Atrial Fibrillation and Sleep Apnea: A Hidden but Critical Connection

By Amit V. Patel, MD, FCCP, ABIM Sleep Medicine & Adam S. Fein, MD, Cardiac Electrophysiology 

Atrial fibrillation (AFib) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide. One of the cornerstones of treatment of Atrial Fibrillation is looking to address lifestyle choices and modifiable risk factors to reduce frequence of arrhythmia events.  While many people are familiar with its association with aging, hypertension, or obesity, far fewer are aware of one of its significant and treatable contributors: obstructive sleep apnea (OSA).

The Link Between Sleep and Heart Rhythms

Research has highlighted a strong correlation between sleep apnea and AFib. Studies have shown that over 80% of individuals with atrial fibrillation undergoing advanced therapies also have underlying sleep apnea. The pauses in breathing, drops in oxygen levels, and surges in sympathetic nervous activity that characterize sleep apnea contribute to structural and electrical changes in the heart that promote arrhythmias.

“When we diagnose and treat sleep apnea, we are not just helping patients sleep better, we are improving their cardiovascular health.”, says Dr. Amit Patel, Medical Director of Virginia Heart’s Sleep Center.

Treating Sleep Apnea Can Change the Course of AFib

Virginia Heart seeks to optimize all patient-related factors that can help them get the best response to treatment.    Addressing sleep apnea, particularly with continuous positive airway pressure (CPAP) therapy, can make a significantly improve the effectiveness of AFib treatment.

Virginia Heart is interested in this correlation so that we can help our AFib patients have a better quality of life. Dr. Fein published a study in which the results showed that CPAP therapy dramatically improved outcomes for AFib patients undergoing ablation procedures.

These findings underscore an important message for patients undergoing AFib treatment, especially procedures like catheter ablation, that untreated OSA can significantly diminish the benefits and increase the likelihood of AFib recurrence.

Moving Toward Integrated Care

Most patients with AFib, particularly those being considered for ablation or with risk factors such as obesity, snoring, or excessive daytime sleepiness, should be screened for OSA.

“Patients with AFib who used CPAP had notably better outcomes after ablation compared to those who didn’t treat their sleep apnea,” explains Dr. Adam Fein, electrophysiologist at Virginia Heart. “It’s a clear indicator that managing OSA should be part of a comprehensive AFib treatment plan.”

We have compelling evidence that treating sleep apnea isn’t just about reducing fatigue or improving sleep, it’s about improving your heart health.