Bidirectional temporal association of device-detected atrial fibrillation and sleep apnea.

IF 7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2026-11-01 Epub Date: 2026-07-18 DOI:10.1016/j.hrthm.2026.07.026

Philipp Spitaler, Valentin Bilgeri, Gudrun Feuchtner, Patrick Rockenschaub, Fabian Barbieri, Birkan Tugrul, Agne Adukauskaite, Markus Stühlinger, Bernhard Erich Pfeifer, Peter Willeit, Axel Bauer, Wolfgang Dichtl

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引用次数: 0

Abstract

Background: The relationship between atrial fibrillation (AF) and sleep apnea (SA) is well established, but the day-to-day temporal direction of this association remains uncertain.

Objective: This study aimed to examine the bidirectional day-to-day association between device-detected AF (DDAF) and device-detected SA (DDSA), while distinguishing DDAF episode onset from continuation of ongoing episodes.

Methods: Data were obtained from the prospective ACaSA study in pacemaker patients undergoing continuous remote monitoring. Data collected from September 2020 to August 2025 were analyzed. Severe DDSA was defined as a respiratory disturbance index of ≥20 and a DDAF episode as a daily burden of ≥6 minutes. 3 day-level, time-stratified intraindividual case-crossover analyses were performed: pathway 1 related preceding-day DDAF burden to incident severe DDSA on the subsequent night, pathway 2 related preceding-night severe DDSA to incident DDAF episode onset the next day, and pathway 3 related preceding-night severe DDSA to continuation of an already active DDAF episode. Generalized linear mixed-effects models were used as secondary analyses.

Results: A total of 112,242 patient-days from 218 patients were analyzed. Incident severe DDSA was preceded by higher odds of elevated DDAF burden on the previous day in a graded manner, with odds ratios (ORs) of 1.38 (95% confidence interval [CI], 1.10-1.74) for 6 minutes to 1 hour, 1.81 (95% CI, 1.52-2.15) for 1-12 hours, and 2.52 (95% CI, 1.97-3.22) for ≥12 hours (all P ≤ .005). Both incident DDAF episode onset and the continuation of ongoing DDAF episodes were preceded by higher odds of severe DDSA on the previous night (OR, 1.35; 95% CI, 1.10-1.64; P = .003, and OR, 2.39; 95% CI, 1.47-3.88; P < .001, respectively).

Conclusion: Continuous monitoring identified a bidirectional temporal association between DDAF and DDSA. Incident severe DDSA was preceded by higher odds of elevated DDAF burden, whereas both incident DDAF episode onset and continuation of ongoing episodes were preceded by higher odds of severe DDSA.

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设备检测心房颤动与睡眠呼吸暂停的双向时间关联。

背景：房颤（AF）和睡眠呼吸暂停（SA）之间的关系已经确立，但这种关联的日常时间方向仍然不确定。目的：研究设备检测到的房颤（DDAF）和设备检测到的睡眠呼吸暂停（DDSA）之间的双向日常关联，同时区分DDAF发作与持续发作。方法：对接受持续远程监测的起搏器患者进行前瞻性ACaSA研究。分析了从2020年9月到2025年8月收集的数据。重度DDSA定义为呼吸障碍指数(RDI)≥20，DDAF发作每日负担≥6分钟。进行了三天水平、时间分层的个体间病例交叉分析：途径1将前一天的DDAF负担与随后晚上发生的严重DDSA相关；途径2与夜间严重DDSA与次日发生的DDAF发作相关；途径3与前一天晚上严重DDSA与已经活跃的DDAF发作的持续相关。二次分析采用广义线性混合效应模型。结果：共分析了218例患者的112,242个患者日。严重DDSA事件发生前，DDAF负担升高的几率较高，且呈分级方式，6分钟- 1小时的比值比（OR）为1.38(95%可信区间[CI] 1.10 - 1.74)， 1 - 12小时的比值比（OR）为1.81 (95% CI 1.52 - 2.15)，≥12小时的比值比（OR）为2.52 (95% CI 1.97 - 3.22)（均p≤0.005）。在发生DDAF发作和持续的DDAF发作之前，前一晚发生严重DDSA的几率较高（OR为1.35；95% CI为1.10 - 1.64;p = 0.003； OR为2.39；95% CI为1.47 - 3.88;p < 0.001）。结论：持续监测发现DDAF和DDSA在时间上存在双向关联。在发生严重DDSA之前，DDAF负担升高的几率更高，而在发生严重DDSA之前，DDAF发作和持续发作的几率都更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.