The Hidden Link Between Sleep Apnea and Atrial Fibrillation

Do you start your mornings feeling exhausted, even after a seemingly restful night's sleep? Or have you had heart palpitations or irregular heartbeat? If so, you could be grappling with two interconnected health conditions: sleep apnea and atrial fibrillation (AFib).

These silent, often overlooked, conditions can have a profound impact on your overall health and well-being. Let's explore the intersecting worlds of sleep apnea and AFib, exploring their unique characteristics and the complex relationship between them.

What to Know About Sleep Apnea

Sleep apnea, often characterized by snoring and gasping for air during sleep, is a serious condition that affects millions worldwide. While it can manifest in various forms, the most common is obstructive sleep apnea (OSA). This occurs when the airway becomes blocked during sleep, causing repeated interruptions in breathing.

These interruptions can have far-reaching consequences for your health. As your body struggles to get enough oxygen, it may jolt awake, disrupting your sleep cycle. This regular disruption can lead to the following:

Daytime fatigue or feeling tired and groggy throughout the day, even after a full night's sleep
Mood disorders marked by irritability, anxiety, and depression
Cognitive impairment exemplified by difficulty concentrating, remembering things, and making decisions
Increased risk of accidents because of the higher likelihood of falling asleep while driving or working

Beyond these immediate effects, sleep apnea can also have a significant impact on your cardiovascular health. When your breathing is interrupted, your heart rate increases to compensate for the lack of oxygen. This constant stress on your heart can lead to diseases and health risks as outlined here.

High blood pressure caused by increased workload on your heart
Heart disease which can develop over time or even escalate to heart failure
Stroke risk that is prompted by the irregular heart rhythms associated with sleep apnea that heighten your risk of blood clots

What to Know About Atrial Fibrillation

Atrial fibrillation (AFib or AF) is a heart rhythm disorder where the upper chambers of your heart (atria) beat irregularly and out of sync with the lower chambers (ventricles). This irregular rhythm can cause symptoms such as heart palpitations or a fluttering or a racing sensation in your chest, fatigue, shortness of breath, or lightheadedness. Lightheadedness and dizziness are especially concerning when they occur suddenly.

AFib can also increase your risk of serious complications such as stroke and heart failure, as explained below.

Stroke

In AFib, the heart's upper chambers (atria) beat irregularly. This can cause blood to pool and form clots. These clots can break off and travel through the bloodstream to the brain. When they reach the brain and block blood flow, they can cause a stroke. Individuals with both AFib and OSA have a higher risk of stroke compared to those with only one of these conditions.

Heart failure

The irregular heart rhythm in AFib puts extra strain on the heart muscle. Over time, this can weaken the heart muscle. A weakened heart muscle may not be able to pump blood as efficiently as it should. This can lead to heart failure, a condition where the heart cannot pump enough blood to meet the body's needs. OSA can further worsen heart failure by disrupting sleep and causing oxygen levels to drop, putting additional stress on the heart.

Both AFib and OSA pose significant health risks, and when they occur together, the risks are amplified. It's essential for individuals with both or either condition to manage them effectively to reduce the risk of serious complications like stroke and heart failure.

The Connection between Sleep Apnea and AFib

While sleep apnea and AFib may seem like unrelated conditions, there is a strong link between them. Over the years, multiple studies have shown that people with sleep apnea are significantly more likely to develop AFib. The exact mechanisms underlying this connection are complex, but several factors are believed to play a role.

A 2017 study has emphasized the shared risk factors associated with OSA and AFib, namely cardiovascular disease, hypertension, diabetes, and obesity. A higher BMI puts one at higher risk of AFib, just as obesity is one of the most prominent risk factors for OSA among adults. Furthermore, a Sleep Heart Study has established that AFib and other clinically significant ventricular arrhythmias are more prevalent in patients with sleep-disordered breathing.

In 2022, a comprehensive meta-analysis of almost 55,000 patients found that the incidence of AFib is 88% higher in patients with OSA. Findings also suggest that OSA treatment could help reduce the recurrence of AFib. Hence, doctors who treat patients with OSA are strongly encouraged to refer them early to a cardiologist.

