Poor sleep quality associated with self-reported AF episodes the next day


In the I-STOP-AFib trial, poor night sleep quality during the preceding night was associated with increased risk of self-reported AF episodes on the subsequent day in patients with symptomatic AF.

This summary is based on the publication of Wong CX, Modrow MF, Sigona K, et al. - Preceding Night Sleep Quality and Atrial Fibrillation Episodes in the I-STOP-AFIB Randomized Trial. JACC Clin Electrophysiol. 2024 Jan;10(1):56-64. doi: 10.1016/j.jacep.2023.09.009.

Introduction and methods


Chronic sleep disruptions are associated with incident or recurrent AF [1-3]. It remains unclear whether a night of disrupted or poor sleep affects the near-term risk of AF.

Aim of the study

This study aimed to investigate the association of self-reported nighttime sleep quality with the risk of discrete AF episodes the next day.


I-STOP-AFib (Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation) was a smartphone-based randomized trial that enrolled adults with symptomatic AF. Participants were randomized to individualized (n-of-1) trigger testing or AF monitoring alone. All participants received daily mobile app-based surveys to report on sleep quality during the preceding night. Sleep quality was divided into 5 categories: amazing, good, average, bad and horrible. AF was assessed daily by self-reporting and with a mobile ECG device. I-STOP-AFib study lasted for 10 weeks, after which participants had the option to participate in a successive 10-week study period to study up to 4 triggers of AF. Sleep data from 419 participants was available. In the initial 10 weeks of the study, data of 15,755 days were available with a total of 3459 self-reported AF events and 867 mobile ECG-confirmed AF events.


Outcomes were the occurrence of AF episodes and AF duration.

Main results

  • Average, bad and horrible sleep during the preceding night was associated with a higher risk of self-reported AF compared with amazing sleep (each worsening sleep quality category, OR: 1.15; 95%CI: 1.10-1.20; P<0.0001).
  • There was no association between worse sleep quality and the occurrence of mobile ECG-confirmed AF events (OR: 1.04; 95%CI: 0.95-1.13; P=0.43).
  • Average and bad sleep during the preceding night was associated with longer AF episodes on the following day compared with amazing sleep (P=0.02 and P<0.001, respectively). Horrible sleep was not associated with longer AF duration (P=0.23).
  • Each worse sleep category was associated with an estimated 16 minutes (95%CI: 12-21) increase in self-reported AF duration the next day (P<0.001).


In the smartphone-based I-STOP-AFib trial, poor sleep quality was associated with an increased risk of self-reported AF episodes on the subsequent day. Progressively worse sleep was also associated with longer durations of AF episodes on the subsequent day. There was no association between mobile ECG-recorded AF episodes and sleep quality, which might be due to limited statistical power, lack of a continuous ECG monitoring method or true lack of association. The authors conclude that “[t]hese data suggest that sleep quality may be a potentially modifiable and immediate trigger of discrete AF episode”.

Find this article online at JACC Clin Electrophysiol.


1. Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565-71.

2. Christensen MA, Dixit S, Dewland TA, et al. Sleep characteristics that predict atrial fibrillation. Heart Rhythm. 2018;15(9):1289-1295.

3. Genuardi MV, Ogilvie RP, Saand AR, et al. Association of short sleep duration and atrial fibrillation. Chest. 2019;156(3):544-552.

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