Sleep fragmentation and incidence of congestive heart failure: the Sleep Heart Health Study

Abstract

Study objectives: Sleep fragmentation (SF) has been reported to be associated with cardiovascular risk. The aim of this study was to explore the relationship between SF and congestive heart failure (CHF).

Methods: A total of 4,887 participants (2,256 males and 2,631 females; mean age of 63.6 ± 11.0 years) from the Sleep Heart Health Study were included in this study. Incident CHF was defined as the first occurrence of CHF between baseline in-home polysomnography (PSG) and the end of follow-up. Objective assessments for SF, including sleep fragmentation index (SFI), arousal index (ArI), sleep efficiency (SE), and wake after sleep onset (WASO), were determined based on in-home PSG records. Multivariate Cox regression analysis was used to investigate the relationship between SF and incident CHF.

Results: During an average of 10 years of follow-up, 543 participants with CHF (11.1%) were observed. Individuals with CHF had a significantly higher SFI, total ArI, and WASO and a lower SE than controls. After multivariate Cox regression analysis, SE (odds ratio [OR], 0.967; 95% confidence interval [CI], 0.955-0.978; P < .001), WASO (OR, 1.009; 95% CI, 1.006-1.012; P < .001), SFI (OR, 1.046; 95% CI, 1.007-1.086; P = .021), and total ArI (OR, 1.018; 95% CI, 1.000-1.035; P = .044) were found to be associated with the incidence of CHF in participants without hypertension.

Conclusions: Objectively measured SF was associated with the incidence of CHF. The role of SFI, total ArI, SE, and WASO deserves further investigation.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Sleep Heart Health Study (SHHS) Data Coordinating Center (SHHS); URL: https://ichgcp.net/clinical-trials-registry/NCT00005275; Identifier: NCT00005275.

Citation: Yan B, Wu Y, Fan X, Lu Q, Ma X, Bai L. Sleep fragmentation and incidence of congestive heart failure: the Sleep Heart Health Study. J Clin Sleep Med. 2021;17(8):1619-1625.

Keywords: Sleep Heart Health Study; congestive heart failure; polysomnography; sleep fragmentation.

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. Eligibility criteria for the study population.

CHF = congestive heart failure.

Figure 2. Unadjusted Kaplan-Meier plots of cumulative risk for congestive heart failure stratified by sleep fragmentation quartiles in individuals without hypertension.

(A) SE (< 78.0% vs 78.0–85.2% vs 85.3–90.4% vs ≥ 90.5%); (B) WASO (< 30.0 min vs 30.0–49.4 min vs 49.5–81.4 min vs ≥ 81.5 min); (C) SFI (< 6.6 events/h vs 6.6–8.5 events/h vs 8.6–10.6 events/h vs ≥ 10.7 events/h); (D) Total ArI (< 12.0 events/h vs 12.0–16.7 events/h vs 16.8–23.5 events/h vs ≥ 23.6 events/h). ArI = arousal index, SE = sleep efficiency, SFI = sleep fragmentation index, WASO = wake after sleep onset.

Figure 3. Unadjusted Kaplan-Meier plots of cumulative risk for congestive heart failure stratified by sleep fragmentation quartiles in individuals with hypertension.

(A) SE (< 78.0% vs 78.0–85.2% vs 85.3–90.4% vs ≥ 90.5%); (B) WASO (< 30.0 min vs 30.0–49.4 min vs 49.5–81.4 min vs ≥ 81.5 min); (C) SFI (< 6.6 events/h vs 6.6–8.5 events/h vs 8.6–10.6 events/h vs ≥ 10.7 events/h); (D) Total ArI (< 12.0 events/h vs 12.0–16.7 events/h vs 16.8–23.5 events/h vs ≥ 23.6 events/h). ArI = arousal index, SE = sleep efficiency, SFI = sleep fragmentation index, WASO = wake after sleep onset.