Related Experiment Video
Updated: Aug 6, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Bidirectional temporal association of device-detected atrial fibrillation and sleep apnea
Philipp Spitaler1, Valentin Bilgeri1, Gudrun Feuchtner2
1Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
Background:
The relationship between atrial fibrillation (AF) and sleep apnea (SA) is well established, but the day-to-day temporal direction of this association remains uncertain.
Objective:
This study aimed to examine the bidirectional day-to-day association between device-detected AF (DDAF) and device-detected SA (DDSA), while distinguishing DDAF episode onset from continuation of ongoing episodes.
Methods:
Data were obtained from the prospective ACaSA study in pacemaker patients undergoing continuous remote monitoring. Data collected from September 2020 to August 2025 were analyzed. Severe DDSA was defined as a respiratory disturbance index of ≥20 and a DDAF episode as a daily burden of ≥6 minutes. 3 day-level, time-stratified intraindividual case-crossover analyses were performed: pathway 1 related preceding-day DDAF burden to incident severe DDSA on the subsequent night, pathway 2 related preceding-night severe DDSA to incident DDAF episode onset the next day, and pathway 3 related preceding-night severe DDSA to continuation of an already active DDAF episode. Generalized linear mixed-effects models were used as secondary analyses.
Results:
A total of 112,242 patient-days from 218 patients were analyzed. Incident severe DDSA was preceded by higher odds of elevated DDAF burden on the previous day in a graded manner, with odds ratios (ORs) of 1.38 (95% confidence interval [CI], 1.10-1.74) for 6 minutes to 1 hour, 1.81 (95% CI, 1.52-2.15) for 1-12 hours, and 2.52 (95% CI, 1.97-3.22) for ≥12 hours (all P ≤ .005). Both incident DDAF episode onset and the continuation of ongoing DDAF episodes were preceded by higher odds of severe DDSA on the previous night (OR, 1.35; 95% CI, 1.10-1.64; P = .003, and OR, 2.39; 95% CI, 1.47-3.88; P < .001, respectively).
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.
