title: Association between sleep disordered breathing and electrocardiographic markers of atrial abnormalities: the MESA study.
abstract: OBJECTIVE
  Electrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB.
  
  
  RESULTS
  1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate corrected PR interval) were measured from resting standard digital ECG tracings using standardized processing. Linear and logistic regression analyses were utilized to examine the cross-sectional associations of measures of SDB (apnea hypopnea index [AHI] and % time spent with oxygen saturation <90% [%SpO290]) with each ECG marker. In a multivariable analysis adjusting for demographics, cardiovascular risk factors, and comorbidities, AHI was associated with greater PTFV1 but not with other ECG markers of LA abnormalities. A 1-SD increase of AHI (16.6/hr) was associated with higher levels of PTFV1 (175.1 µV.ms, 95% confidence interval [95%CI] 75.4, 274.7) and higher odds of abnormally elevated PTFV1 (≥4000 µV.ms) (Odds Ratio: 1.21 [95%CI 1.05, 1.39]). No association was found between %SpO290 and ECG markers of LA abnormalities.
  
  
  CONCLUSIONS
  Severity of SDB, as measured by AHI, is associated with subclinical LA disease, as indicated by PTFV1. PTFV1 may be an important ECG marker linking SDB and AF.
authors.affiliation: Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, 55455 MN, USA.|Division of Cardiovascular Medicine, University of Virginia, 800158 Charlottesville, VA, USA.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, University of Minnesota, Minneapolis, 55455 MN, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Misialek
authors.affiliation: Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, 55455 MN, USA.|Division of Cardiology, University of Minnesota, Minneapolis, 55455 MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, 30322 GA, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, 55455 MN, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, 98101 WA, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, 02115 MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, 27157 NC, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D016279:Atrial Function, Left; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012119:Respiration; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; Epidemiology; P wave index; P wave terminal force; Sleep apnoe; Sleep disordered breathing