Central Sleep Apnea Tied to AF Risk in Older Men

Tara Haelle

November 26, 2015

Central sleep apnea and Cheyne Stokes respiration are linked to increased odds of atrial fibrillation, particularly in men aged 76 years and older, according to a prospective cohort study published online November 23 in the American Journal of Respiratory and Critical Care Medicine.

"Although these prospective findings do not prove a causal relationship of [central sleep apnea] and [atrial fibrillation], they highlight the potential role of [central sleep apnea] as a marker of [atrial fibrillation] development," write Anna M. May, MD, from University Hospitals Case Medical Center in Cleveland, Ohio, and colleagues.

The researchers prospectively followed a population cohort of 843 older men without atrial fibrillation at baseline for a mean of 6.5 years. The men underwent assessments for their apnea-hypopnea index, presence of central or obstructive sleep apnea, presence of Cheyne Stokes respiration, and proportion of sleep time with greater than 90% oxygen saturation.

In calculating the men's odds of developing incident atrial fibrillation, the authors adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and apnea type (obstructive or central).

Men with central sleep apnea had 2.58 greater odds of atrial fibrillation than men without it (odds ratio [OR], 2.58; 95% confidence interval, 1.18 - 5.66), and men with central sleep apnea–Cheyne Stokes respiration had a similar increased risk (OR, 2.27; 95% CI, 1.13 - 4.56; P < .05 for both). Men with obstructive sleep apnea or hypoxemia, however, had no increased odds of atrial fibrillation.

Participants aged 76 years and older with central sleep-disordered breathing had much greater odds of atrial fibrillation: nearly 10 times greater for central apnea (OR, 9.97; 95% CI, 2.72 - 36.50) and 6.31 times greater for central apnea–Cheyne Stokes respiration (OR, 6.31; 95% CI, 1.94 - 20.51). These odds had wide confidence intervals because of small atrial fibrillation counts. The older men also had 1.22 times greater odds of atrial fibrillation for each five-unit increase in their apnea-hypopnea index (OR, 1.22; 95% CI, 1.08 - 1.39).

One potential limitation of these findings is survivorship bias, the study authors acknowledge, as 390 of the men who died had sleep-disordered breathing.

The authors discuss several mechanisms by which sleep-disordered breathing may contribute to atrial fibrillation, but they note there are some data to indicate that atrial fibrillation may contribute to sleep-disordered breathing.

The greater risk for atrial fibrillation among older participants may represent a multiplicative effect from advanced age and sleep-disordered breathing, the authors suggest. "For example, the pathophysiologic insults of [sleep-disordered breathing] including intermittent hypoxia, autonomic imbalance, and intrathoracic pressure swings may have more pronounced effects on atrial arrhythmogenesis when superimposed on the aged heart which has a different electrophysiological substrate compared to younger individuals," they write.

The research was supported by the National Institutes of Health.

Am J Respir Crit Care Med. Published online November 23, 2015. Abstract

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