Background. While sleep disorders are implicated in atrial fibrillation (AF), interplay of physiologic alterations and symptoms remains unclear. Sleep-based phenotypes can account for this complexity and translate to actionable approaches to identify at-risk patients and therapeutic interventions.

Objectives. We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.

Methods. Data from the STARLIT Registry on Cleveland Clinic patients (age≥18) who underwent PSG from 11/27/2004-12/30/2015 were retrospectively examined. Phenotypes were identified using latent class analysis of symptoms and PSG-based measures of sleep disordered breathing and sleep architecture. Phenotypes were included as the primary predictor in a multivariable-adjusted Cox-proportional hazard models for incident AF.

Results. In our cohort (n=43,433, age 51.8±14.5 years, 51.9% male, 74.9% White), 7.3% (n=3,166) had baseline AF. Over a 7.6±3.4-year follow-up period, 8.9% (n=3,595) developed incident AF. Five phenotypes were identified. The Hypoxia subtype (n=3,245) had 48% increased incident AF (HR=1.48, 95%CI=1.34-1.64), Apneas + Arousals subtype (n=4,592) had 22% increased incident AF (HR=1.22, 95%CI=1.10-1.35), and Short Sleep + NREM subtype (n=6,126) had 11% increased incident AF (HR=1.11, 95%CI=1.01-1.22) compared to Long Sleep + REM (n=26,809), the reference group. The Hypopneas subtype (n=2,661) did not differ from reference (HR=0.89, 95%CI=0.77-1.03).

Conclusions. Consistent with prior evidence supporting hypoxia as an AF driver and cardiac risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates vulnerability for AF development, providing potential value in enhancing our understanding of integrated sleep-specific symptoms and physiologic risk of atrial arrhythmogenesis.

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, FACC, CCDS


Important Dates
Date of Release: September 23, 2024
Term of Approval/Date of CME/MOC Expiration: September 22, 2025