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Higher night-to-night variability in sleep apnea increases the risk and burden of persistent device-detected atrial fibrillation.
A new prospective analysis from the ACaSA study shows that night-to-night variability in sleep apnea severity is strongly linked with the persistence and burden of device-detected atrial fibrillation (DDAF) in patients with implanted pacemakers.
Using pacemaker-derived thoracic impedance monitoring, researchers continuously tracked sleep apnea in 171 patients without permanent atrial fibrillation (AF) at baseline, with a median follow-up of 539 days. During an initial 28-night AF–free run-in period, baseline variability in the respiratory disturbance index (RDI) was calculated using the coefficient of variation.
The study found a median RDI variability of 38.7% (interquartile range 29.9%–47.6%), while 20.5% of patients (35 individuals) exhibited high variability (≥50%). Over the follow-up period, 17 patients (9.9%) developed persistent DDAF, defined as episodes lasting ≥7 days. Importantly, the risk of persistent AF elevated markedly with greater variability. Each 10% rise in RDI variability nearly doubled the risk of persistent DDAF (adjusted HR 1.89; p=0.002). In addition, those with high variability experienced a substantially greater cumulative DDAF burden as opposed to those with lower variability (9.6% vs. 1.9%; p=0.016).
These findings suggest that dynamic instability in sleep apnea, rather than static severity alone, is a key driver of AF persistence and overall arrhythmia burden. Continuous long-term monitoring through pacemaker systems may therefore yield a novel and clinically actionable tool for risk stratification, enabling earlier intervention and more personalized management of those at risk for AF.
Journal of Sleep Research
Night-To-Night Variability in Sleep Apnea Is Associated With Persistence and Burden of Device-Detected Atrial Fibrillation
Philipp Spitaler et al.
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