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. 2021 Sep 21;78(12):1197-1207.
doi: 10.1016/j.jacc.2021.07.023.

Healthy Sleep Patterns and Risk of Incident Arrhythmias

Xiang Li  1 , Tao Zhou  2 , Hao Ma  3 , Tao Huang  4 , Xiang Gao  5 , JoAnn E Manson  6 , Lu Qi  7
Affiliations

Healthy Sleep Patterns and Risk of Incident Arrhythmias

Xiang Li et al. J Am Coll Cardiol. .

Abstract

Background: Emerging evidence has linked sleep behaviors with the risk of cardiac arrhythmias. The various sleep behaviors are typically correlated; however, most of the previous studies only focused on the individual sleep behavior, without considering the overall sleep patterns.

Objectives: The purpose of this study was to prospectively investigate the associations between a healthy sleep pattern with the risks of cardiac arrhythmias.

Methods: A total of 403,187 participants from UK Biobank were included. A healthy sleep pattern was defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. Weighted genetic risk score for atrial fibrillation was calculated.

Results: The healthy sleep pattern was significantly associated with lower risks of atrial fibrillation/flutter (AF) (HR comparing extreme categories: 0.71; 95% CI: 0.64-0.80) and bradyarrhythmia (HR: 0.65; 95% CI: 0.54-0.77), but not ventricular arrhythmias, after adjustment for demographic, lifestyle, and genetic risk factors. Compared with individuals with a healthy sleep score of 0-1 (poor sleep group), those with a healthy sleep score of 5 had a 29% and 35% lower risk of developing AF and bradyarrhythmia, respectively. Additionally, the genetic predisposition to AF significantly modified the association of the healthy sleep pattern with the risk of AF (P interaction = 0.017). The inverse association of the healthy sleep pattern with the risk of AF was stronger among those with a lower genetic risk of AF.

Conclusions: Our results indicate that a healthy sleep pattern is associated with lower risks of AF and bradyarrhythmia, independent of traditional risk factors, and the association with AF is modified by genetic susceptibility.

Keywords: cardiac arrhythmias; cohort study; genetic risk; sleep pattern.

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Conflict of interest statement

Funding Support and Author Disclosures The study has been conducted using the UK Biobank Resource under Application 29256. The study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383), the Fogarty International Center (TW010790), and Tulane Research Centers of Excellence Awards. Dr Li was the recipient of the American Heart Association Predoctoral Fellowship Award (19PRE34380036). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Dose-response relationship between healthy sleep score and arrhythmias.
Models were adjusted for age, sex, Townsend deprivation index, center, alcohol intake, smoking status, physical activity, sedentary hours, healthy diet score, systolic blood pressure, anti-hypertensive medications, blood glucose, high cholesterol, medications for diabetes, and genetic risk score for atrial fibrillation. For AF, p for test of curvature =0.04, p for linearity <0.0001; for ventricular arrhythmias, p for test of curvature =0.71, p for linearity =0.44; for bradyarrhythmia, p for test of curvature =0.69, p for linearity <.0001.
Figure 2.
Figure 2.. Multivariable-adjusted hazard ratios for arrhythmias in subgroups.
Stratified analysis was performed according to subgroups of each covariate. Models were adjusted for age, sex, Townsend deprivation index, center, alcohol intake, smoking status, physical activity, sedentary hours, healthy diet score, systolic blood pressure, anti-hypertensive medications, blood glucose, high cholesterol, medications for diabetes, and genetic risk score for atrial fibrillation. The interaction term of healthy sleep score with each potential modifier was included in the model. AF: atrial fibrillation or atrial flutter; BMI: body mass index; MET: metabolic equivalent task.
Central Illustration.
Central Illustration.. Healthy sleep pattern and risks of cardiac arrhythmias.
Stratified analysis according to the tertile categories of AF-GRS. Models were adjusted for age, race, sex, assessment center, Townsend deprivation index, smoking status, alcohol intake, physical activity, sedentary hour, healthy diet score, systolic blood pressure, glucose, high cholesterol, anti-hypertensive medications, and medications for diabetes.
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