Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study

Abstract

Introduction Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men. Methods We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79–90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5–10 min period of a crescendo-decrescendo respiratory pattern associated with CSA. Results The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95–11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09–4.01). CSB showed similar trends as CSA. Conclusions After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.

Obstructive Sleep Apnea Syndrome Associated with Atrial Fibrillation in Adult Patients: A Systematic Review and Meta-Analysis

“…The association of the degrees of severity of the OSA (mild, moderate, and severe) with AF can be questioned by studies where it is confirmed, such as that of Gemma Cadby et al [26] or no significant association is found [27,28]. Further studies are needed to see the relationship in this topic.…”

Personalized management of sleep apnea in patients with atrial fibrillation: An interdisciplinary and translational challenge

“…This is crucial given that OSA treatment is recommended as an important component of combined risk factor management by current AF practice guidelines [3] . Although Anzai et al show that CSA/CSR is associated with higher odds of AF [6] , current guidelines do not recommend management of CSA/CSR in AF populations at this timepoint [3] . In the case of predominant CSA/CSR in AF patients, the initial work-up should mainly focus on managing heart failure and other clinical or sub-clinical comorbidities.…”

“…In this issue of the IJC Heart & Vasculature, Anzai et al performed a cross-sectional analysis using two large population studies: [6] The Kuakini Honolulu-Asia Aging Study, a longitudinal cohort study of Japanese-American men living in Hawaii, and the Osteoporotic Fractures in Men (MrOS) Sleep Study, a longitudinal cohort study of White-American men in the U.S. After adjustment for reported concomitant conditions, CSA and CSR were both associated with higher odds of AF in Japanese-Americans and in White-Americans.…”

“…Therefore, the presence of CSA and CSR should always trigger a detailed heart failure workup and consequent clinical management, as CSA/CSR may often be a consequence of underlying untreated heart failure [16] . Importantly, in the study by Anzai et al [6] the presence and diagnosis of heart failure was solely ascertained by a questionnaire interrogating clinical signs of heart failure. Heart failure contributes to AF.…”

Recent highlights on the prevalence and role of sleep disordered breathing in cardiovascular diseases from the International Journal of Cardiology Heart & Vasculature

“…Sleep disturbances and sleep disordered breathing (SDB) have been associated widely with cardiovascular diseases [1] , [2] , [3] , [4] , [5] . Also misalignment of the internal circadian time with external physical time due to environmental factors or due to genetic variation in circadian clock genes has been associated with increased incidence of cardiovascular risk factors [6] .…”