P2901No impact of atrial fibrillation on sleep quality and sleep duration in patients with sleep-disordered breathing and preserved ejection fraction

Abstract

Introduction: Sleep characteristics as shown by sleep duration and architecture seem to have a substantial impact on the onset of atrial fibrillation (AFib). Sleep Disordered Breathing (SDB) is highly prevalent in patients with AFib and may represent the main comorbidity influencing sleep quality (SQ) and sleep duration (SD). Purpose: The purpose of the present study was to investigate the impact of AFib on SQ and SD in patients with preserved LVEF and documented SDB. Methods: Retrospective matched control analysis of SQ and SD using full attended polysomnography with video surveillance in 200 consecutive patients with documented SDB and either sinus rhythm (n=100) or AFib (n=100). Groups were matched for age, gender and extent of sleep apnoea (apnoea-hypopnoea index, AHI). The AHI was used as a standard metric to differentiate none to mild (AHI<15/h), moderate (AHI 15/h to 30/h) from severe SDB (AHI≥30/h). The predominant type of SDB was classified according to the predominant type of apnoea. Key parameters of SQ were total sleep time (TST), sleep efficiency (TST/time in bed; SE), wake after sleep onset time (WASO) and percentage of REM and slow-wave sleep (N3). Results: Despite a larger left atrium (51±8mm vs. 40±7mm, p<0.001) and a lower reported exercise tolerance by EHRA classification (1.8±0.9 vs. 1.4±1.0, p=0.006) of AFib patients, there was no significant difference in patients' characteristics. AFib patients presented either with persistent or permanent AFib, which was well controlled and patients did not show acute signs of cardiac insufficiency. The Epworth sleepiness scale, a standard questionnaire to detect sleepiness in obstructive sleep apnoea and non-cardiac patients, was within the normal range and did not differ between both groups (7.4±4.4 vs. 7.9±4.6). No differences in proportion of sleep stages (N3/TST: 24±19% vs. 24±17%; REM/TST: 10±8% vs. 11±7%), sleep efficiency (79±14% vs. 82±11%, p=0.051) and sleep duration (352±68min vs. 363±59min) were found. Furthermore AFib patients showed significantly more central apnoeas (34±56 vs. 18±42, p=0.022) and fewer obstructive events (34±57 vs. 54±78, p=0.042) than SR patients. Conclusions: Other than expected, in our matched cohort of 200 patients with and without AFib, preserved LVEF and known SDB, no differences in sleep architecture and duration were found. Nevertheless, obstructive sleep apnoea has a documented high prevalence in patients with AFib and a proven significant impact on the onset of AFib (electrical and mechanical remodeling) and efficacy of any anti-arrhythmic treatment in these patients.