Nocturnal Arrhythmias Across a Spectrum of Obstructive and Central Sleep-Disordered Breathing in Older Men: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study
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BACKGROUND: Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men. METHODS: A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed. RESULTS: An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19-3.89) and CVE (OR, 1.43; 95% CI, 1.12-1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95% CI, 1.61-4.47) than CVE (OR, 1.27; 95% CI, 0.97-1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23-2.14) compared with the lowest quartile. CONCLUSIONS: In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.
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In the Outcomes of Sleep Disorders in Older Men Study, there was a dose-dependent association of OSA with prevalent atrial fibrillation.
“while in the Outcomes of Sleep Disorders in Older Men Study there was a dose-dependent association of OSA with prevalent AF.720”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [720]
The Results section (page not provided) reports a dose-dependent association between OSA severity and AF in unadjusted analyses. The association did not persist after adjustment for confounding factors; the adjusted dose-response finding was for overall sleep-disordered breathing, not OSA specifically. (LLM, conf=0.88)
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- Authors
- Mehra, R., Stone, K. L., Varosy, P. D., Hoffman, A. R., Marcus, G. M., Blackwell, T., Ibrahim, O. A., Salem, R., & Redline, S.
- Affiliations
- Case Western Reserve University (US)
- San Francisco VA Medical Center (US)
- ORCID
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-06-22
- Volume
- 169
- Issue
- 12
- Pages
- 1147
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC2802061
- OpenAlex
- W2162509245
- Semantic Scholar
- a6e20afb1823fe86770b9901448e0c1308040351
- Cited by
- 269
- References
- 50
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 10 · 2023: 11 · 2022: 21 · 2021: 15 · 2020: 13 · 2019: 9 · 2018: 16 · 2017: 24 · 2016: 28 · 2015: 20 · 2014: 17 · 2013: 14 · 2012: 16
- FWCI
- 11.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (U01-AG-18197, U01AG018197, U01AG027810)
- National Heart, Lung, and Blood Institute (R01HL070847, R01HL070839, R01HL070838, R01HL070841, R01HL070848, R01HL071194, R01HL070837, R01HL070842, K23HL079114)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR45614, U01-AR45632, U01 AR45647, U01AR045583, U01 AR-45583, U01-AR-45654, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, U01AR066160, U01AR45580)
- National Center for Research Resources (UL1RR024140)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- obstructive sleep apnea, central sleep apnea, atrial flutter, nocturnal arrhythmia, hypoxemia, older men, respiratory disturbance index, apnea-hypopnea index, central apnea index, arrhythmia risk
- MeSH terms
- Aged, Arrhythmias, Cardiac, Circadian Rhythm, Electrocardiography, Follow-Up Studies, Heart Rate, Humans, Male, Retrospective Studies, Sleep Wake Disorders, Time Factors, United States, Prevalence, Odds Ratio, Polysomnography
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