Cited by 269Obstructive Sleep Apnea ResearchSleep and related disordersHeart Rate Variability and Autonomic Control

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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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Mehra, Reena, Stone, Katie L., Varosy, Paul D., Hoffman, Andrew R., Marcus, Gregory M., Blackwell, Terri, Ibrahim, Osama A., Salem, Rawan, Redline, Susan·2009·Archives of Internal Medicine

DOI 10.1001/archinternmed.2009.138PMC PMC2802061

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Abstract

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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Self-citation

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: Mehra, Reena
Stone, Katie L.
Varosy, Paul D.
Hoffman, Andrew R.
Marcus, Gregory M.
Blackwell, Terri
Redline, Susan
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)
DOI: 10.1001/archinternmed.2009.138
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 (medical) › 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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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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