Atrial Fibrillation Development Predicted by Sleep Disruption

An overweight man sleeping
An overweight man sleeping
Individuals with more frequent nighttime awakening exhibited a higher risk for atrial fibrillation.

Individuals with more frequent nighttime awakening exhibited a 33% greater risk for atrial fibrillation (AF), according to the results of a recent study published in Heart Rhythm.

Sleep quality was first assessed using an Internet-based prospective cohort study (Health eHeart) to identify the characteristics of sleep that were associated with prevalent AF. The Cardiovascular Health Study population-based prospective cohort study was then carried out to determine whether sleep quality would predict incident AF. Finally, the researchers assessed whether a physician-coded diagnosis of insomnia was a predictor of incident AF by accessing the California Healthcare Cost and Utilization Project (HCUP) medical record database.

The 3 study methodologies included 4553 patients in the Internet-based prospective cohort, 5703 patients in the population-based prospective cohort, and 14,330,651 patients in the California HCUP medical record database cohort. Of the Health eHeart participants, 12% had prevalent AF. Only longer sleep onset latency and frequent nighttime awakening were statistically significant with prevalent AF. Incident AF developed in 28% of the Cardiovascular Health Study prospective cohort over 11.6 years. Only nighttime awakening at baseline was associated with a statistically significant 33% increased risk for AF. Finally, AF developed in 1.8% of the HCUP cohort over a median follow-up of 3.9 years. Diagnosis of insomnia was associated with a 36% increased risk for incident AF.

The authors wrote, “Across 3 independent data sources, we found that sleep disruption was consistently associated with prevalent and incident AF.”

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They also noted a possible mechanism, suggesting, “Sympathetic tone is high during REM sleep, suggesting that those with less REM sleep may on average experience greater vagal tone.”


Christensen MA, Dixit S, Dewland T, et al. Sleep characteristics that predict atrial fibrillation [published online June 25, 2018]. Heart Rhythm. doi: 10.1016/j.hrthm.2018.05.008