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Cited by 110Obstructive Sleep Apnea ResearchAtrial Fibrillation Management and OutcomesSleep and related disorders

Variability of Sleep Apnea Severity and Risk of Atrial Fibrillation

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Linz, Dominik, Brooks, Anthony G., Elliott, Adrian D., Nalliah, Chrishan J., Hendriks, Jeroen M.L., Middeldorp, Melissa E., Gallagher, Celine, Mahajan, Rajiv +4 more·2019·JACC: Clinical Electrophysiology
DOI 10.1016/j.jacep.2019.03.005
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Abstract

OBJECTIVES This study sought to determine night-to-night variability in the severity of sleep-disordered breathing (SDB) and the dynamic intraindividual relationship to daily risk of incident atrial fibrillation (AF) by using simultaneous long-term day-by-day SDB and AF monitoring. BACKGROUND Night-to-night variability in SDB severity may result in a dynamic exposure to SDB related conditions impacting the timing and extent of cardiovascular responses. METHODS This study was an observational cohort study. Daily data for AF burden and average respiratory disturbance index (RDI) were extracted from pacemakers capable of monitoring nightly SDB and daily AF burden in 72 patients. Nightly RDI values were grouped into quartiles of severity within each patient. AF burdens of >5 min, >1 h, and >12 h were the outcome variables. RESULTS A total of 32% of patients had a mean RDI of ≥20/h, indicative of overall severe SDB. There was significant night-to-night variation in RDI reflected by an absolute SD of ±6.3 events/h (range 2 to 14 events/h) within any given patient. Within each patient, the nights with the highest RDI (in their highest quartile) conferred a 1.7-fold (1.2 to 2.2; p < 0.001), 2.3-fold (1.6 to 3.5; p < 0.001), and 10.2-fold (3.5 to 29.9; p < 0.001) increase risk of having at least 5 min, 1 h, and 12 h, respectively, of AF during the same day compared with the best sleep nights (in their lowest quartiles). CONCLUSIONS There is considerable night-to-night variability in SDB severity which cannot be detected by 1 single overnight sleep study. SDB burden may be a better metric with which to assess the extent of dynamic SDB related cardiovascular responses such as daily AF risk than the categorical diagnosis of SDB. (Night-to-Night Variability in Severity of Sleep Apnea and Daily Dynamic Atrial Fibrillation Risk [VARIOSA-AF]; ACTRN 12618000757213).

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  • In patients with paroxysmal atrial fibrillation, night-to-night variation in OSA severity predicts changes in atrial fibrillation burden.

    “Similarly, in patients with paroxysmal AF, night-to-night variation in OSA severity predicts changes in AF burden.734”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [734]

    The Burden section reports that nights with higher respiratory disturbance indices were associated with more AF on the same day, supporting the central relationship. But the Patient Population section describes a pacemaker cohort selected by AF burden, not specifically patients with paroxysmal AF. The Study Limitations section also says the monitoring algorithm could not distinguish obstructive from central apnea, so the finding cannot be attributed specifically to OSA. Page numbers were not available in our copy. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [26]26. Linz D, Hohl M, Ukena C, et al. Obstructive respiratory events increase premature atrial con- tractions after cardioversion. Eur Respir J 2015;45: 1332-40.

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Authors
Linz, D., Brooks, A. G., Elliott, A. D., Nalliah, C. J., Hendriks, J. M. L., Middeldorp, M. E., Gallagher, C., Mahajan, R., Kalman, J. M., McEvoy, R. D., Lau, D. H., & Sanders, P.
Affiliations
  • Royal Adelaide Hospital (AU)
  • The Royal Melbourne Hospital (AU)
  • Flinders University (AU)
Corresponding author
Sanders, Prashanthan
ORCID
Venue
JACC: Clinical Electrophysiology
Publisher
Elsevier BV
Published
2019-06
Volume
5
Issue
6
Pages
692-701
ISSN
2405-500X (ISSN-L)
DOI
10.1016/j.jacep.2019.03.005
OpenAlex
W2942899885
Semantic Scholar
c571e1a395a491bc6501972e5b2ee1722f0a91ae
Cited by
110
References
29
Citations by year
2026: 9 · 2025: 10 · 2024: 13 · 2023: 15 · 2022: 13 · 2021: 25 · 2020: 19 · 2019: 6
FWCI
10.80
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC. Clinical electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
  • Biotronik
  • University of Adelaide
  • National Heart Foundation of Australia
  • Medtronic
  • Boehringer Ingelheim
  • Pfizer
  • National Health and Medical Research Council
  • Sanofi
  • Abbott Laboratories
  • Bayer
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
sleep apnea, sleep-disordered breathing, atrial fibrillation, night-to-night variability, respiratory disturbance index, pacemaker monitoring, incident atrial fibrillation risk, cardiovascular risk
MeSH terms
Atrial Fibrillation, Humans, Monitoring, Physiologic, Severity of Illness Index, Sleep Apnea Syndromes, Cohort Studies, Incidence, Logistic Models, Cardiac Resynchronization Therapy Devices

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