title: Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men.
abstract: BACKGROUND
  Although research supports a sleep-disordered breathing and atrial fibrillation association, prospective data examining sleep-disordered breathing predicting incident atrial fibrillation are lacking.
  
  
  OBJECTIVE
  To investigate sleep-disordered breathing indices as predictors of incident atrial fibrillation.
  
  
  METHODS
  A cohort (n = 843) of ambulatory older men without prevalent atrial fibrillation was assessed for baseline sleep indices: apnea-hypopnea index, central sleep apnea (central apnea index, ≥5 vs. <5), central sleep apnea or Cheyne-Stokes respiration, obstructive apnea-hypopnea index, and percentage of sleep time with less than 90% oxygen saturation. Incident clinically symptomatic adjudicated or self-reported atrial fibrillation outcome was ascertained (mean follow-up, 6.5 ± 0.7 yr). We used logistic regression models adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and alternate apnea type for obstructive and central apnea. Age interaction terms and median age-stratified analyses were performed.
  
  
  RESULTS
  Central sleep apnea (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.18-5.66) and Cheyne-Stokes respiration with central sleep apnea (OR, 2.27; 95% CI, 1.13-4.56), but not obstructive apnea or hypoxemia, predicted incident atrial fibrillation. Central apnea, Cheyne-Stokes respiration, and sleep-disordered breathing-age interaction terms were significant (P < 0.05). Unlike the case with younger participants, among participants aged 76 years or older (albeit with small atrial fibrillation counts), atrial fibrillation was related to central apnea (OR, 9.97; 95% CI, 2.72-36.50), Cheyne-Stokes respiration with central apnea (OR, 6.31; 95% CI, 1.94-20.51), and apnea-hypopnea index (OR, 1.22; 95% CI, 1.08-1.39 [per 5-unit increase]).
  
  
  CONCLUSIONS
  In older men, central apnea and Cheyne-Stokes respiration predicted increased atrial fibrillation risk, with findings being strongest in older participants in whom overall sleep-disordered breathing also increased atrial fibrillation risk.
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Anna M
authors.initials: AM
authors.lastname: May
authors.affiliation: 2 California Pacific Medical Center Research Institute, San Francisco, California.
authors.forename: Terri
authors.initials: T
authors.lastname: Blackwell
authors.affiliation: 3 Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Stone
authors.affiliation: 2 California Pacific Medical Center Research Institute, San Francisco, California.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.affiliation: 2 California Pacific Medical Center Research Institute, San Francisco, California.
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Cawthon
authors.affiliation: 4 University of Colorado at Denver, Denver, Colorado.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: 4 University of Colorado at Denver, Denver, Colorado.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: 3 Brigham and Women's Hospital, Boston, Massachusetts.|5 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: 6 Sleep Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002639:Cheyne-Stokes Respiration / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D020182:Sleep Apnea, Central / Q000453:epidemiology*; D014481:United States
keywords: atrial fibrillation; cohort study; sleep-disordered breathing