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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

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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.

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Data availability

Available upon a reasonable request.

Code availability

NA.

Abbreviations

AF:

Atrial fibrillation

BMI:

Body mass index

CI:

Confidence interval

HR:

Hazard ratio

Metafor:

Meta-analysis package for R

NOS:

Newcastle–Ottawa Quality Assessment Scale

PPPM:

Predictive, preventive, and personalized medicine

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

SBP:

Systolic blood pressure

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Acknowledgements

We would like to thank Drs. Kawanishi and Misaki, the former and current presidents of the Suita Medical Association, the members of Suita City Health Center, all cohort members, and staff. We also express our gratitude to Prof. Iso from Osaka University.

Funding

This study was supported by the Intramural Research Fund (20–4-9) for the cardiovascular diseases of the National Cerebral and Cardiovascular Center, JST Grant Number JPMJPF2018, the Meiji Yasuda Research Institute, Inc., and Meiji Yasuda Life Insurance Company.

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Authors and Affiliations

  1. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan

    Ahmed Arafa, Yoshihiro Kokubo, Rena Kashima, Emi Watanabe, Yukie Sakai, Jiaqi Li, Masayuki Teramoto & Haytham A. Sheerah

  2. Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan

    Ahmed Arafa, Jiaqi Li, Masayuki Teramoto & Haytham A. Sheerah

  3. Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt

    Ahmed Arafa

  4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    Keiko Shimamoto & Kengo Kusano

  5. Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government, Ibaraki, Osaka, Japan

    Rena Kashima

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  1. Ahmed Arafa
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Contributions

AA (draft writing, review literature, and data analysis), YK (resources, funding acquisition, and supervision), and all authors (visualization, validation, critical revision, and editing).

Corresponding author

Correspondence to Ahmed Arafa.

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Ethics approval

The Institutional Review Board of the National Cerebral and Cardiovascular Center, Suita, Japan, approved the study protocol (M25-043–4). The study was conducted per the Declaration of Helsinki.

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Written informed consent was obtained from all participants.

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All authors had full access to all the data in the study and accept responsibility to submit for publication.

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The authors declare no competing interests.

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The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Arafa, A., Kokubo, Y., Shimamoto, K. et al. 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 Journal 13, 77–86 (2022). https://doi.org/10.1007/s13167-022-00275-4

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