Association between sleep apnoea and arrhythmia: A multivariable Mendelian randomization study

Background

Sleep apnoea is recognized as a cardiovascular risk factor, especially in individuals with existing heart conditions. Understanding the direct causal relationship between sleep apnoea and arrhythmia, while accounting for confounding cardiovascular factors such as coronary artery disease, hypertension, heart failure, and myocardial infarction, is essential for effective cardiovascular risk management.

Methods

Utilizing data from the FinnGEN study spanning 1998 to 2019, we conducted a Mendelian randomization analysis on a European cohort to explore the association between genetically predicted sleep apnoea and various arrhythmias, including atrioventricular block, atrial fibrillation, and ventricular arrhythmia. The study aimed to identify specific genetic components contributing to these associations.

Results

The genetic analysis demonstrated significant associations between a genetic predisposition to sleep apnoea and certain arrhythmias. Importantly, sleep apnoea showed an independent association with atrioventricular block, even after adjusting for other cardiovascular conditions. Two single nucleotide polymorphisms, rs9937053 and rs10507084, were identified as critical factors in the causal pathway connecting sleep apnoea to atrioventricular block. However, there were no direct causal relationships found between sleep apnoea and the other arrhythmias examined.

Conclusions

This study emphasizes the critical role of considering sleep apnoea in cardiovascular management, particularly due to its direct causal link to atrioventricular block influenced by specific genetic variants. These findings call for additional research to further explore the impact of sleep apnoea on other types of arrhythmias.

What Is New?

• This study establishes a direct causal link between sleep apnoea and atrioventricular block using Mendelian randomization in a large European cohort from the FinnGEN study.

• Two genetic markers, rs9937053 and rs10507084, are identified as critical components in the causal pathway connecting sleep apnoea to atrioventricular block, highlighting potential targets for future intervention.

• The study also uncovers bidirectional causal relationships between sleep apnoea and hypertension, and sleep apnoea and obesity-related traits like BMI, suggesting complex interactions that affect cardiovascular and metabolic health.

What Are the Clinical Implications?

• The findings emphasize the importance of considering sleep apnoea in cardiovascular management, particularly concerning its direct causal role in atrioventricular block influenced by specific genetic variants.

• Including sleep apnoea in the clinical assessment and management strategies for patients with or at risk of atrioventricular block could enhance individualized patient care and improve cardiovascular outcomes.

• The identification of specific genetic variants associated with sleep apnoea-related arrhythmias suggests new avenues for research and the development of targeted therapies, potentially leading to more effective prevention and treatment approaches for cardiovascular comorbidities in patients with sleep apnoea.