Effect of sleep disorders on the incidence of paroxysmal atrial fibrillation
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Katedra i Klinika Kardiologii, Uniwersytet Medyczny w Lublinie
Oddział Chorób Wewnętrznych z Pododdziałem Kardiologii, Szpital Powiatowy w Strzyżowie
Katedra i Zakład Medycyny Rodzinnej, Uniwersytet Medyczny w Lublinie
Med Og Nauk Zdr. 2012;18(1):27–30
Atrial fibrillation (atrial fibrillation – AF) is the most common supraventricular arrhythmia, which occurs in about 1% of adults. The aim of the study was to assess the relationship between sleep disorders and incidence of paroxysmal AF.

Material and Methods:
The study covered 51 patients with the onset of AF during the night hours (AF-night, mean age 60.8 ± 9.5), and 51 patients in whom the beginning of AF occurred exclusively during the daytime (AF-day, mean age 61.1 ± 11.2). All patients were hospitalized due to the occurrence of a subsequent episode of paroxysmal AF. Clinical data, biochemical parameters, and the results of questionnaires assessing sleep disturbances were taken into consideration.

The groups examined did not differ with respect to age and gender. In the group AF-night, heart failure was observed more frequently (32% vs. 0%, p<0.001), also poor sleep quality (100% vs. 70%, p<0.001), and high risk of obstructive sleep apnea (47% vs. 25%, p<0.001). Correlation was observed between the onset of AF at night and the deterioration of sleep quality (r=0.299, p=0.003), poor sleep quality (r=0.345, p<0.001), severity of insomnia (r =0.306, p =0.002) and high risk of obstructive sleep apnea (r=0.376, p<0.001). In the AF-day group, hypertension was observed more frequently (73% vs. 28%, p=0.005).

Sleep quality is significantly worse in patients with the onset of AF at night. The clinical significance of this relationship requires further studies.

Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart (British Cardiac Society). 2001; 86 (5): 516‐521.
Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998; 82 (8A): 2N‐9N.
Trusz-Gluza M, Wnuk-Wojnar AM, Filipecki A, Wita K. Zaburzenia rytmu i przewodzenia. W: Kardiologia. Szczeklik A, Tendera M (red.). Medycyna Praktyczna, Krakow 2009: 423‐436.
Coumel P. Paroxysmal atrial fibrillation: a disorder of automatic tone? Eur Heart J. 1994; 15 (suppl.A): 9‐16.
Inoue H, Zipes DP. Changes in atrial and ventricular refractoriness and in atrioventricular nodal conduction produced by combinations of vagal and sympathetic stimulation that result in a constant sinus cycle length. Circ Res. 1987; 60: 942‒951.
Jenkins LS, Bubien RS. Quality of life in patients with atrial fibrillation. Cardiol Clin. 1996; 14: 597‒606.
Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98: 946‐952.
Kiejna A, Rymaszewska J, Wojtyniak B, Stokwiszewski J. Prevalence of insomnia in Poland – results of the National Health Interview Survey. Acta Neuropsychiatrica. 2003; 15 (2): 68‐73.
Dew MA, Hoch CC, Buysse DJ, Monk TH, Begley AE, Houck PR, et al. Healthy older adults› sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med. 2003; 65: 63‒73.
Parish JM, Shepard JW Jr. Cardiovascular effects of sleep disorders. Chest. 1990; 97: 1220‒1126.
Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S. Association of sleep-disordered breathing, sleep apnea, and hypertension in large community- based study. JAMA. 2000; 283: 1829‒1836.
Carlson JT, Hedner JA, Ejnell H, Peterson LE. High prevalence of hypertension in sleep apnea patients independent of obesity.Am J Respir Crit Care Med. 1994; 1: 72‒77.
Somers VK, Dyken ME, Mark AL, Abbound FM. Sympathetic- nerve activity during sleep in normal subjects. N Engl J Med. 1993; 328: 303‒307.
Kuo TB, Lai CJ, Shaw FZ, Lai CW, Yang CC. Sleep-related sympathovagal imbalance in SHR. Am J Physiol Heart Circ Physiol. 2004; 3: 1170‒1176.
Ogawa Y, Kanbayashi T, Saito Y, Takahashi Y, Kitajima T, Takahashi K, et al. Total sleep deprivation elevates blood pressure through arterial baroreflex resetting: a study with microneurographic technique. Sleep. 2003; 8: 986‒989.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28: 193‒213.
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens insomnia scale: Validation of an instrument based on ICD-10 criteria. J Psychosom Res. 2000; 48: 555‒560.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; Oct 5131 (7): 485‒91.
The International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003; 4 (2): 121‐132.
Beck AT, Steer RA, Brown GK. Beck Depression Inventory BDI-II Manual. 2nd ed. Orlando, FL: Psychological Corporation; 1996.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983‒988.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983; 52: 490‒4.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004; 110: 364‒367.
Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003; 107: 2589‒2594.
Alvarez GG, Ayas NT. The impact of daily sleep duration on health: a review of the literature. Progress in Cardiovascular Nursing. 2004; 2: 56‒59.
Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, et al. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol. 2005; 98: 2024‒2032.
Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension. 1996; 27: 1318‒1324.
Chen HI. Effects of 30-h sleep loss on cardiorespiratory functions at rest and in exercise. Med Sci Sports Exerc. 1991; 23: 193‒198.
Finkel MS, Oddis CV, Jacob TD, Watkins SC, Hattler BG, Simmons RL. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science. 1992; 257: 387‒9.
Alex CG, Onal E, Lopata M. Upper airway occlusion during sleep in patients with Cheyne-Stokes respiration. Am Rev Respir Dis. 1986; 133: 42‒5.
Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnea. J Hyperten. 1990; 8: 941‒6.
Miyauchi T, Masaki T. Pathophysiology of endothelin in the cardiovascular system. Annu Rev Physiol. 1999; 61: 391‒415.