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

Ahmed Arafa; Yoshihiro Kokubo; Keiko Shimamoto; Rena Kashima; Emi Watanabe; Yukie Sakai; Jiaqi Li; Masayuki Teramoto; Haytham A Sheerah; Kengo Kusano

doi:10.1007/s13167-022-00275-4

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 Feb 26;13(1):77-86. doi: 10.1007/s13167-022-00275-4. eCollection 2022 Mar.

Authors

Ahmed Arafa^{1

2

3}, Yoshihiro Kokubo¹, Keiko Shimamoto⁴, Rena Kashima^{1

5}, Emi Watanabe¹, Yukie Sakai¹, Jiaqi Li^{1

2}, Masayuki Teramoto^{1

2}, Haytham A Sheerah^{1

2}, Kengo Kusano⁴

Affiliations

¹ Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka 564-8565 Japan.
² Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
³ Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.
⁴ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁵ Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government, Ibaraki, Osaka Japan.

Abstract

Background: Short and long sleep durations are common behaviors that could predict several cardiovascular diseases. However, the association between sleep duration and atrial fibrillation (AF) risk is not well-established. AF is preventable, and risk prevention approaches could reduce its occurrence. Investigating whether sleep duration could predict AF incidence for possible preventive interventions and determining the impact of various lifestyle and clinical characteristics on this association to personalize such interventions are essential. Herein, we investigated the association between sleep duration and AF risk using a prospective cohort study and a meta-analysis of epidemiological evidence.

Methods: Data of 6898 people, aged 30-84 years, from the Suita Study, were analyzed. AF was diagnosed during the follow-up by ECG, medical records, checkups, and death certificates, while a baseline questionnaire was used to assess sleep duration. The Cox regression was used to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) of AF risk for daily sleep ≤ 6 (short sleep), ≥ 8 (long sleep), and irregular sleep, including night-shift work compared with 7 h (moderate sleep). Then, we combined our results with those from other eligible prospective cohort studies in two meta-analyses for the short and long sleep.

Results: In the Suita Study, within a median follow-up period of 14.5 years, short and irregular sleep, but not long sleep, were associated with the increased risk of AF in the age- and sex-adjusted models: HRs (95% CIs) = 1.36 (1.03, 1.80) and 1.62 (1.16, 2.26) and the multivariable-adjusted models: HRs (95% CIs) = 1.34 (1.01, 1.77) and 1.63 (1.16, 2.30), respectively. The significant associations between short and irregular sleep and AF risk remained consistent across different ages, sex, smoking, and drinking groups. However, they were attenuated among overweight and hypertensive participants. In the meta-analyses, short and long sleep durations were associated with AF risk: pooled HRs (95% CIs) = 1.21 (1.02, 1.42) and 1.18 (1.03, 1.35). No signs of significant heterogeneity across studies or publication bias were detected.

Conclusion: Short, long, and irregular sleep could be associated with increased AF risk. In the context of predictive, preventive, and personalized medicine, sleep duration should be considered in future AF risk scores to stratify the general population for potential personalized lifestyle modification interventions. Sleep management services should be considered for AF risk prevention, and these services should be individualized according to clinical characteristics and lifestyle factors.

Supplementary information: The online version contains supplementary material available at 10.1007/s13167-022-00275-4.

Keywords: Atrial fibrillation; Lifestyle; Meta-analysis; Predictive, preventive, and personalized medicine; Risk factors; Risk prevention; Sleep duration.