Obstructive sleep apnea and the day-night pattern of paroxysmal atrial fibrillation burden.

STUDY

OBJECTIVES

Obstructive sleep apnea (OSA) is a common condition that contributes to atrial fibrillation occurrence, but the evidence on the day-night pattern of paroxysmal atrial fibrillation (PAF) is still scanty. The aim of this study was to evaluate whether OSA is associated with a higher occurrence of PAF, especially PAF events during the nighttime, and determine the frequency and potential underdiagnoses of OSA in patients with PAF.

METHODS

We recruited consecutive patients who had undergone a recent 24-hour Holter monitoring and showed at least 1 episode of PAF. All patients were invited to undergo a clinical evaluation. To assess OSA status, we conducted validated portable sleep monitoring. OSA was defined by an apnea-hypopnea index of ≥ 15 events/h.

RESULTS

We studied 102 patients (mean age: 64 ± 9 years, 56% male). Sixty patients (57%) had OSA (none with a previous diagnosis). A total of 339 episodes of PAF (a third of them occurring at night) were available for analysis. We observed a significant association between OSA and nighttime PAF episodes: patients with OSA had a higher chance of nighttime episodes than those without OSA (odds ratio = 1.78, 95% confidence interval = 1.12-2.83; P = .014). Interestingly, the distribution of PAF episodes over 24 hours showed that patients with OSA had more atrial fibrillation episodes between 10 pm and 4 am than patients without OSA (OSA: median = 10 [interquartile range = 7.5-11] vs No OSA: median = 2 [interquartile range = 3-5.5]; P = .037), suggesting an abnormal day-night pattern of the PAF occurrence.

CONCLUSIONS

OSA is common, underdiagnosed, and in patients with OSA, associated with a higher nighttime occurrence of PAF episodes compared with patients without OSA.

CITATION: Rocha CMG, de Medeiros HD, Brigido ARD, et al. Obstructive sleep apnea and the day-night pattern of paroxysmal atrial fibrillation burden. J Clin Sleep Med. 2025;21(12):2073-2079.