The association between sleep fragmentation and incident atrial fibrillation: a prospective cohort study in a community population

Sleep fragmentation (SF) has been recognized as a risk factor for cardiovascular disease. This study aims to investigate the impact of SF on atrial fibrillation (AF). A total of 2377 participants without pre-existing AF from the Sleep Heart Health Study were enrolled in this study. Wake after sleep onset (WASO), sleep fragmentation index (SFI), arousal index (ArI), and sleep efficiency (SE) were used to describe SF objectively. Multivariate logistic regression and restricted cubic spline analysis were conducted to investigate the association between SF and AF. During a mean follow-up of 5.3 years, we observed 221 (9.30%) participants developed AF. Participants with incident AF had significantly worse WASO, ArI, and SE compared with those without incident AF. Multivariate logistic regression revealed that WASO was associated with incident AF in both overall sample and participants without obstructive sleep apnea (OSA), with odds ratios (ORs) of 1.61 (95%CI: 1.04, 2.49; P=0.033) and 5.89 (95%CI: 2.18, 19.16; P=0.001) for the fourth quartile of WASO, respectively. The first quartile of SE (OR, 3.51; 95%CI: 1.28, 10.49; P = 0.019) and the fourth quartile of ArI (OR, 3.16; 95%CI: 1.23, 9.01; P = 0.021) were associated with incident AF in participants without OSA. This study demonstrated that worsening SF, as assessed by WASO, SE, and ArI, was associated with an increased odds of incident AF in participants without OSA. Thus, improving SF may contribute to decreasing the odds of incident AF.