when adjusted for AHI. No significant association was present between sleep duration and AF. In a model including AHI and arousal index, the association between AHI and AF was strengthened (AHI: OR 1.49 (1.15 to 1.91) per SD, p=0.002) and a significant inverse association between arousal index and AF was observed (OR 0.65 (0.50 to 0.86) per SD (12/h), p=0.005).

Conclusions In a study of a large multiethnic population, AF was associated with AHI severity, and was more common in individuals with poor sleep quality as measured by reduced slow wave sleep time, a finding that was independent of AHI.

  • Sleep apnoea

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