Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study

Abstract

Introduction: Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men.

Methods: We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79-90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5-10 min period of a crescendo-decrescendo respiratory pattern associated with CSA.

Results: The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95-11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09-4.01). CSB showed similar trends as CSA.

Conclusions: After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.

Keywords: Atrial fibrillation; Atrial flutter; Central sleep apnea; Ethnicity.

Fig. 1

Study’s recruitment and enrollment. The Kuakini HAASSA 1999–2000, and Mr.OS Sleep Study 2003–2005, . ECG, Electrocardiogram; HAASSA, Honolulu-Asia Aging Study of Sleep; HAAS, Honolulu Asia Aging Study; Mr. OS, the Osteoporotic Fractures in Men Sleep Study; PSG, polysomnography.

Fig. 2

AF prevalence between sleep apnea and no-sleep apnea in two different ethnic groups and adjusted associations (Odds Ratios and 95% Confidence Interval) between sleep apnea and prevalence of AF estimated by multiple logistic regression models; the Kuakini HAASSA (1999–2000) and Mr.OS sleep study (2003–2005). AF, Atrial Fibrillation/Flutter; CI, Confidence Interval; CSA, Central Sleep Apnea; CSB, Cheyne-Stokes Breathing; HAASSA, Honolulu-Asia Aging Study of Sleep Apnea; Mr. OS, Osteoporotic Fracture in Men; OAHI, Obstructive Apnea–Hypopnea Index; OR, Odds Ratio; OSA, Obstructive sleep apnea; P value derived from chi-square test, or Fisher exact test if any expected cell frequencies are < 5. *Adjusted Model: Age, Body Mass Index, Hypertension, Type2-diabetes medication use, and History of stroke and Coronary Heart Disease.