Skip to main content

Advertisement

SpringerLink
Log in

Association of sleep duration with atrial fibrillation/flutter mortality in the United States: a cross-sectional analysis

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The association between sleep duration and atrial fibrillation risk is poorly understood, with inconsistent findings reported by several studies. We sought to assess the association between long sleep duration and mortality due to atrial fibrillation/atrial flutter (AF/AFL).

Methods

The 2016–2020 Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research dataset was used to identify death records secondary to AF/AFL in the United States population. We used the 2018 Behavioral Risk Factor Surveillance System (BRFSS) dataset of sleep duration at the county level. All counties were grouped into quartiles based on the percentage of their population with long sleep duration (i.e., ≥ 7 h), Q1 being the lowest and Q4 the highest quartile. Age-adjusted mortality rates (AAMR) were calculated for each quartile. County Health Rankings for Texas were used to adjust the AAMR for comorbidities using linear regression.

Results

Overall, the AAMR for AF/AFL were highest in Q4 (65.9 [95% CI, 65.5–66.2] per 100,000 person-years) and lowest in Q1 (52.3 [95% CI, 52.1–52.5] per 100,000 person-years). The AAMR for AF/AFL increased stepwise from the lowest to highest quartiles of the percentage population with long sleep duration. After adjustment for the county health ranks of Texas, long sleep duration remained associated with a significantly higher AAMR (coefficient 220.6 (95% CI, 21.53–419.72, p-value = 0.03).

Conclusions

Long sleep duration was associated with higher AF/AFL mortality. Increased focus on risk reduction for AF, public awareness about the importance of optimal sleep duration, and further research to elucidate a potential causal relationship between sleep duration and AF are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

Publically available Centers for Disease Control and Prevention (CDC) Wide‐Ranging Online Data for Epidemiologic Research was used for the present analysis.

Abbreviations

AF:

Atrial fibrillation

AF/AFL:

Atrial fibrillation/atrial flutter

AAMR:

Age-adjusted mortality rate

aHR:

Multivariate adjusted hazard ratio

BRFSS:

Behavioral Risk Factor Surveillance System

CDC:

Centers for Disease Control and Prevention

NREM:

Non-rapid eye movement

REM:

Rapid eye movement

US:

United States

References

  1. Song Q, Liu X, Hu W, Zhou W, Liu A, Wang X, Wu S. Long Sleep Duration Is an Independent Risk Factor for Incident Atrial Fibrillation in a Chinese Population: A Prospective Cohort Study.  Sci Rep 2017;7(1):3679. https://doi.org/10.1038/S41598-017-04034-8.

  2. Menezes AR, Lavie CJ, De Schutter A, Milani RV, O’Keefe J, DiNicolantonio JJ, … Abi-Samra FM. Lifestyle modification in the prevention and treatment of atrial fibrillation. Progr Cardiovasc Dis 2015;58(2), 117–125. https://doi.org/10.1016/J.PCAD.2015.07.001.

  3. Morovatdar N, Ebrahimi N, Rezaee R, Poorzand H, Tork MAB, Sahebkar A. Sleep Duration and Risk of Atrial Fibrillation: a Systematic Review. J Atrial Fibrillation 2019;11(6):2132. https://doi.org/10.4022/JAFIB.2132.

  4. Benjamin EJ, Al-Khatib SM, Desvigne-Nickens P, Alonso A, Djoussé L, Forman DE, … Go AS. Research Priorities in the Secondary Prevention of Atrial Fibrillation: A National Heart, Lung, and Blood Institute Virtual Workshop Report. J Am Heart Assoc 2021;10(16), 21566. https://doi.org/10.1161/JAHA.121.021566.

  5. Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, … null, null. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation. 2020;141(16), e750–e772. https://doi.org/10.1161/CIR.0000000000000748.

  6. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, … Sanders P. Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. J Am College Cardiol. 2015;66(9), 985–996. https://doi.org/10.1016/J.JACC.2015.06.488.

  7. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, … Sanders P. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am College Cardiol. 2015;65(20), 2159–2169. https://doi.org/10.1016/J.JACC.2015.03.002.

  8. Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, … Sanders P. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am College Cardiol. 2014;64(21), 2222–2231. https://doi.org/10.1016/J.JACC.2014.09.028.

  9. Middeldorp ME, Pathak RK, Meredith M, Mehta AB, Elliott AD, Mahajan R, … Sanders P. PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study. Europace. 2018;20(12), 1929–1935. https://doi.org/10.1093/EUROPACE/EUY117.

  10. Rienstra M, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brügemann J, … Van Gelder IC. Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial. Eur Heart J. 2018;39(32), 2987–2996. https://doi.org/10.1093/EURHEARTJ/EHX739.

  11. Tao F, Cao Z, Jiang Y, Fan N, Xu F, Yang H, … Wang Y. Associations of sleep duration and quality with incident cardiovascular disease, cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants. Sleep Med. 2021;81:401–409. https://doi.org/10.1016/J.SLEEP.2021.03.015.

  12. Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, … Kusano K. Sleep duration and atrial fibrillation risk in the context of predictive, preventive, and personalized medicine: the Suita Study and meta-analysis of prospective cohort studies. EPMA J. 2022;13(1), 77–86. https://doi.org/10.1007/S13167-022-00275-4.

