Association between arousal index during REM sleep and the incidence of atrial fibrillation in patients with obstructive sleep apnea.

BACKGROUND

Accumulating studies have linked obstructive sleep apnea (OSA) to the occurrence of atrial fibrillation (AF). However, data on the relationship between sleep architecture parameters in OSA patients and the occurrence of AF are limited.

OBJECTIVE

This exploratory study examined the association between 14 objectively collected sleep architecture parameters and the incidence of AF in OSA patients.

METHODS

This study is a population-based prospective cohort study that included 1810 participants from the Sleep Heart Health Study (SHHS) who underwent in-home polysomnography monitoring at baseline. Logistic regression analysis was used to investigate the relationship between sleep architecture parameters in OSA patients and the occurrence of AF.

RESULTS

A significant inverse association was observed between arousal index during REM sleep (ArI-REM) and the occurrence of AF after full adjustment (OR = 0.982, 95 % CI = 0.966-0.998, p = 0.027). Individuals in the highest quartile of ArI-REM had a significantly lower risk of new-onset AF compared to the lowest quartile (adjusted OR = 0.623, 95 % CI = 0.410-0.929, p = 0.023). The relationship between ArI-REM and the occurrence of AF was linear (p for trend = 0.030). Stratified analyses demonstrated a significant interaction with OSA severity (p_interaction = 0.004), with the most notable association observed in the severe OSA subgroup (adjusted OR = 0.96; 95 % CI = 0.94-0.99; p = 0.008).

CONCLUSION

There was a significant linear inverse relationship between an increase in ArI-REM and the risk of incident AF. The association was most notable in those severe OSA subgroups. Future research should explore whether continuous positive airway pressure can lower AF risk in severe OSA patients with a low ArI-REM.