Prevalence of sleep apnea syndrome in lone atrial fibrillation: a case-control study.

BACKGROUND According to several studies, obstructive sleep apnea predisposes to cardiac arrhythmias, but the prevalence of sleep apnea in specific arrhythmias has not been determined. Our case-control study assesses prevalence of sleep apnea syndrome (SAS) in lone atrial fibrillation (AF). METHODS Patients with AF (n = 59; 48 men and 11 women; mean age, 59 years; age range, 25 to 84 years) without evident cardiovascular diseases, and their 56 gender-matched, age-matched, and cardiovascular morbidity-matched community control subjects underwent an overnight sleep study. RESULTS Prevalence of SAS in the AF group was 32%, which did not differ from that in control subjects (29%, p = 0.67). In men, mean neck circumference was higher in the AF group (40.9 cm vs 39.5 cm, p = 0.01) than in control subjects. In men, after adjusting for body mass index and waist circumference, neck circumference was independently related to AF, with an odds ratio (OR) of 1.8 (95% confidence interval, 1.3 to 2.5) per 1-cm increase, and an OR of 5.2 (95% confidence interval, 1.6 to 17.0) for values > 40 cm. Compared to control subjects, the AF group reported more daily/almost-daily tiredness (29% vs 4%, p < 0.001), daily/almost-daily sleepiness (27% vs 7%, p = 0.005), and nightly/almost-nightly breathing pauses during sleep (12% vs 2%, p = 0.03). CONCLUSIONS SAS seems to be common in lone AF. Nevertheless, we could not show SAS to be more common in patients with AF than in gender-matched, age-matched, and cardiovascular morbidity-matched community control subjects. Compared to control subjects, men with AF seem to have thicker necks, and patients with lone AF report more daytime tiredness, daytime sleepiness, and breathing pauses during sleep.

[1]  J. Peter,et al.  Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease , 1991, Klinische Wochenschrift.

[2]  C. Janson,et al.  Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. , 2002, Thorax.

[3]  T. Young,et al.  Epidemiology of obstructive sleep apnea: a population health perspective. , 2002, American journal of respiratory and critical care medicine.

[4]  Michel Haïssaguerre,et al.  Benefit of atrial pacing in sleep apnea syndrome. , 2002, The New England journal of medicine.

[5]  V. Fuster,et al.  ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conference , 2001, Circulation.

[6]  I. Fietze,et al.  Sleep Apnea Syndrome in Patients with Cardiac Pacemaker , 2000, Respiration.

[7]  T. Young,et al.  Prospective study of the association between sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[8]  J. Peter,et al.  Heart block in patients with sleep apnoea , 1998, Thorax.

[9]  EW Russi,et al.  Diving and the risk of barotrauma , 1998, Thorax.

[10]  M. Holm,et al.  Autonomic modulation of the atrial cycle length by the head up tilt test: non-invasive evaluation in patients with chronic atrial fibrillation , 1998, Heart.

[11]  M. Allessie,et al.  Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. , 1997, Circulation.

[12]  M. Russo,et al.  Histological substrate of atrial biopsies in patients with lone atrial fibrillation. , 1997, Circulation.

[13]  M. Gugger.  Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome. , 1997, The European respiratory journal.

[14]  A. Goette,et al.  Electrical remodeling in atrial fibrillation. Time course and mechanisms. , 1996, Circulation.

[15]  C. Guilleminault,et al.  A laboratory validation study of the diagnostic mode of the Autoset system for sleep-related respiratory disorders. , 1996, Sleep.

[16]  T. Rabben,et al.  Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. , 1996, Coronary artery disease.

[17]  C. Zwillich,et al.  Influence of treatment on muscle sympathetic nerve activity in sleep apnea. , 1996, American journal of respiratory and critical care medicine.

[18]  N. Douglas,et al.  Comparison of polysomnography with ResCare Autoset in the diagnosis of the sleep apnoea/hypopnoea syndrome. , 1995, Thorax.

[19]  B. Sanner,et al.  [Structural cardiac changes in patients with obstructive sleep apnea]. , 1995, Zeitschrift fur Kardiologie.

[20]  J. Peter,et al.  Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure. , 1995, American journal of respiratory and critical care medicine.

[21]  V. Hoffstein,et al.  Cardiac arrhythmias, snoring, and sleep apnea. , 1994, Chest.

[22]  W. McNicholas,et al.  Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias. , 1994, Postgraduate medical journal.

[23]  D. Levy,et al.  Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. , 1994, JAMA.

[24]  J. Le Heuzey,et al.  [Arrhythmia and syndrome of obstructive sleep apnea in adults]. , 1993, Archives des maladies du coeur et des vaisseaux.

[25]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[26]  F. Charpentier,et al.  Early after/depolarizations and triggered activity: mechanisms and autonomic regulation , 1993, Fundamental & clinical pharmacology.

[27]  K. Arakawa,et al.  Electrophysiological Properties in Chronic Lone Atrial Fibrillation , 1991, Circulation.

[28]  J. Stradling,et al.  Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. , 1991, Thorax.

[29]  J. Stradling,et al.  The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. , 1990, The European respiratory journal.

[30]  Arthur S Slutsky,et al.  Do patients with obstructive sleep apnea have thick necks? , 1990, The American review of respiratory disease.

[31]  K. Hashiba,et al.  Electrophysiologic properties of atrial muscle in paroxysmal atrial fibrillation. , 1989, The American journal of cardiology.

[32]  P. Scanlon,et al.  Acetylcholine release by a stimulus train lowers atrial fibrillation threshold. , 1987, The American journal of physiology.

[33]  C Guilleminault,et al.  Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. , 1983, The American journal of cardiology.