Sleep Duration and Risk of Atrial Fibrillation (From the Physicians’ Health Study)

Study Questions:

In a large prospective cohort of male physicians, is there an association between sleep duration and incident atrial fibrillation (AF)?

Methods:

The Physicians’ Health Study is a completed, randomized, double-blind, placebo-controlled trial, designed to study the effects of low-dose aspirin and beta-carotene on cardiovascular disease and cancer among US male physicians. Self-reported sleep duration was ascertained during the 2002 annual follow-up questionnaire. Incident AF was ascertained through annual follow-up questionnaires. The diagnosis of sleep apnea was based on self-report.

Results:

A sample of 18,755 participants was used for the present analysis. The average age at baseline was 67.7 ± 8.6 years. During a mean follow-up of 6.9 ± 2.1 years, 1,468 cases of AF occurred. The crude incidence rate of AF was 9.6, 9.9, and 14.9 cases/1,000 person-years for those reporting an average sleep duration of ≤6, 7, and ≥8 hours, respectively. Using 7 hours of sleep as the reference group, the multivariate adjusted hazard ratio for AF was 1.06 (95% confidence interval, 0.92-1.22), 1.0 (reference), and 1.13 (95% confidence interval, 1.00-1.27) from the lowest to greatest category of sleep duration (p for trend = 0.26), respectively. In a secondary analysis, adiposity did not modify the sleep duration–AF association (p = 0.69). Evidence was found for an interaction between the sleep duration and sleep apnea on the risk of incident AF (p = 0.01).

Conclusions:

Association of sleep-disordered breathing (SDB) with incident coronary artery disease, AF, and heart failure in patients with type 2 diabetes mellitus justifies increased screening for SDB in patients with type 2 diabetes mellitus, realizing that SDB is a potentially modifiable risk factor.

Perspective:

Current data do not suggest a causal association between sleep duration and AF. The majority of sleep in humans is nonrapid eye movement sleep, and is generally considered to be associated with high parasympathetic activity. This study supports the hypothesis that those with long sleep duration may have prolonged exposure to increased vagal tone, which is associated in certain patients with bradycardia-mediated AF.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Sleep Apnea

Keywords: Coronary Artery Disease, Heart Failure, Sleep, Atrial Fibrillation, Questionnaires, Diabetes Mellitus


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