Abstract 13444: Decreased REM Sleep is Associated With Higher Risk of Incident Atrial Fibrillation

Introduction: Reduced sleep quality, beyond that caused by obstructive sleep apnea (OSA), has recently been associated with the development of obesity, hypertension, stroke, and death. While OSA has been shown to predict AF, it remains unknown if sleep disturbances independent of apnea predict the disease. Hypothesis: Reduced sleep quality increases the risk of incident AF independent of OSA Methods: We performed a longitudinal analysis in a sub-set of participants in the Cardiovascular Health Study who were co-enrolled in the Sleep Heart Health Study. Sleep duration, efficiency, latency, and architecture were measured at baseline using at-home polysomnography. Severity of OSA was determined using clinical cut-offs with the apnea-hypopnea-index (AHI), also measured by polysomnography. Cox proportional hazards models were used to obtain effect estimates and adjust for OSA severity and other potential confounders including: age, sex, race, site, BMI, smoking, alcohol use, use of sleeping pills, diabetes, HTN, CHD, and CHF. Results: Among 1,131 participants with a mean age of 77 ± 4.5 years, 665 (59%) were female, and 647 (60%) had at least mild OSA (AHI > 5). Over a median follow-up of 9.8 years (IQR, 5.5 - 11.7), 259 (23%) developed AF. Decreased REM sleep was associated with increased risk of AF before and after adjustment for OSA and other potential confounders ( Figure ). For every standard deviation decrease in the proportion of sleep spent in REM (SD 6.6%) there was an approximate 23% increase in the risk of AF (adjusted hazard ratio 1.23; 95% CI, 1.05 - 1.44, p = .01). Conclusions: Reduced REM sleep was independently associated with greater risk of incident AF among older adults. Aspects of sleep beyond OSA may be involved in the pathogenesis of AF and sleep quality may be an important modifiable risk factor for AF.