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Prevalence of Sleep Apnea Syndrome in Lone Atrial Fibrillation^*

A Case-Control Study

^* From the Department of Medicine (Dr. Porthan), Helsinki University Central Hospital, Helsinki; Departments of Medicine (Dr. Melin), Clinical Neurophysiology (Dr. Kupila), and Respiratory Medicine (Dr. Venho), Jyväskylä Central Hospital, Jyväskylä; and Rinnekoti Research Center (Dr. Partinen), Espoo, Finland.

Correspondence to: Kimmo Markus Porthan, MD, Tilkankatu 39 C 5, 00300 Helsinki, Finland; e-mail: porthan{at}mappi.helsinki.fi

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.

Key Words: atrial fibrillation • case-control studies • sleep apnea syndromes

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