A-Fib & Obstructive Sleep Apnea=Higher Mortality Rate, Longer Hospital Stays

At least 43% of patients with Atrial Fibrillation also suffer from Obstructive Sleep Apnea (OSA), a disorder characterized by recurrent collapse of the upper airway during sleep. It occurs when the muscles supporting the soft tissues in the throat relax, the airway is narrowed, and breathing is momentarily cut off.

Inadequate or improper sleep is a life-style risk factor for Atrial Fibrillation, a modifiable factor you can control.

Recent research indicates sleep apnea may contribute to A-Fib by causing stress on the Pulmonary Vein openings and/or by depriving the lungs and body of adequate oxygen supply (Hypoxemic Hypoxia).

Obstructive Sleep Apnea: a Major Public Health Problem

OSA affects almost one billion individuals worldwide. Ninety percent of patients with OSA are still undiagnosed. Some reports have estimated that at least 20.2% of men and 10.0% of women are affected with moderate-severe OSA.

The rise in OSA cases is attributed to increased obesity rates and overall general advancements in healthcare leading to longer lifespans.

Aside from causing or triggering A-Fib, untreated sleep apnea can cause many other serious health threats. Research reveals that patients with sleep apnea have a higher mortality rate, a longer duration of hospitalization, and incur greater medical costs.

The Wisconsin Sleep Cohort Study

Beginning in 1989, the U. of Wisconsin study used a random sample of 1,522 Wisconsin state employees. The participants underwent overnight sleep apnea studies and many other tests at four-year intervals. They were not selected because they had known sleep problems. (After the testing, researchers contacted participants with severe sleep apnea and explained the health risks.)

Researchers examined 22-years of mortality data on the study’s participants and revealed the numerous life-altering and life-threatening health issues associated with sleep apnea.

Patients with severe sleep apnea are…

• 4X more likely to have a stroke
• 5X greater risk of cardiovascular death
• 2X as likely to develop depression
• 5X more likely to die from cancer

And more likely on average to:

• develop cognitive impairment a decade earlier
• develop Alzheimer’s 5 years earlier

Sleep Apnea: a condition in which one or more pauses in breathing occur while sleeping, pauses can last a few seconds to minutes and can occur 30 times or more an hour.

More EPs are Sending Patients for Sleep Studies

So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study.

Patients receiving CPAP therapy appear to have a lower risk of A-Fib recurrence after A-Fib ablation.

Although an in-lab sleep study (called “attended polysomnography” or PSG) is the gold standard to diagnose OSA, it is time-consuming and is associated with higher costs. Home Sleep Apnea Testing (HSAT) is now available to diagnose OSA (requires a prescription from your doctor).

It’s now available at a fraction of the cost of an in-lab sleep study ($250–$300 vs. $1100–$2,000). And it’s convenient (especially if being away from home overnight is problematic).

A home sleep apnea test is a very simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort while worn. It does not fully capture what is monitored with an overnight sleep study.

Additional Benefit of Treatment: Patients receiving CPAP therapy appear to have a lower risk of A-Fib recurrence after having a catheter ablation.

Treatments for Sleep Apnea

The most common treatment is a CPAP (Continuous Positive Airway Pressure) machine that blows steady air through a mask to keep your airway open while you sleep. Other treatment choices include a custom mouth guard to move your jaw forward; Lifestyle changes like weight loss; Or surgery to open blocked airways.

For some lucky A-Fib patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea.

Take Action: Sleep Apnea Can be Lethal

Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. (Just like A-Fib, you don’t have to just live with it).

If your significant other tells you that you pause breathing when you sleep or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)

Talk with your doctors about testing for sleep apnea. A Home Sleep Apnea Test may be just what the doctors orders. If more extensive data is needed, you may need an in-lab sleep study.

On a Personal Note: My wife. Patti, has sleep apnea (but not A-Fib). While sleeping, she would actually stop breathing for what seemed like a long time, then suddenly gasp for air. It was very scary! But now she uses a CPAP machine, sleeps soundly and wakes up rested.
Patti’s last sleep study was a Home Sleep Apnea Test. An overnight kit was supplied through her doctor’s office. She watched a YouTube video about setup and returned the kit the next day for diagnosis.
BTW: Sleep apnea may run in families. Her brother has sleep apnea also.

Resources for this article

Abbasi A, Gupta SS, Sabharwal N, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci. 2021;14(2):142–154. doi: 10.5935/1984-0063.20200056.

Marin JM, Carrizo SJ, Vincente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53. doi: 10.1016/S0140-6736(05)71141-7.

Cunningham J, Hunter M, Budgeon C, et al. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med. 2021;17(10):2029–2039. doi: 10.5664/jcsm.9378.

Young, Terry. New Wisconsin Study Documents Severity of Sleep Apnea Risk. UW Health 2008 Annual Report. http://www.uwhealth.org/about-uwhealth/annual-report/new-wisconsin-study-documents-severity-of-sleep-apnea-risk/15018

Nieto, Javier. Sleep Apnea Associated with Higher Mortality from Cancer. University of Wisconsin School of Medicine and Public Health. News and Events, Med.Wisc.edu, 05/21/2012. http://www.med.wisc.edu/news-events/sleep-apnea-associated-with-higher-mortality-from-cancer/37687

Gill, Jashan & Chunyi Wu. In-hospital Outcomes and Arrhythmia Burden in Patients with Obstructive Sleep Apnea and Heart Failure with Preserved Ejection Fraction. The Journal of Innovations in Cardiac Rhythm Management, June 2022, Volume 12/Number 6. p. 5033.