Disclosures: The study and editorial authors report no relevant financial disclosures.
September 13, 2021
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Healthy sleep patterns may lower arrhythmia risk

Disclosures: The study and editorial authors report no relevant financial disclosures.
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Healthy sleep patterns may be associated with reduced risk for atrial fibrillation/atrial flutter and bradyarrhythmia, according to research published in the Journal of the American College of Cardiology.

However, healthy sleep patterns did not appear to affect risk for ventricular arrhythmias, according to the study.

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“It has been shown that sleep deprivation may disturb the autonomic nervous balance of sympathetic nervous and vagal outflows, which has been associated with induction and sustained arrhythmias,” Xiang Li, MD, PhD, postdoctoral fellow in the department of epidemiology at Tulane School of Public Health and Tropical Medicine, and colleagues wrote. “Because various sleep behaviors may affect the development of cardiac arrhythmias via different and complementary pathways, it is not surprising that their associations with arrhythmias exhibit an additive fashion when analyzed jointly in the sleep pattern, as observed in our study.

“For the first time, our study comprehensively examined the overall sleep patterns with the risk of cardiac arrhythmias, including AF, ventricular arrhythmias, and bradyarrhythmia,” the researchers wrote.

To evaluate the association between overall sleep pattern and risk for cardiac arrhythmias, researchers included 403,187 participants in the UK Biobank. Participants completed a touchscreen questionnaire that evaluated five factors of a healthy sleep pattern: chrono type, sleep duration, insomnia, snoring and excessive daytime sleepiness. Healthy factors were defined as early chronotype; sleep 7 to 8 hours per day; never, rarely or sometimes insomnia symptoms; no self-reported snoring; and no excessive daytime sleepiness. The presence of a healthy sleep factor was given a score of 1, potentially summing up to a maximum score of five healthy sleep factors.

Sleep and arrhythmia risk

The primary outcomes were AF, ventricular arrhythmias and bradyarrhythmia.

Compared with a healthy sleep pattern score of zero or 1, a score of 5 was associated with lower risk for AF/atrial flutter (HR = 0.71; 95% CI, 0.64-0.8; P < .001) and bradyarrhythmia (HR = 0.65; 95% CI, 0.54-0.77; P < .001), but not ventricular arrhythmias (P = .71), after adjustment for demographic, lifestyle and genetic risk factors.

According to the study, for every 1-point increase in the healthy sleep score, individuals experienced an approximately 9% lower risk for AF/atrial flutter (HR = 0.91; 95% CI, 0.9-0.93) and a 10% lower risk for bradyarrhythmia (HR = 0.9; 95% CI, 0.87-0.92) compared with those with the lowest score.

Moreover, genetic predisposition for AF significantly modified the association between overall healthy sleep pattern with the risk for AF (P = .017). Individuals with low genetic risk for AF and a healthy sleep pattern had an approximately 50% lower risk for AF compared with those at high genetic risk and poor sleep patterns (HR = 0.54; 95% CI, 0.42-0.69).

“The results of the current study ... emphasize the importance of improving the overall sleep behaviors in the prevention of cardiovascular disease at an early stage among the high-risk populations,” the researchers wrote. “Our findings lend support to potential interventions targeting the improvement of multiple sleep behaviors in the prevention of arrhythmias and cardiovascular disease risk in general.”

Do not ‘lose sleep’ over findings

In a related editorial, Alan Kadish, MD, president of New York Medical College, and Jason Jacobson, MD, director of the complex arrhythmia ablation program at Westchester Medical Center, wrote the results may be preliminary and hypothesis-generating.

“The results of the study are intriguing and add to a growing body of data that suggest that the quality and quantity of sleep may affect overall AF and bradyarrhythmia, the imprecise definition and documentation of ‘arrhythmias,’ and the absence of a specific hypothesis about why some arrhythmias were more associated with disturbed sleep patterns,” Kadish and Jacobson wrote. “These results must be taken as preliminary and hypothesis-generating, rather than findings that are ready to affect clinical practice. For this to occur, a trial of interventions to encourage healthy sleep would be required, with intensive cardiac monitoring to provide accurate arrhythmia diagnoses. The authors are to be congratulated for undertaking such a large and comprehensive study that certainly provides cause for concern. However, rest assured, we must not yet lose sleep over their findings.”

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