The Link Between Sleep Apnea and AFib

Sleep apnea is a medical condition that causes pauses in breathing, called “apneas,” during sleep. The most common kind of sleep apnea is obstructive sleep apnea (OSA), in which the upper airways become blocked and restrict airflow. Left untreated, OSA can lead to medical complications like heart disease, heart failure, stroke, and sudden death.

Atrial fibrillation, sometimes called AFib or AF, is the most common type of heart arrhythmia (irregular heartbeat). AFib is a highly irregular and usually rapid heart rhythm, caused by chaotic and disordered electrical impulses in the upper chambers of the heart (the atria). It can cause stroke, heart failure, blood clots, and other health complications.

AFib and sleep apnea share some risk factors and potential complications in common. In fact, those with sleep apnea may be at higher risk of atrial fibrillation.

This article will discuss the link between sleep apnea and AFib, shared risk factors, getting diagnosed for either condition, and how to treat both conditions.

The Relationship Between Sleep Apnea and AFib

There is evidence of an association between sleep apnea and AFib. However, it’s not entirely clear how the two conditions are linked.

Current estimates indicate that having OSA increases the risk of having AFib by two to four times. Severe OSA is associated with an even higher risk of developing AFib. 

The risk of developing temporary AFib is also higher immediately following an apnea event during sleep. People with OSA also have a higher likelihood of developing recurrent AFib, especially if their OSA is left untreated. 

There is no single cause of either sleep apnea or AFib. Several of the risk factors for both conditions overlap, including:

• Obesity
• High blood pressure
• Age
• Being male
• Excessive alcohol use
• Smoking
• Family history of heart disease
• Hormonal imbalances, such as thyroid conditions

Because of the strong correlation between sleep apnea and AFib, many clinicians recommend that you be screened for OSA if you have an AFib diagnosis. This is especially true if you have any of the above risk factors.

Sleep apnea and AFib can also lead to some of the same negative health outcomes, especially if left untreated. These may include:

• Stroke
• Heart disease
• Heart failure
• Cognitive impairments, including dementia
• Sudden death

Diagnosing Sleep Apnea

Sleep apnea causes breathing interruptions during sleep. Each apnea event typically lasts 10 seconds or more. In severe cases, someone with sleep apnea may experience 30 or more of these pauses per hour. 

The signs and symptoms of sleep apnea may include:

• Choking or gasping for air during sleep
• Loud, frequent snoring
• Excessive daytime sleepiness
• Falling asleep during the day
• Irritability and mood swings
• Difficulty concentrating
• Headaches or dry mouth upon waking
• Feeling tired after a full night of sleep

The only way to definitively diagnose someone with sleep apnea is with an overnight sleep study, which is also called polysomnography. A sleep study measures your breathing rate, leg and eye movements, heart rate and rhythms, oxygen levels, and brain waves while you rest. 

A sleep specialist can use this data to determine your apnea-hypopnea index (AHI), which measures how many breathing interruptions experienced per hour. Your AHI will determine whether you have mild, moderate, or severe sleep apnea.

Diagnosing AFib

AFib is caused by misfiring electrical signals that cause your atria (upper heart chambers) to quiver and flutter (fibrillate). 

AFib is usually diagnosed when a healthcare provider notices a completely irregular, often rapid, heart rate. This diagnosis can be confirmed with an electrocardiogram (ECG), which measures your heart rhythms and electrical activity using sensors attached to your skin. 

Healthcare providers often classify AFib into various clinical patterns, which may affect the choice of treatment. These classifications include:

• Paroxysmal fibrillation, when the heart rate returns to normal on its own within a week 
• Persistent AFib, which lasts for more than seven days
• Long-standing AFib, which lasts for more than 12 months
• Permanent AFib, which continues indefinitely
• Nonvalvular AFib, which is not caused by a problem with the heart valve

Treating Both Conditions

The first choice of treatment for OSA is positive airway pressure (PAP) treatment, which involves pumping pressurized air into the airways through a mask placed over the nose or nose and mouth during sleep.

Usually, this is done with a continuous positive airway pressure (CPAP) device. If you have sleep apnea, regular use of a CPAP device can reduce the risk of AFib.

There are several different possible treatments for AFib, including:

• Taking prescribed blood thinners to lower the risk of stroke
• Taking prescribed medications to control your heart rate and/or heart rhythms
• Cardioversion, which “shocks” the heart back into a normal rhythm
• Pulmonary vein isolation, a type of catheter ablation that uses gentle burning to block abnormal electrical impulses and prevent AFib
• Using a pacemaker

If you have both OSA and AFib, it’s important to treat both conditions at the same time. Among people with OSA, the risk of developing recurrent AFib is higher after catheter ablation. Some studies show that regular use of a CPAP device as prescribed can lower the risk of recurrent AFib in people with sleep apnea. 

Because sleep apnea and AFib share several risk factors, it can also help to make certain lifestyle changes in order to prevent and manage both conditions. These may include: 

• Quitting smoking
• Reducing alcohol intake
• Managing stress
• Losing weight 
• Exercising regularly
• Eating a nutritious diet
• Getting adequate sleep

Summary

Sleep apnea is a medical condition that causes intermittent breathing interruptions during sleep. The most common type is obstructive sleep apnea (OSA). OSA can be diagnosed with an overnight sleep study. Atrial fibrillation (AFib) is a common type of heart arrhythmia. AFib can be diagnosed with an echocardiogram (ECG). 

There is evidence of an association between sleep apnea and AFib. About half of people with OSA also have AFib. Sleep apnea and AFib share some risk factors in common, including age, obesity, and smoking. Both sleep apnea and AFib may lead to health complications like stroke and heart failure.

Treating OSA with continuous positive airway pressure (CPAP) therapy can reduce the recurrence of atrial fibrillation.

A Word From Verywell

If you’ve been diagnosed with atrial fibrillation, you might want to ask your healthcare provider about the possibility of being assessed for OSA. It’s important to treat both sleep apnea and AFib as advised by your healthcare provider. This can help you prevent, manage, and treat the symptoms of both conditions.