Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women

Patricia Tung, Yamini S. Levitzky, Rui Wang, Jia Weng, Stuart F Quan, Daniel J. Gottlieb, Michael Rueschman, Naresh M. Punjabi, Reena Mehra, Suzie Bertisch, Emelia J. Benjamin, Susan Redline

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12- lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index ≥5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2- to 3-fold increased odds of developing AF (central apnea index ≥ 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to < 15 OR, 0.84, 0.59-1.17; OAHI 15 to < 30 OR, 0.93, 0.60-1.45; OAHI ≥30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.

Original languageEnglish (US)
Article numbere004500
JournalJournal of the American Heart Association
Volume6
Issue number7
DOIs
StatePublished - Jul 1 2017

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Central Sleep Apnea
Obstructive Sleep Apnea
Atrial Fibrillation
Apnea
Odds Ratio
Cheyne-Stokes Respiration
Sleep Apnea Syndromes

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Cohort
  • Obstructive sleep apnea
  • Sleep apnea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women. / Tung, Patricia; Levitzky, Yamini S.; Wang, Rui; Weng, Jia; Quan, Stuart F; Gottlieb, Daniel J.; Rueschman, Michael; Punjabi, Naresh M.; Mehra, Reena; Bertisch, Suzie; Benjamin, Emelia J.; Redline, Susan.

In: Journal of the American Heart Association, Vol. 6, No. 7, e004500, 01.07.2017.

Research output: Contribution to journalArticle

Tung, P, Levitzky, YS, Wang, R, Weng, J, Quan, SF, Gottlieb, DJ, Rueschman, M, Punjabi, NM, Mehra, R, Bertisch, S, Benjamin, EJ & Redline, S 2017, 'Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women', Journal of the American Heart Association, vol. 6, no. 7, e004500. https://doi.org/10.1161/JAHA.116.004500
Tung, Patricia ; Levitzky, Yamini S. ; Wang, Rui ; Weng, Jia ; Quan, Stuart F ; Gottlieb, Daniel J. ; Rueschman, Michael ; Punjabi, Naresh M. ; Mehra, Reena ; Bertisch, Suzie ; Benjamin, Emelia J. ; Redline, Susan. / Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 7.
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abstract = "Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ({"}parent{"}) cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12- lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index ≥5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2- to 3-fold increased odds of developing AF (central apnea index ≥ 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to < 15 OR, 0.84, 0.59-1.17; OAHI 15 to < 30 OR, 0.93, 0.60-1.45; OAHI ≥30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.",
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AU - Tung, Patricia

AU - Levitzky, Yamini S.

AU - Wang, Rui

AU - Weng, Jia

AU - Quan, Stuart F

AU - Gottlieb, Daniel J.

AU - Rueschman, Michael

AU - Punjabi, Naresh M.

AU - Mehra, Reena

AU - Bertisch, Suzie

AU - Benjamin, Emelia J.

AU - Redline, Susan

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12- lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index ≥5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2- to 3-fold increased odds of developing AF (central apnea index ≥ 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to < 15 OR, 0.84, 0.59-1.17; OAHI 15 to < 30 OR, 0.93, 0.60-1.45; OAHI ≥30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.

AB - Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12- lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index ≥5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2- to 3-fold increased odds of developing AF (central apnea index ≥ 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to < 15 OR, 0.84, 0.59-1.17; OAHI 15 to < 30 OR, 0.93, 0.60-1.45; OAHI ≥30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Cohort

KW - Obstructive sleep apnea

KW - Sleep apnea

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