Chest
Volume 125, Issue 3, March 2004, Pages 879-885
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Clinical Investigations
SLEEP AND BREATHING
Prevalence of Sleep Apnea Syndrome in Lone Atrial Fibrillation: A Case-Control Study

https://doi.org/10.1378/chest.125.3.879Get rights and content

Background

According to several studies, obstructive sleep apnea predisposes to cardiac arrhythmias, but the prevalence of sleep apnea in specific arrhythmias has not been determined. Our case-control study assesses prevalence of sleep apnea syndrome (SAS) in lone atrial fibrillation (AF).

Methods

Patients with AF (n = 59; 48 men and 11 women; mean age, 59 years; age range, 25 to 84 years) without evident cardiovascular diseases, and their 56 gender-matched, age-matched, and cardiovascular morbidity-matched community control subjects underwent an overnight sleep study.

Results

Prevalence of SAS in the AF group was 32%, which did not differ from that in control subjects (29%, p = 0.67). In men, mean neck circumference was higher in the AF group (40.9 cm vs 39.5 cm, p = 0.01) than in control subjects. In men, after adjusting for body mass index and waist circumference, neck circumference was independently related to AF, with an odds ratio (OR) of 1.8 (95% confidence interval, 1.3 to 2.5) per 1-cm increase, and an OR of 5.2 (95% confidence interval, 1.6 to 17.0) for values > 40 cm. Compared to control subjects, the AF group reported more daily/almost-daily tiredness (29% vs 4%, p < 0.001), daily/almost-daily sleepiness (27% vs 7%, p = 0.005), and nightly/almost-nightly breathing pauses during sleep (12% vs 2%, p = 0.03).

Conclusions

SAS seems to be common in lone AF. Nevertheless, we could not show SAS to be more common in patients with AF than in gender-matched, age-matched, and cardiovascular morbidity-matched community control subjects. Compared to control subjects, men with AF seem to have thicker necks, and patients with lone AF report more daytime tiredness, daytime sleepiness, and breathing pauses during sleep.

Section snippets

Study Population

We identified AF cases among patients treated for lone AF in Jyva¨skyla¨ Central Hospital (JCH). The hospital database included 699 patients with International Classification of Diseases, Tenth Revision diagnosis I48 (AF/atrial flutter) in 1999. Assessing hospital patient files, we classified AF as lone if the patient did not have any of the known causes of AF: hypertension, ischemic heart disease, valvular heart disease, and hyperthyroidism; and acute causes: alcohol intake, surgery,

Characteristics of the Study Population

Mean time between the last visit to JCH and sleep recording in the AF group was 24 months (SD, 4 months). At the time of sleep recording in the AF group, 39 patients (66%) received a beta-blocker, 20 patients (34%) received flecainide, 4 patients (7%) received amiodarone, 4 patients (7%) received digoxin, 1 patient (2%) received quinidine sulfate, and 18 patients (31%) received warfarin. All control subjects were in sinus rhythm, had normal S-TSH, and were clinically euthyroid.

Table 1 shows the

Discussion

To the best of our knowledge, this may be the first report of the prevalence of SAS in lone AF. Using same cut-off values for SAS as in a recent study,20 AI ≥ 5 plus AHI ≥ 15, the prevalence of SAS in lone AF was 32%, which is higher than that in population-based trials.3 In a population-based study, Sjöström et al21 reported sleep-disordered breathing in 31% of hypertensive men. We did not exclude subjects by BP measurements made just before they joined the study. It would, in fact, have been

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    This work was performed at Jyva¨skyla¨ Central Hospital, Jyva¨skyla¨, Finland.

    This study was supported by The Finnish Anti-Tuberculosis Association Foundation, The Ida Montin Foundation, The Va¨inö and Laina Kivi Foundation, The Pa¨ivikki and Sakari Sohlberg Foundation, and an EVO (erityisvaltionosuusraha) grant from Jyva¨skyla¨ Central Hospital.

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