Long-term changes in sleep patterns, genetic susceptibility, and incident atrial fibrillation

Atrial fibrillation (AF), one of the most common arrhythmias, is associated with substantially increased risks of death, dementia, stroke, and other cardiovascular diseases.1 Beyond established lifestyle risk factors such as smoking, alcohol consumption, physical activity, and obesity, recent studies suggest that sleep-related behaviours—including daytime sleepiness, poor sleep quality, abnormal sleep duration, insomnia, and obstructive sleep apnoea—also contribute to AF risk.1–5 However, the majority of earlier studies have used only one-time measurements of sleep, which might not adequately reflect the evolving patterns of sleep behaviours or their long-term influence on the risk of AF. To address this knowledge gap, we obtained sleep data at two separate time points and prospectively examined how changes in sleep patterns influenced the subsequent risk of AF in a middle-aged UK population. In our analysis, we included 44 313 participants who underwent repeated sleep assessments, excluding those who had AF either before enrolment or during the interval between the two sleep assessments (Figure 1A). Atrial fibrillation was defined using ICD-10 code I48, consistent with standard approaches in UK Biobank studies. Sleep behaviours (chronotype, snoring, sleep duration, insomnia, and daytime sleepiness) were self-reported at baseline and follow-up via touchscreen questionnaires. Each optimal behaviour was scored as 1 (else 0), generating a healthy sleep score (HSS) from 0 to 5, with higher scores indicating healthier sleep. Changes in HSS were assessed continuously as the absolute difference between baseline and follow-up scores and categorically by dichotomizing HSS at the median value of 4. Participants were classified into four groups: stable poor (