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Which Comes First: Sleep Apnea or Atrial Fibrillation?

Obstructive Sleep Apnea (OSA) affects about 100 million people worldwide with 85% of cases going undiagnosed.

Of Atrial Fibrillation patients, about 43% additionally suffer with Obstructive Sleep Apnea.

Could undiagnosed sleep apnea be linked to development of Atrial Fibrillation?

OSA Link to A-Fib

OSA is characterized by repetitive episodes of shallow or paused breathing during sleep that lead to a drop in blood oxygen level and disrupted sleep.

85% of Sleep Apnea cases go undiagnosed.

New research has found that patients with Sleep Apnea may be at greater risk of developing Atrial Fibrillation. Abnormal oxygen saturation level during sleep may be responsible.

Patients with OSA are more likely to have high blood pressure, or hypertension, which is a major risk factor for heart disease and other cardiovascular conditions.

Risk of New Onset A-Fib: The Clinical Cohort Study

Lead author Dr. Tetyana Kendzerska, Ph.D., of the University of Ottawa in Canada, and colleagues reviewed the records of 8,256 adults (average age 47) with suspected OSA. Individuals with any diagnosis of arrhythmias were excluded. Participants were followed for an average of 10 years. During that time, 173 developed A-Fib resulting in hospitalization.

Study Results

The reviewers found that the amount of sleep time spent with lower than normal oxygen saturation (below 90 percent) was a significant predictor of developing Atrial Fibrillation.

By contrast, the number of breathing pauses during each hour of sleep did not appear to affect A-Fib risk.

Study participants who developed A-Fib during the follow-up period were more likely to be older, current or former smokers, and have a high level of comorbidities (e.g. high blood pressure, or hypertension).

“The association between oxygen desaturation and A-Fib remains significant, suggesting that OSA can directly cause A-Fib.”

What This Means to Patients

In light of this study, a diagnosis of Atrial Fibrillation raises the question, ”Could my A-Fib have been brought on by undiagnosed Sleep Apnea?”

Sandy from Boston

Sandy from Boston and her doctor say ‘yes”. Updating her personal A-Fib story, she wrote:

“After my [successful] CryoBalloon ablation at BWH in 2014, I underwent a sleep study that revealed during REM sleep I stopped breathing an average of 32 times every hour. My physician suspected that my traumatic brain injury in 1995 caused my undiagnosed sleep apnea, which in turn caused Paroxysmal A-Fib. I have been using a CPAP ever since.”

Take Action: Sleep Apnea Can be Lethal: If you have untreated Sleep Apnea, you are at greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment.

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

Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. To learn more, see Sleep Apnea: When Snoring Can Be Lethal.

Resources for this article
Atrial Fibrillation and Sleep Apnea. Heart Rhythm Society.

What You Need to Know: Sleep apnea may increase atrial fibrillation risk., May 22, 2017.

Kendzerska, T, et al. Sleep Apnea Increases the Risk of New Onset Atrial Fibrillation: A Clinical Cohort Study. American Thoracic Society. Public Release: 22-May-2017.

Whiteman, H. Obstructive sleep apnea might lead to irregular heartbeat. Medical News Today. May 23, 2017.

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