Introduction: Sleep apnea (SA) is associated with burden of atrial fibrillation (AF), but studies of SA and ectopic beats, potential triggers of AF, are sparse. Our study contributes by examining the association of SA with AF, premature atrial contractions (PACs), and premature ventricular contractions (PVCs) from 48-hour continuous ambulatory electrocardiogram (aECG) monitoring.
Methods: The study population includes 716 black and 438 white participants from the ARIC 48-hour aECG ancillary study, after excluding those with a paced rhythm (n=43) or poor quality measures (n=8). SA was defined as self-reported physician diagnosis or hospital discharge records with ICD-9-CM codes for SA. Prevalent AF was defined using 48-hour aECG monitoring, study visit ECGs, or hospital discharge code (427.3) since study baseline in 1986-1987. PACs and PVCs were defined if ectopy was present 1-5% (occasional) and >5% (frequent) of the recording time versus <1% of the recording time (referent). Multivariable logistic regression was used to examine this association with inverse variance weighting to account for the sampling and non-response.
Results: Participants with SA (unweighted N=217) were more likely to be female (55%), white race (52%), current smokers (57%), have hypertension (82%), and be obese (57%). Participants with SA were 7.3 (95% CI: 3.7, 14.5) times more likely to have AF compared to those without SA after adjusting for covariates. Compared to participants without SA, the relative odds of occasional and frequent PACs versus the referent was increased by 20% and 50% respectively among participants with SA after adjusting for confounders, although not statistically significant. The association was similar and not statistically significant for frequent PVCs.
Conclusions: In a community-based population using standardized 48-hour aECG monitoring, SA was associated with prevalent AF, but not significantly associated with PACs or PVCs. Further study is needed to establish mechanisms that link SA and cardiac arrhythmias.