NEW ORLEANS – Reduced duration of REM sleep may independently increase the risk of atrial fibrillation in patients with or without obstructive sleep apnea (OSA), according to data presented at the 2016 American Heart Association Scientific Sessions in New Orleans.1
While OSA has previously been shown to impact risk of atrial fibrillation, how other sleep-related factors impact risk is not well known.
For this study, researchers led by Matthew A. Christensen, BS, a fourth-year medical student at the University of Michigan in Ann Arbor, performed a longitudinal analysis on a sub-set of participants who were co-enrolled in the Cardiovascular Health Study and Sleep Heart Health Study. Researchers measured sleep duration, efficiency, latency, and architecture using polysomnography, and gauged OSA severity with the apnea-hypopnea-index (AHI) and polysomnography.
Models were adjusted for OSA severity, age, sex, race, site, body mass index, smoking status, alcohol use, sleep aid use, diabetes, hypertension, coronary heart disease, and congested heart failure.
“By examining the actual characteristics of sleep, such as how much REM sleep you get, it points us toward a more plausible mechanism,” Mr Christensen said in a statement. 2“There could be something particular about how sleep impacts the autonomic nervous system.”
Ultimately, 1131 participants were included in the study (mean age:77 years; 59% female). Sixty percent of participants had at least mild OSA (AHI>5). Over the course of follow-up (median 9.8 years), 23% developed atrial fibrillation. Both before and after adjustment for OSA and other confounders, decreased REM sleep was found to be associated with an increased risk for atrial fibrillation, which translated to a 23% increase in risk for every decrease in standard deviation (SD: 6.6%) in proportion to sleep spent in REM sleep (adjusted hazard ratio [HR]: 1.23; 95% confidence interval, 1.05 - 1.44, P= .01).
“… even without a clear understanding of the responsible mechanisms, we believe these findings suggest that strategies to enhance sleep quality, such as incorporating known techniques to improve sleep hygiene, may help prevent this important arrhythmia,” senior author Gregory Marcus, MD, MAS, of the University of California, San Francisco, said in a statement.2
In a related abstract,3 Mr Christensen and colleagues also found that people who wake frequently have about a 26% greater risk of developing atrial fibrillation, while those who have been diagnosed with insomnia face a 29% increased risk.
The results of both studies suggest that sleep-related factors, especially sleep quality, may play a role in atrial fibrillation pathogenesis and may in turn serve as modifiable risk factors for atrial fibrillation.
Disclosures: Dr Marcus reports significant grant support from Medtronic, Inc. and Pfizer, as well as ownership interest in Incarda Therapeutics, Inc.
- Christensen MA, Dixit S, Vittinghoff E, et al. Abstract 733. Decreased REM sleep is associated with higher risk of incident atrial fibrillation. Presented at: the 2016 American Heart Association Scientific Sessions. November 12-16, 2016; New Orleans, LA..
- Poor sleep may increase risk for irregular heart rhythms [press release]. Dallas, TX: American Heart Association/American Stroke Association Newsroom; November 14, 2016.
- Christensen MA, Dixit S, Whitman IR, et al. Abstract 218. Sleep disruption is associated with incident atrial fibrillation independent of obstructive sleep apnea. Presented at: the 2016 American Heart Association Scientific Sessions. November 12-16, 2016; New Orleans, LA.