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
Background
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.
Methods
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
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).
Conclusion
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”.
References
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.