Arrhythmias & electrophysiology
Bidirectional temporal association of device-detected atrial fibrillation and sleep apnea
Authors' conclusion
Continuous monitoring identified a bidirectional temporal association between DDAF and DDSA. Incident severe DDSA was preceded by higher odds of elevated DDAF burden, whereas both incident DDAF episode onset and continuation of ongoing episodes were preceded by higher odds of severe DDSA.
Study context
- Population
- Pacemaker patients undergoing continuous remote monitoring, September 2020 to August 2025112,242 patient-days analyzed
- Participants
- 218 patients
- Exposure
- Bidirectional day-to-day association between device-detected AF (DDAF) and device-detected SA (DDSA): preceding-day DDAF burden and incident severe DDSA; preceding-night severe DDSA and DDAF episode onset or continuation
- Outcome
- Elevated DDAF burden on the previous day preceding incident severe DDSA (pathway 1)
- Follow-up
- Previous day
Methodological detailsprospective ACaSA study, continuous remote monitoring, generalized linear mixed-effects models as secondary analyses
- Prospective ACaSA study
- Continuous remote monitoring
- Generalized linear mixed-effects models as secondary analyses
Main finding
As reported in the abstract
Odds ratio (95% CI)P value
DDAF burden 6 minutes to 1 hour
1.38(1.10–1.74)
P ≤ 0.005DDAF burden 1-12 hours
1.81(1.52–2.15)
P ≤ 0.005DDAF burden ≥12 hours
2.52(1.97–3.22)
P ≤ 0.005Observational data: associations, not effects.
Further findings
Severe DDSA on the previous night preceding incident DDAF episode onset (pathway 2)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Severe DDSA on the previous nightHigher odds preceding incident DDAF episode onset | 1.35 (1.10–1.64) | P = 0.003 | |
| 0.512Odds ratio (log scale) |
Severe DDSA on the previous night preceding continuation of ongoing DDAF episodes (pathway 3)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Severe DDSA on the previous nightHigher odds preceding continuation of ongoing DDAF episodes | 2.39 (1.47–3.88) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Bidirectional temporal association of device-detected atrial fibrillation and sleep apnea. Heart Rhythm. Published 18 July 2026. doi:10.
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