Sleep Medicine · Oct 31, 2026

Respiratory control instability during sleep is associated with incident atrial fibrillation

By Hu YT, Oppersma E, Ganglberger W et al.

Background There is an association between central sleep apnea (CSA) and atrial fibrillation (AF). However, standard scoring and threshold criteria for CSA are relatively rigid and does not capture the entirety of expressed high loop gain (HLG) of the respiratory control system during sleep. We aimed to investigate the association between HLG sleep apnea, as measured by a respiratory self-similarity (SS) detection algorithm, and the risk of incident AF. Methods Polysomnograms from the Sleep Heart Health Study (SHHS) and the Osteoporotic Fractures in Men Study (MrOS) were analyzed to quantify expressed HLG using an automated algorithm that calculates SS% and a Central Respiratory Event Index (CREI). Multivariable Logistic regression models were used to assess the relationship between HLG metrics and incident AF. Results A total of 3,706 participants (2,897 from SHHS and 809 from MrOS) were included. In MrOS, high SS% (≥13.5%) and high CREI (≥30 events/hour) remained significantly associated with incident AF after mutual adjustment with CSA (SS%: OR 1.697, 95% CI 1.027–2.805, p: 0.039; CREI: OR 1.661, 95% CI 1.022–2.699, p: 0.041). In SHHS participants <65 years, SS% >10.5% was associated with AF after full adjustment (OR 3.613, 95% CI 1.347–9.693, p: 0.011) and remained significant after adjustment for CSA (OR 7.661, 95% CI 1.875–31.309, p: 0.005). Conclusions Expressed high loop gain sleep apnea is independently associated with incident atrial fibrillation in community-based cohorts.

doi.org/10.1016/j.sleep.2026.109341PubMed 42987775Populations