Variability of Sleep Apnea Severity and Risk of Atrial Fibrillation: The VARIOSA-AF Study

Dominik Linz, Anthony G. Brooks, Adrian D. Elliott, Chrishan J. Nalliah, Jeroen M.L. Hendriks, Melissa E. Middeldorp, Celine Gallagher, Rajiv Mahajan, Jonathan M. Kalman, R. Doug McEvoy, Dennis H. Lau, Prash Sanders

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83 Citations (Scopus)


Objectives: This study sought to determine night-to-night variability in the severity of sleep-disordered breathing (SDB) and the dynamic intraindividual relationship to daily risk of incident atrial fibrillation (AF) by using simultaneous long-term day-by-day SDB and AF monitoring. Background: Night-to-night variability in SDB severity may result in a dynamic exposure to SDB related conditions impacting the timing and extent of cardiovascular responses. Methods: This study was an observational cohort study. Daily data for AF burden and average respiratory disturbance index (RDI) were extracted from pacemakers capable of monitoring nightly SDB and daily AF burden in 72 patients. Nightly RDI values were grouped into quartiles of severity within each patient. AF burdens of >5 min, >1 h, and >12 h were the outcome variables. Results: A total of 32% of patients had a mean RDI of ≥20/h, indicative of overall severe SDB. There was significant night-to-night variation in RDI reflected by an absolute SD of ±6.3 events/h (range 2 to 14 events/h) within any given patient. Within each patient, the nights with the highest RDI (in their highest quartile) conferred a 1.7-fold (1.2 to 2.2; p < 0.001), 2.3-fold (1.6 to 3.5; p < 0.001), and 10.2-fold (3.5 to 29.9; p < 0.001) increase risk of having at least 5 min, 1 h, and 12 h, respectively, of AF during the same day compared with the best sleep nights (in their lowest quartiles). Conclusions: There is considerable night-to-night variability in SDB severity which cannot be detected by 1 single overnight sleep study. SDB burden may be a better metric with which to assess the extent of dynamic SDB related cardiovascular responses such as daily AF risk than the categorical diagnosis of SDB.

Original languageEnglish
Pages (from-to)692-701
Number of pages10
JournalJACC: Clinical Electrophysiology
Issue number6
Publication statusPublished or Issued - Jun 2019


  • atrial fibrillation
  • burden
  • dynamic substrate
  • night-to-night variability
  • pacemaker
  • sleep-disordered breathing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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