Dileep Raman1, Farhad Kaffashi2, Li-Yung Lui3, William H Sauer4, Susan Redline5, Peter Stone5, Peggy M Cawthon3,6, Katie L Stone3, Kristine E Ensrud7,8, Sonia Ancoli-Israel9, Kenneth Loparo2, Reena Mehra10. 1. Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA. 2. Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA. 3. Research Institute, California Pacific Medical Center, San Francisco, CA, USA. 4. University of Colorado School of Medicine. 5. Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 6. University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA. 7. Department of Medicine, University of Minnesota, Minneapolis, MN, USA. 8. Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA. 9. Department of Psychiatry, University of California - San Diego, La Jolla, CA, USA. 10. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
Abstract
BACKGROUND: Autonomic dysfunction contributes to atrial fibrillation (AF). OBJECTIVE: We hypothesized that polysomnogram (PSG)-based heart rate variability (HRV) autonomic function biomarkers are associated with incident AF and these associations are modified by measures of sleep disordered breathing (SDB). METHODS: 2350 participants of a multi-center prospective study (Outcomes of Sleep Disorders in Older Men Study) without baseline AF underwent sleep studies with incident adjudicated AF follow up (8.0 ± 2.6 years). Cox proportional hazard models were used to analyze sleep study-ECG spectral HRV indices [low and high frequency power (LF, HF), LF/HF] and time domain indices [mean of normal to normal beats (MNN), short and long term variability (STV, LTV) and STV/LTV] and premature atrial contractions (PACs) and incident AF (HR and 95% CI). Statistical interactions between HRV and SDB were examined. Models were adjusted for age, race, body mass index, waist circumference, cardiac medications, co-morbid diseases, alcohol use and study site. RESULTS: Lower LF/HF and lower LF were associated with higher AF incidence (LF/HF Q1 vs. Q4: 1.46, 1.02-2.08, LF Q1 vs. Q4: 1.46, 1.02-2.10). Higher STV/LTV was associated with an increased risk of AF (p-trend= 0.028). The highest PAC quartile had a 3-fold increased AF risk (2.99, 1.94-4.62) compared to the lowest quartile. A significant interaction of obstructive apnea was observed in the LF-AF relationship (0.045). CONCLUSIONS: Sleep-related reduced sympathovagal balance (LF/HF) and increased atrial ectopy are independently associated with future AF; a relationship modified by obstructive apnea.
BACKGROUND:Autonomic dysfunction contributes to atrial fibrillation (AF). OBJECTIVE: We hypothesized that polysomnogram (PSG)-based heart rate variability (HRV) autonomic function biomarkers are associated with incident AF and these associations are modified by measures of sleep disordered breathing (SDB). METHODS: 2350 participants of a multi-center prospective study (Outcomes of Sleep Disorders in Older Men Study) without baseline AF underwent sleep studies with incident adjudicated AF follow up (8.0 ± 2.6 years). Cox proportional hazard models were used to analyze sleep study-ECG spectral HRV indices [low and high frequency power (LF, HF), LF/HF] and time domain indices [mean of normal to normal beats (MNN), short and long term variability (STV, LTV) and STV/LTV] and premature atrial contractions (PACs) and incident AF (HR and 95% CI). Statistical interactions between HRV and SDB were examined. Models were adjusted for age, race, body mass index, waist circumference, cardiac medications, co-morbid diseases, alcohol use and study site. RESULTS: Lower LF/HF and lower LF were associated with higher AF incidence (LF/HF Q1 vs. Q4: 1.46, 1.02-2.08, LF Q1 vs. Q4: 1.46, 1.02-2.10). Higher STV/LTV was associated with an increased risk of AF (p-trend= 0.028). The highest PAC quartile had a 3-fold increased AF risk (2.99, 1.94-4.62) compared to the lowest quartile. A significant interaction of obstructive apnea was observed in the LF-AF relationship (0.045). CONCLUSIONS: Sleep-related reduced sympathovagal balance (LF/HF) and increased atrial ectopy are independently associated with future AF; a relationship modified by obstructive apnea.
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