Associations of sleep quality with incident atrial fibrillation: a meta-analysis

Background: The strong relationship between sleep apnoea and atrial fibrillation (AF) is well known. However, it remains unclear whether the sleep quality is related with AF. Aim: To evaluate the associations of sleep duration, insomnia and frequent awakening with AF. Methods: A systematic review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through September 2017 to identify studies that evaluate the risk of AF in adults with short sleep duration, long sleep duration, insomnia and/or frequent awakening. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Ten observational studies (14 296 314 patients) were enrolled. The pooled odds ratios (ORs) of AF in individuals with short sleep (< 6 h) and long sleep (> 8 h) were 1.20 (95% confidence interval (CI) 0.93-1.55, I-2 = 66%) and 1.24 (95% CI 0.96-1.62, I-2 = 58%), respectively. There was no association between increase in sleep duration and AF, with a pooled OR of 0.97 (95% CI 0.84-1.12, I-2 = 0%). However, there were significant associations of AF with insomnia and frequent awakening, with pooled ORs of 1.30 (95% CI 1.26-1.35, I-2 = 3%) and 1.36 (95% CI 1.13-1.63, I-2 = 55%), respectively. Conclusions: Our findings suggest an absence in association between AF and sleep duration but reveal the potential association between AF and both insomnia and frequent nocturnal awakening. As such, the further studies on association of AF and sleep qualities are warranted.