Sleep Apnea and Atrial Fibrillation Connection

Recent medical research has determined that approximately half of patients diagnosed with atrial fibrillation (AFib) also suffer from obstructive sleep apnea or OSA. 

Although no definitive causal connection has been proven between AFib and OSA, it is widely accepted by medical professionals that there is a close relationship between the two conditions. 

A 2018 American Medical Association review found that anywhere from 21% to 74% of AFib patients also suffered from OSA. This is why patients with atrial fibrillation are generally recommended to be tested for obstructive sleep apnea.

Conversely, the same review revealed a connection between atrial fibrillation and sleeping problems such as insomnia and frequent awakenings.

A link between AFib and OSA was not proven conclusively -- but the irregularities in the heart's function was shown to significantly contribute to disrupted sleeping patterns.

Obstructive Sleep Apnea

OSA is a recognized medical condition that can affect anyone at any time of life although it is rare in younger people. The condition causes short pauses in breathing (called apneas) when airflow becomes obstructed during sleep.

Atrial Fibrillation

Sometimes referred to as AFib or AF, atrial fibrillation is an irregular (often rapid) heartbeat which is caused by disorganized electrical impulses to the heart's upper chambers (the atria) -- and is the most frequently diagnosed form of heart arrhythmia.

Both conditions, if left untreated, can lead to severe medical problems including heart conditions, strokes, blood clots and possibly even death.

Risk Factors

There are two types of sleep apnea: central sleep apnea and obstructive sleep apnea. 

Of the two, OSA is the one that is most frequently linked with atrial fibrillation. Although the relationship between OSA and AFib has not been provably? demonstrated, a study in Arrhythmia and Electrophysiology Review outlines what the link may be:

Obstructive sleep apnea causes hypoxia (shortage of oxygen), inflammations and these have adverse effects on the central nervous system. It is suspected that these symptoms can be a contributory factor to the onset of AFib.

Another commonality between the two conditions are the risk factors that can lead to both OSA and AFib. These include:

  • High blood pressure
  • Family history of heart conditions
  • Hormonal imbalance
  • Smoking
  • Alcohol abuse
  • Stress
  • Poor levels of fitness
  • Age
  • Being male is also viewed as a possible factor as men are more prone to both OSA and AFib.

PAP Treatment

Both sleep apnea and atrial fibrillation are treatable conditions and what form the treatments take will depend on the severity of the problem. 

A definitive diagnosis of obstructive sleep apnea can only be made by way of a sleep study. This is carried out by a specialist in sleeping disorders -- and is used to measure breathing rate, heart rate and rhythm, oxygen levels, brain wave patterns and eye and leg movement during sleep.

The data collected is used to compose an AHI (apnea-hypopnea index) which determines whether the obstructive sleep apnea is mild, moderate or severe. 

In the majority of OSA cases, the specialist will recommend the use of a Positive Airway Pressure (PAP) device.

PAP devices are of tremendous benefit to OSA sufferers and can also be helpful in the treatment of atrial fibrillation. This is simply because the presence of OSA can exacerbate the symptoms and occurrence of atrial fibrillation. 

Therefore, by improving the quality of sleep, and removing the additional stress placed on the body by OSA, it can also alleviate the effects of AFib.

It is important to note, however, that PAP devices are specifically designed to treat OSA -- and not heart conditions. While these devices may lead to improvement in AFib patients, this is a benefit and not by intentional design. 

Cases of AFib (or any heart complaints) must be treated by a qualified professional who can provide the correct medications and determine the best course of action on an individual basis.

Reducing the Risks

Obstructive sleep apnea and atrial fibrillation are both treatable conditions -- but prevention is always better than cure. There are several risk factors common to both and it is possible to reduce the risk of suffering either condition by making some simple lifestyle changes:

  • Quit smoking or using any tobacco products
  • Limit the amount of alcohol consumed
  • Maintain a healthy and appropriate weight
  • Exercise regularly
  • Follow a balanced and nutritious diet

Stress can also be a harbinger of both OSA and AFib -- so it is wise to reduce stress levels whenever possible. Whether the stress is work-related or has some other cause, taking care to reduce stress levels is important -- not just for mental health but also for overall health.

Patients with both obstructive sleep apnea and atrial fibrillation should consult with a doctor or medical professional to discuss any mental or physical concerns. 

A PAP device will certainly help to control OSA and may also offer relief from AFib but this is not always the case.

Sufficient and better quality sleep can help alleviate atrial fibrillation -- but may not provide a full solution to the problem. Once OSA is under control, it will be easier to determine the cause of AFib -- and if it may be necessary to follow an entirely different path of treatment for this troubling condition.