Novel Sleep Phenotypic Profiles Associated with Incident Atrial Fibrillation in a Large Clinical Cohort (JCEP September 2024)-Article: Novel Sleep Phenotypic Profiles Associated with Incident Atrial Fibrillation in a Large Clinical Cohort

Article: Novel Sleep Phenotypic Profiles Associated with Incident Atrial Fibrillation in a Large Clinical Cohort

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This study explores the relationship between sleep disorders and the development of atrial fibrillation (AF), focusing on specific sleep phenotypes derived from sleep symptoms and polysomnography (PSG) data. Conducted on a cohort of 43,433 patients from the Cleveland Clinic's STARLIT registry, the research utilized a latent class analysis to identify five distinct sleep-based phenotypes. These included: the hypoxia subtype, which showed a 48% increased risk of incident AF; the apneas and arousals subtype with a 22% increased risk; the short sleep and non-rapid eye movement (NREM) subtype with an 11% increase; and two control groups, one of which did not differ from the reference group in terms of AF development.<br /><br />Findings indicate that sleep-related hypoxia and specific sleep architecture characteristics, such as REM duration, contribute significantly to the likelihood of developing AF. The hypoxia subtype, characterized by longer sleep times spent with low oxygen saturation, was most strongly associated with AF, independent of factors like age or obesity.<br /><br />This study underscores the importance of recognizing sleep-related disorders as significant contributors to AF development, suggesting that accurate identification of at-risk phenotypes may aid in early detection and tailored interventions for AF prevention. The research suggests a potential shift in clinical practice towards utilizing comprehensive sleep-specific data rather than relying solely on the apnea hypopnea index (AHI) to assess risk for cardiovascular outcomes. The study's methodology, focusing on precise symptom-based and physiological measures, paves the way for precision medicine approaches in managing AF risk associated with sleep disturbances.

Keywords

sleep disorders

atrial fibrillation

sleep phenotypes

polysomnography

hypoxia subtype

latent class analysis

Cleveland Clinic

REM duration

precision medicine

cardiovascular outcomes