A study conducted in Jordan and released this year found that AFib patients had a 30% greater predisposition to high-risk OSA compared to non-AFib patients. Specifically, the researchers analyzed the records of over 600 patients who visited cardiology clinics between 2017 and 2019. AF patients had an almost 68% risk while non-AF patients had only a 29% risk. In line with the 2022 meta-analysis, the 2024 study also found that the incidence of obesity and smoking was higher among patients who had AFib. On the other hand, patients over 50 years old were prone to high-risk OSA.

Below is a run-down of factors that link AFib with sleep apnea.

Increased stress on the heart

Increased strain on your heart from disrupted breathing can lead to irregular rhythms, such as atrial fibrillation (AFib), and inflammation in the heart and blood vessels. Over time, these factors can increase your risk of heart-related complications.

Inflammation

Chronic inflammation, a persistent state of low-grade inflammation in the body, is often associated with sleep apnea. This inflammation can damage the heart tissue, making it more susceptible to irregular rhythms like AFib. Additionally, chronic inflammation can contribute to other heart health issues, such as high blood pressure, atherosclerosis, and heart failure.

Hormonal imbalances

During sleep, the body releases various hormones that regulate heart rate, blood pressure, and other essential functions.When sleep is interrupted by apnea, the body's hormonal response may become dysregulated. For example, sleep apnea can lead to increased levels of stress hormones like cortisol, which can contribute to high blood pressure and heart rate.

Shared risk factors

As explained earlier, both sleep apnea and AFib are often associated with other risk factors, such as obesity, high blood pressure, and diabetes.

Diagnosis and Treatment for AFib and OSA

If you suspect you may have sleep apnea or AFib, it's crucial to seek medical attention. Early diagnosis and treatment can help prevent serious complications and improve your quality of life.

Diagnosing AFib and sleep apnea often involves a sleep study, ECG, and a Holter monitor.

Sleep study

A sleep study can help diagnose sleep apnea by monitoring your breathing, heart rate, and brain activity while you sleep.

Electrocardiogram (ECG)

An ECG can detect irregular heart rhythms, such as AFib.

Holter monitor

A Holter monitor is a portable device that records your heart's electrical activity over a 24- or 48-hour period and can help identify intermittent AFib episodes.

Once diagnosed, your doctor can suggest appropriate treatment options. What follows is a list of common sleep apnea treatments recommended by specialists.

Positive Airway Pressure (PAP)

CPAP is a machine that delivers pressurized air to keep your airway open during sleep. Meanwhile, BiPAP delivers two different levels of pressure: higher pressure when you inhale and lower pressure when you exhale. Both are non-invasive ventilation devices used to treat conditions that make breathing difficult.

Oral appliances

These devices are often used to treat mild to moderate cases of obstructive sleep apnea (OSA). By preventing the collapse of the airway, oral appliances can help reduce snoring and improve breathing during sleep.

Treatment options for AFib

Meanwhile, treatment for AFib may involve medications to control your heart rate and rhythm. Additionally, procedures like cardioversion and ablation may also be explored.

Cardioversion uses electrical shocks to restore the heart's normal rhythm. This can be done either chemically, using medication, or electrically, using a defibrillator. Ablation, on the other hand, is a more invasive procedure that involves destroying abnormal heart tissue that is causing AFib. This can be done using heat or cold energy. Both procedures aim to reduce the frequency and severity of AFib episodes, improving overall heart health.

Moving Forward from AFib and OSA

Both sleep apnea and AFib are often associated with common risk factors like obesity, high blood pressure, and diabetes.Additionally, sleep apnea can put extra strain on your heart, leading to irregular rhythms like AFib. Chronic inflammation,common in sleep apnea, can damage heart tissue, while disruptions in hormonal balance can also affect heart function.

If you suspect you have either condition, don't ignore the signs. Seeking medical attention is crucial for early diagnosis and treatment, which can help prevent serious complications and improve your quality of life. The sleep experts at nightly.health are at your service!

Addressing both sleep apnea and AFib can reduce your risk of heart-related problems and enjoy a healthier, more fulfilling life.

It's time to take control of your health and break free from the grip of these hidden conditions! Start with a free sleep assessment today.