Chen Siwei, Liu Zhou, Yan Shaohua, Du Zhongyan, Cheng Wenke
Department of Cardiovascular Medicine, Nanchang People's Hospital (The Third Hospital of Nanchang), Jiangxi, China.
Department of Geriatric Medicine, The Fifth People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Yangzhou University, Huai'an, China.
Diabetol Metab Syndr. 2024 Feb 27;16(1):51. doi: 10.1186/s13098-024-01292-1.
Diabetic individuals often encounter various sleep-related challenges. Although the association between sleep duration and atrial fibrillation (AF) have been explored, the association of other sleep traits with the incidence of AF remains unclear. A comprehensive understanding of these traits is essential for a more accurate assessment of sleep conditions in patients with diabetes and the development of novel AF prevention strategies.
This study involved 23,785 patients with diabetes without any pre-existing cardiovascular disease, drawn from the UK Biobank. Sleep behaviour traits examined encompassed sleep duration, chronotype, insomnia, snoring and daytime sleepiness. Sleep duration was categorised into three groups: low (≤ 5 h), proper (6-8 h) and long (≥ 9 h). We assessed associations using multivariate Cox proportional risk regression models. Furthermore, four poor sleep behaviours were constructed to evaluate their impact on the risk of new-onset AF.
Over a mean follow-up period of 166 months, 2221 (9.3%) new cases of AF were identified. Short (hazard ratio (HR), 1.28; 95% confidence interval (CI) 1.10-1.50) and long sleep durations (HR 1.16; 95% CI 1.03-1.32) consistently exhibited an elevated risk of AF compared to optimal sleep duration. Early chronotype, infrequent insomnia and daytime sleepiness were associated with 11% (HR 0.89; 95% CI 0.82-0.97), 15% (HR 0.85; 95% CI 0.77-0.95) and 12% (HR 0.88; 95% CI 0.81-0.96) reduced risk of new-onset AF, respectively. However, no significant association was found between snoring and the incidence of AF (HR 0.99; 95% CI 0.91-1.07).
In diabetic populations, sleep duration, chronotype, insomnia and daytime sleepiness are strongly associated with AF incidence. An optimal sleep duration of 6-8 h presents the lowest AF risk compared to short or long sleep duration. Additionally, poor sleep patterns present a greater risk of new-onset AF in women than in men.
糖尿病患者经常面临各种与睡眠相关的挑战。虽然睡眠时间与心房颤动（AF）之间的关联已被探讨，但其他睡眠特征与AF发病率的关联仍不清楚。全面了解这些特征对于更准确地评估糖尿病患者的睡眠状况以及制定新的AF预防策略至关重要。
本研究纳入了英国生物银行的23785例无心血管疾病史的糖尿病患者。所检查的睡眠行为特征包括睡眠时间、昼夜节律类型、失眠、打鼾和日间嗜睡。睡眠时间分为三组：短（≤5小时）、合适（6 - 8小时）和长（≥9小时）。我们使用多变量Cox比例风险回归模型评估关联。此外，构建了四种不良睡眠行为以评估它们对新发AF风险的影响。
在平均166个月的随访期内，共识别出2221例（9.3%）新发AF病例。与最佳睡眠时间相比，短睡眠时间（风险比（HR）为1.28；95%置信区间（CI）为1.10 - 1.50）和长睡眠时间（HR为1.16；95% CI为1.03 - 1.32）始终表现出较高的AF风险。早起型昼夜节律、不常出现失眠和日间嗜睡分别与新发AF风险降低11%（HR为0.89；95% CI为0.82 - 0.97）、15%（HR为0.85；95% CI为0.77 - 0.95）和12%（HR为0.88；95% CI为0.81 - 0.96）相关。然而，未发现打鼾与AF发病率之间存在显著关联（HR为0.99；95% CI为0.91 - 1.07）。
在糖尿病人群中，睡眠时间、昼夜节律类型、失眠和日间嗜睡与AF发病率密切相关。与短睡眠时间或长睡眠时间相比，6 - 8小时的最佳睡眠时间呈现出最低的AF风险。此外，不良睡眠模式在女性中导致新发AF的风险高于男性。
