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Night-To-Night Variability in Sleep Apnea Is Associated With Persistence and Burden of Device-Detected Atrial
Philipp Spitaler1, Valentin Bilgeri1, Patrick Rockenschaub2
1Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
Journal of Sleep Research
|February 23, 2026
Summary
Nightly sleep apnea variability, tracked by pacemakers, predicts atrial fibrillation risk. Higher variability in the respiratory disturbance index (RDI) increases the likelihood and burden of device-detected atrial fibrillation (DDAF).
Area of Science:
- Cardiology
- Sleep Medicine
- Biomedical Engineering
Background:
- Sleep apnea is a common condition often associated with cardiovascular disease.
- Atrial fibrillation (AF) is a significant risk factor for stroke and other cardiovascular complications.
- Continuous monitoring of physiological parameters can aid in risk stratification and management of chronic conditions.
Purpose of the Study:
- To investigate the association between night-to-night variability of sleep apnea, assessed via pacemaker-derived thoracic impedance, and the development and burden of device-detected atrial fibrillation (DDAF).
- To explore the potential of continuous, non-invasive monitoring for stratifying DDAF risk in pacemaker patients.
Main Methods:
- A prospective study (ACaSA) followed 171 pacemaker patients without baseline atrial fibrillation.
- Thoracic impedance monitoring from pacemakers was used to quantify night-to-night variability of the respiratory disturbance index (RDI) over a 28-night run-in period.
- Patients were monitored for the onset and cumulative burden of persistent DDAF (≥7 days) over a median of 539 days.
Main Results:
- Median RDI variability was 38.7%; 20.5% of patients exhibited high variability (≥50%).
- 17 patients (9.9%) developed persistent DDAF.
- Each 10% increase in RDI variability significantly elevated the risk of persistent DDAF (adjusted HR 1.89). Patients with high RDI variability had a greater cumulative DDAF burden (9.6% vs. 1.9%).
Conclusions:
- Dynamic instability of sleep apnea, indicated by night-to-night RDI variability, is significantly associated with DDAF persistence and burden.
- Pacemaker-derived thoracic impedance monitoring offers a novel, continuous method for assessing sleep apnea variability.
- This approach may enable improved risk stratification and personalized management strategies for DDAF in patients with cardiac implantable devices.
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