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Study Objectives: <p>Obstructive sleep apnea (OSA) is a common condition that contributes to atrial fibrillation occurrence, but the evidence on the day-night pattern of paroxysmal atrial fibrillation (PAF) is still scanty. The aim of this study was to evaluate whether OSA is associated with a higher occurrence of PAF, especially PAF events during the nighttime, and determine the frequency and potential underdiagnoses of OSA in patients with PAF.</p> Methods: <p>We recruited consecutive patients who had undergone a recent 24-hour Holter monitoring and showed at least 1 episode of PAF. All patients were invited to undergo a clinical evaluation. To assess OSA status, we conducted validated portable sleep monitoring. OSA was defined by an apnea-hypopnea index of ≥ 15 events/h.</p> Results: <p>We studied 102 patients (mean age: 64 ± 9 years, 56% male). Sixty patients (57%) had OSA (none with a previous diagnosis). A total of 339 episodes of PAF (a third of them occurring at night) were available for analysis. We observed a significant association between OSA and nighttime PAF episodes: patients with OSA had a higher chance of nighttime episodes than those without OSA (odds ratio = 1.78, 95% confidence interval = 1.12–2.83; <i>P</i> = .014). Interestingly, the distribution of PAF episodes over 24 hours showed that patients with OSA had more atrial fibrillation episodes between 10 <span>pm</span> and 4 <span>am</span> than patients without OSA (OSA: median = 10 [interquartile range = 7.5–11] vs No OSA: median = 2 [interquartile range = 3–5.5]; <i>P</i> = .037), suggesting an abnormal day-night pattern of the PAF occurrence.</p> Conclusions: <p>OSA is common, underdiagnosed, and in patients with OSA, associated with a higher nighttime occurrence of PAF episodes compared with patients without OSA.</p> Citation: <p>Rocha CMG, de Medeiros HD, Brigido ARD, et&#xa0;al. Obstructive sleep apnea and the day-night pattern of paroxysmal atrial fibrillation burden. <i>J Clin Sleep Med</i>. 2025;21(12):2073–2079.</p>

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Obstructive sleep apnea and the day-night pattern of paroxysmal atrial fibrillation burden

  • 期刊论文

  • 发表日期：

    2025年12月1日

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  • Creuza Macedo Goes Rocha,
  • Heitor Dutra de Medeiros,
  • Alexandra Régia Dantas Brigido,
  • Francisco C. Darrieux,
  • Paola Pretti Nunes Ferreira Falcochio,
  • Sílvio Barbosa,
  • Cesar Gruppi,
  • Geraldo Lorenzi-Filho,
  • Luciano F. Drager

摘要

Study Objectives:

Obstructive sleep apnea (OSA) is a common condition that contributes to atrial fibrillation occurrence, but the evidence on the day-night pattern of paroxysmal atrial fibrillation (PAF) is still scanty. The aim of this study was to evaluate whether OSA is associated with a higher occurrence of PAF, especially PAF events during the nighttime, and determine the frequency and potential underdiagnoses of OSA in patients with PAF.

Methods:

We recruited consecutive patients who had undergone a recent 24-hour Holter monitoring and showed at least 1 episode of PAF. All patients were invited to undergo a clinical evaluation. To assess OSA status, we conducted validated portable sleep monitoring. OSA was defined by an apnea-hypopnea index of ≥ 15 events/h.

Results:

We studied 102 patients (mean age: 64 ± 9 years, 56% male). Sixty patients (57%) had OSA (none with a previous diagnosis). A total of 339 episodes of PAF (a third of them occurring at night) were available for analysis. We observed a significant association between OSA and nighttime PAF episodes: patients with OSA had a higher chance of nighttime episodes than those without OSA (odds ratio = 1.78, 95% confidence interval = 1.12–2.83; P = .014). Interestingly, the distribution of PAF episodes over 24 hours showed that patients with OSA had more atrial fibrillation episodes between 10 pm and 4 am than patients without OSA (OSA: median = 10 [interquartile range = 7.5–11] vs No OSA: median = 2 [interquartile range = 3–5.5]; P = .037), suggesting an abnormal day-night pattern of the PAF occurrence.

Conclusions:

OSA is common, underdiagnosed, and in patients with OSA, associated with a higher nighttime occurrence of PAF episodes compared with patients without OSA.

Citation:

Rocha CMG, de Medeiros HD, Brigido ARD, et al. Obstructive sleep apnea and the day-night pattern of paroxysmal atrial fibrillation burden. J Clin Sleep Med. 2025;21(12):2073–2079.