Associations Between Objective Sleep Characteristics From Wearable Physiologic Monitors and Incident Atrial...

Previous research suggests a link between sleep and atrial fibrillation (AF). Most published studies are limited by the use of self-reported data or absence of information regarding sleep architecture. The predictive role of objectively measured sleep parameters for incident AF remains underexplored.

The objective of the study is to examine associations between objectively measured sleep parameters, including total sleep duration and sleep stages and incident AF in a large, diverse cohort.

We analyzed data from 52,952 participants in the All of Us Research Program with wearable-derived sleep data and no baseline AF, followed for a median of 935 days. Subjects with total sleep under 3 hours or over 16 hours were excluded. Incident AF (n = 437; 0.84%) was identified via electronic health records. Cox proportional hazards models were used to estimate HRs adjusted for demographic, behavioral, and clinical covariates.

Incident AF was associated with older age, male sex, White race, smoking, and comorbidities (all P < 0.001). Longer total sleep duration was linked to increased AF risk, particularly >9 hours (HR _{vs 6-9h}: 1.47; 95% CI: 1.12-1.94). Duration of deep and rapid eye movement sleep was inversely associated with AF, whereas light sleep and nonmain sleep ≥2 hours were associated with increased risk (HR: 1.65; 95% CI: 1.23-2.20 vs 1-2 hours).

Wearable-derived sleep parameters are independently associated with AF risk. Prolonged total and nonmain sleep, reduced deep and REM sleep, and increased light sleep are independently associated with incident AF, supporting their potential role in AF risk stratification and prevention.