睡眠特征与心房颤动的关联：动脉粥样硬化多民族研究
Association of sleep characteristics with atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis.
作者信息
Kwon Younghoon, Gharib Sina A, Biggs Mary L, Jacobs David R, Alonso Alvaro, Duprez Daniel, Lima Joao, Lin Gen-Min, Soliman Elsayed Z, Mehra Reena, Redline Susan, Heckbert Susan R
机构信息
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
出版信息
Thorax. 2015 Sep;70(9):873-9. doi: 10.1136/thoraxjnl-2014-206655. Epub 2015 May 18.
BACKGROUND
Population-based studies have linked measures of sleep disordered breathing to nocturnally occurring atrial fibrillation (AF) episodes. Whether measures of sleep disordered breathing and sleep quality are associated with prevalent AF has not been studied in an unselected population. We investigated the cross-sectional association with prevalent AF of objectively collected prespecified measures of overnight sleep breathing disturbances, sleep stage distributions, arousal and sleep duration.
METHODS
AF prevalence, defined by diagnosis codes, study electrocardiography and sleep study were examined among Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent polysomnography in the MESA Sleep Study (n=2048).
MEASUREMENTS AND MAIN RESULTS
Higher apnoea hypopnoea index (AHI) was associated with increased odds of AF, although the significance was attenuated after full adjustment for covariates including prevalent cardiovascular disease (OR: 1.22 (0.99 to 1.49) per SD (17/h), p=0.06). Analyses of sleep architecture measures and AF revealed significantly lower odds of AF associated with longer duration of slow wave sleep (OR: 0.66 (0.5 to 0.89) per SD (34 min), p=0.01) which persisted after additionally adjusting for AHI (OR: 0.68 (0.51 to 0.92), p=0.01). Higher sleep efficiency was significantly associated with lower likelihood of AF but the significance was lost when adjusted for AHI. No significant association was present between sleep duration and AF. In a model including AHI and arousal index, the association between AHI and AF was strengthened (AHI: OR 1.49 (1.15 to 1.91) per SD, p=0.002) and a significant inverse association between arousal index and AF was observed (OR 0.65 (0.50 to 0.86) per SD (12/h), p=0.005).
CONCLUSIONS
In a study of a large multiethnic population, AF was associated with AHI severity, and was more common in individuals with poor sleep quality as measured by reduced slow wave sleep time, a finding that was independent of AHI.
背景
基于人群的研究已将睡眠呼吸障碍的指标与夜间发生的心房颤动（AF）发作联系起来。在未经过筛选的人群中，尚未研究睡眠呼吸障碍指标和睡眠质量是否与现患AF相关。我们调查了客观收集的过夜睡眠呼吸紊乱、睡眠阶段分布、觉醒和睡眠时间的预先指定指标与现患AF的横断面关联。
方法
在多民族动脉粥样硬化研究（MESA）睡眠研究中接受多导睡眠图检查的参与者（n = 2048）中，通过诊断代码、研究心电图和睡眠研究来检查AF患病率。
测量指标和主要结果
较高的呼吸暂停低通气指数（AHI）与AF几率增加相关，尽管在对包括现患心血管疾病在内的协变量进行完全调整后，这种相关性的显著性有所减弱（每标准差（17/h）的比值比（OR）：1.22（0.99至1.49），p = 0.06）。对睡眠结构指标和AF的分析显示，与慢波睡眠时间较长相关的AF几率显著降低（每标准差（34分钟）的OR：0.66（0.5至0.89），p = 0.01），在额外调整AHI后该结果仍然存在（OR：0.68（0.51至0.92），p = 0.01）。较高的睡眠效率与AF可能性较低显著相关，但在调整AHI后这种相关性的显著性消失。睡眠时间与AF之间无显著关联。在一个包括AHI和觉醒指数的模型中，AHI与AF之间的关联得到加强（AHI：每标准差的OR 1.49（1.15至1.91），p = 0.002），并且观察到觉醒指数与AF之间存在显著的负相关（每标准差（12/h）的OR 0.65（0.50至0.86），p = 0.005）。
结论
在一项对大型多民族人群的研究中，AF与AHI严重程度相关，并且在慢波睡眠时间减少所衡量的睡眠质量较差的个体中更为常见，这一发现独立于AHI。
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