Long Sleep Duration Is an Independent Risk Factor for Incident Atrial Fibrillation in a Chinese Population: A Prospective Cohort Study

Abstract

There is limited information on the relation between sleep duration and incident atrial fibrillation. We aimed to investigate this association in a Chinese population using cohort data from a study in Kailuan. The analysis included 87,693 participants (age range, 18–98 years) free of atrial fibrillation at the baseline survey. Participants were divided into three categories according to self-reported sleep duration: ≤6.0 hours, 7 hours (ref), ≥8.0 hours. Atrial fibrillation diagnosis was made on a standard 12-lead electrocardiogram and via self-reported history. Cox proportional hazards models were used to calculate hazard ratio (HR) and confidence interval (CI) for atrial fibrillation, according to sleep duration. During median follow-up of 7.89 (range, 6.36–8.57) years, 322 cases of atrial fibrillation had occurred. Using 7 hours of sleep as the reference group, multivariable adjusted HRs (95% CI) for atrial fibrillation were 1.07 (0.75–1.53), 1.0 (ref), and 1.50 (1.07–2.10), from lowest to highest category of sleep duration. Secondary analysis showed no evidence of interactions between sleep duration and sex and snoring on the risk of incident atrial fibrillation (p = 0.75/0.25). We conclude long sleep duration may be a potential predictor/marker for incident atrial fibrillation.

Associations of sleep quality with incident atrial fibrillation: a meta‐analysis

“…Thus, the final analysis included eight articles, 21-28 including 10 observational studies (seven cohort studies 21,22,24,25,27,28 and three cross-sectional studies 23,25,26 ) with 14 296 314 individuals. After the exclusion of 1560 articles as they were case reports, correspondences, review articles, in vitro studies, animal studies or interventional studies, there were 31 articles for full-length review.…”

“…25 Although arousal index is part of OSA physiological variables, 11 included studies did not provide data on frequent night awakening related to OSA. [21][22][23][24][25][26][27][28] …”

“…The possible source of this heterogeneity includes the difference in population, methods used to diagnose AF, the definition of insomnia and variation in confounder adjustments. [21][22][23][24][25][26][27][28] AF detection should be strictly defined by more extended monitoring tools such as 30-day event monitor or 3-day Holter monitor. Therefore, the episodes could include arousal from OSA.…”

“…2,5,6 Sleep is a dynamic and complex process. [21][22][23][24][25][26][27][28] However, the relationship between these sleep quality problems and AF remains unclear, with conflicting findings from previous studies. 7 Recently, accumulated evidence of sleep disorders and their association with arrhythmia is reported, 8,9 especially obstructive sleep apnoea (OSA).…”

“…[12][13][14][15][16][17][18][19][20] Various aspects of sleep including short and long sleep duration, insomnia and frequent awakening at night are increasingly recognised problems in general populations worldwide. [21][22][23][24][25][26][27][28] However, the relationship between these sleep quality problems and AF remains unclear, with conflicting findings from previous studies. [21][22][23][24][25][26][27][28] This systematic review and meta-analysis aims to assess the association between AF and these sleep quality problems, including either short or long sleep duration, insomnia and frequent awakening at night.…”