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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
Open accessAbstract
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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“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]
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Citations
Cites
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“risk factor for overall as well as cardiovascular-specific mortality.(13,14,18) Sleep-”
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Self-citationObstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043104 · Cited by 3,004
Sleep-disordered Breathing and Cardiovascular Disease
SHAHAR, E., WHITNEY, C. W., REDLINE, S., LEE, E. T., NEWMAN, A. B., JAVIER NIETO, F., O'CONNOR, G. T., BOLAND, L. L., SCHWARTZ, J. E., & SAMET, J. M. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.1.2001008 · Cited by 2,901
Self-citationSympathetic neural mechanisms in obstructive sleep apnea.
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Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort
(2008) · Sleep · doi:10.5665/sleep/31.8.1071 · Cited by 1,853 · cited 2×
“risk factor for overall as well as cardiovascular-specific mortality.(13,14,18) Sleep-”
Association of Nocturnal Arrhythmias with Sleep-disordered Breathing
Mehra, R., Benjamin, E. J., Shahar, E., Gottlieb, D. J., Nawabit, R., Kirchner, H. L., Sahadevan, J., & Redline, S. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200509-1442oc · Cited by 1,262
Self-citationAssociation of Atrial Fibrillation and Obstructive Sleep Apnea
Gami, A. S., Pressman, G., Caples, S. M., Kanagala, R., Gard, J. J., Davison, D. E., Malouf, J. F., Ammash, N. M., Friedman, P. A., & Somers, V. K. (2004) · Circulation · doi:10.1161/01.cir.0000136587.68725.8e · Cited by 1,148
Cited by
Sorted by citations
Berry, R. B., Budhiraja, R., Gottlieb, D. J., Gozal, D., Iber, C., Kapur, V. K., Marcus, C. L., Mehra, R., Parthasarathy, S., Quan, S. F., et al. (2012) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2172 · Cited by 5,302
“72 Using this definition for CSB, Mehra and colleagues found an association between the presence of CSB C o p y r i g h t © A m e r i c a n A c a d e m y o f S l ee p M e d i c i n e and complex ventricular ectopy independent of self-reported heart failure.”
Self-citationObstructive sleep apnoea and cardiovascular disease
Sánchez‐de‐la‐Torre, M., Campos‐Rodríguez, F., & Barbé, F. (2012) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(12)70051-6 · Cited by 512
Prevention of Atrial Fibrillation
Benjamin, E. J., Chen, P., Bild, D. E., Mascette, A. M., Albert, C. M., Alonso, Á., Calkins, H. G., Connolly, S. J., Curtis, A. B., Darbar, D., et al. (2009) · Circulation · doi:10.1161/circulationaha.108.825380 · Cited by 477
Linz, D., McEvoy, R. D., Cowie, M. R., Somers, V. K., Nattel, S., Lévy, P., Kalman, J. M., & Sanders, P. (2018) · JAMA Cardiology · doi:10.1001/jamacardio.2018.0095 · Cited by 411
“In 2911 participants of the Outcomes of SleepDisorders in OlderMen study, increasing severity of sleep apneawas associatedwith a progressive increase in the oddsofAFandcardiovascular events.39AlthoughCSAwasvery rare in this study, cardiovascular events were most strongly associated withOSAandhypoxia,whereasAFwasmostst…”
BackgroundInfluentialInternational Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350
Metadata
- 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 (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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