title: Association of sleep characteristics with atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Population-based studies have linked measures of sleep disordered breathing to nocturnally occurring atrial fibrillation (AF) episodes. Whether measures of sleep disordered breathing and sleep quality are associated with prevalent AF has not been studied in an unselected population. We investigated the cross-sectional association with prevalent AF of objectively collected prespecified measures of overnight sleep breathing disturbances, sleep stage distributions, arousal and sleep duration.
  
  
  METHODS
  AF prevalence, defined by diagnosis codes, study electrocardiography and sleep study were examined among Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent polysomnography in the MESA Sleep Study (n=2048).
  
  
  RESULTS
  Higher apnoea hypopnoea index (AHI) was associated with increased odds of AF, although the significance was attenuated after full adjustment for covariates including prevalent cardiovascular disease (OR: 1.22 (0.99 to 1.49) per SD (17/h), p=0.06). Analyses of sleep architecture measures and AF revealed significantly lower odds of AF associated with longer duration of slow wave sleep (OR: 0.66 (0.5 to 0.89) per SD (34 min), p=0.01) which persisted after additionally adjusting for AHI (OR: 0.68 (0.51 to 0.92), p=0.01). Higher sleep efficiency was significantly associated with lower likelihood of AF but the significance was lost when adjusted for AHI. No significant association was present between sleep duration and AF. In a model including AHI and arousal index, the association between AHI and AF was strengthened (AHI: OR 1.49 (1.15 to 1.91) per SD, p=0.002) and a significant inverse association between arousal index and AF was observed (OR 0.65 (0.50 to 0.86) per SD (12/h), p=0.005).
  
  
  CONCLUSIONS
  In a study of a large multiethnic population, AF was associated with AHI severity, and was more common in individuals with poor sleep quality as measured by reduced slow wave sleep time, a finding that was independent of AHI.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Sina A
authors.initials: SA
authors.lastname: Gharib
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Biggs
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA Department of Medicine, Hualien-Armed Forces General Hospital, Hualien, Taiwan.
authors.forename: Gen-Min
authors.initials: GM
authors.lastname: Lin
authors.affiliation: Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
authors.affiliation: Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications*; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology
keywords: Sleep apnoea