Objective: To explore the correlation between night ECG parameters and sleep quality in elderly patients with atrial premature beat (PAC). Methods: A total of 307 elderly patients with PAC were selected from March 2022 to March 2024. The parameters of room morning load and heart rate variability (HRV) at night (22:00–6:00) were collected by 24h holter electrocardiogram, and the sleep quality of PAC patients was evaluated by Pittsburgh Sleep Quality Index (PSQI). Multiple regression analysis was used to explore the correlation between night ECG parameters and sleep quality. Results: The incidence of sleep disorder in 307 elderly PAC patients was 62.54%. Univariate analysis showed that there were no statistically significant differences in gender, BMI and education level (P > 0.05), but there were statistically significant differences in age, disease course, underlying diseases, atrial morning load, SDNN, RMSSD, LF, HF, LF/HF and TP (P < 0.05). Multivariate Logistic regression analysis showed that atrial morning load, SDNN, RMSSD, LF and LF/HF were independent influencing factors of sleep disorder in elderly PAC patients (P < 0.05). Patients with sleep disorders were divided into mild group, moderate group and severe group according to PSQI score, and there were statistically significant differences in the indexes of atrial morning load, SDNN, LF, LF/HF and TP among the three groups (all P < 0.05). Spearman correlation analysis showed that room morning load, LF, LF/HF and TP were positively correlated with the degree of sleep disorder, while SDNN parameters were negatively correlated with the degree of sleep disorder (all P < 0.05). Conclusion: There is a significant correlation between night ECG parameters and sleep disorders in elderly patients with PAC. It is possible to prevent and treat sleep disorders by monitoring ECG abnormalities and improve the reliability of treatment.