  13. Kwon Y, Gharib SA, Biggs ML, Jacobs DR, Alonso A, Duprez D, … Heckbert SR. Association of sleep characteristics with atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis. Thorax. 2015;70(9), 873–879. https://doi.org/10.1136/THORAXJNL-2014-206655.

  14. Khawaja O, Sarwar A, Albert CM, Gaziano JM, Djoussé L. Sleep Duration and Risk of Atrial Fibrillation (From the Physicians’ Health Study). Am J Cardiol. 2013;111(4):547. https://doi.org/10.1016/J.AMJCARD.2012.10.038.

    Article  PubMed  Google Scholar 

  15. Wang C, Bangdiwala SI, Rangarajan S, Lear SA, AlHabib KF, Mohan V, … Yusuf S. Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries. Eur Heart J. 2019;40(20), 1620–1629. https://doi.org/10.1093/EURHEARTJ/EHY695.

  16. Methodology | PLACES: Local Data for Better Health | CDC. (n.d.). Retrieved October 1, 2022, from https://www.cdc.gov/places/methodology/index.html.

  17. BRFSS | CDC. (n.d.). Retrieved Sept 30, 2022, from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/brfss.htm.

  18. Health Risk Behaviors Measure Definitions | PLACES: Local Data for Better Health | CDC. (n.d.). Retrieved Oct 1, 2022, from https://www.cdc.gov/places/measure-definitions/unhealthy-behaviors/index.html.

  19. Insufficient Sleep* | County Health Rankings & Roadmaps. (n.d.). Retrieved Oct 1, 2022, from https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-factors/health-behaviors/insufficient-sleep?year=2022.

  20. Friede A, Reid JA, Ory HW. CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention. Am J Public Health. 1993;83(9):1289–94. https://doi.org/10.2105/AJPH.83.9.1289.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Underlying Cause of Death, 1999–2020 Request. (n.d.). Retrieved October 1, 2022, from https://wonder.cdc.gov/ucd-icd10.html.

  22. Cross SH, Mehra MR, Bhatt DL, Nasir K, O’Donnell CJ, Califf RM, Warraich HJ. Rural-Urban Differences in Cardiovascular Mortality in the US, 1999–2017. JAMA. 2020;323(18):1852–4. https://doi.org/10.1001/JAMA.2020.2047.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Spencer JC, Wheeler SB, Rotter JS, Holmes GM. Decomposing Mortality Disparities in Urban and Rural U.S. Counties. Health Services Res. 2018;53(6), 4310–4331. https://doi.org/10.1111/1475-6773.12982.

  24. Wang YH, Wang J, Chen SH, Li JQ, Lu QD, Vitiello MV, … Bao YP. Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality. JAMA network open. 2020; 3(5). https://doi.org/10.1001/JAMANETWORKOPEN.2020.5246

  25. Yin J, Jin X, Shan Z, Li S, Huang H, Li P, … Liu L. Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2017;6(9). https://doi.org/10.1161/JAHA.117.005947.

  26. Shen X, Wu Y, Zhang D. Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: a meta-analysis of prospective cohort studies. Sci Rep. 2016;6:21480. https://doi.org/10.1038/SREP21480.

  27. Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-Nerve Activity during Sleep in Normal Subjects. N Engl J Med 1993;328(5):303–7. https://doi.org/10.1056/NEJM199302043280502.

    Article  CAS  PubMed  Google Scholar 

  28. Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999;8(3):175–83. https://doi.org/10.1046/J.1365-2869.1999.00155.X.

    Article  CAS  PubMed  Google Scholar 

  29. Chen W, Cai X, Yan H, Pan Y. Causal effect of obstructive sleep apnea on atrial fibrillation: A mendelian randomization study. J Am Heart Assoc 2021;10(23):22560. https://doi.org/10.1161/JAHA.121.022560.

    Article  Google Scholar 

  30. Arias E, Heron M, Hakes J. The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update. Vital Health Stat 2. 2016;172:1–21.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA

    Ashish Kumar

  2. Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

    Kinza Iqbal

  3. Department of Surgery, Mayo Clinic, Rochester, Minneapolis, MN, USA

    Mariam Shariff

  4. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

    John M. Stulak

  5. Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Narayan G. Kowlgi, Virend K. Somers, Nandan Anavekar & Abhishek Deshmukh

Authors
  1. Ashish Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kinza Iqbal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariam Shariff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John M. Stulak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Narayan G. Kowlgi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Virend K. Somers
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nandan Anavekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Abhishek Deshmukh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhishek Deshmukh.

Ethics declarations

Disclosure

VKS is a consultant for Jazz Pharmaceuticals, Zoll, ResMed, Wesper and Huxley and serves on the Scientific Advisory Board for Sleep Number.

Ethical approval

Not Applicable.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, A., Iqbal, K., Shariff, M. et al. Association of sleep duration with atrial fibrillation/flutter mortality in the United States: a cross-sectional analysis. J Interv Card Electrophysiol 67, 157–164 (2024). https://doi.org/10.1007/s10840-023-01593-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-023-01593-x

Keywords

Search

Navigation