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Under Pressure: The Stress of Obstructive Sleep Apnea and the Link to Atrial Fibrillation

Note: There are a few types of sleep apnea with obstructive sleep apnea being the most common, which is the focus of this piece.


Atrial fibrillation is the most common arrhythmia, or irregular heart rhythm, in the world, affecting around 5 million people just in the United States. A diagnosis of atrial fibrillation can have many downstream effects; long-term fatigue, increased risk for stroke, and overall increased risk of death. In modern days, it is a manageable condition and more often than not, it is largely avoidable. Among the causes of atrial fibrillation that are controllable, one cause can sometimes go unnoticed: obstructive sleep apnea.


What is obstructive sleep apnea?


Obstructive sleep apnea (OSA) is a condition where breathing is interrupted during sleep due to a blockage in the airway. In OSA, relaxed muscles in the throat cause a blockage intermittently throughout the night. This blockage sends a signal to the brain to wake up as it's not getting enough oxygen. This can occur repeatedly through the night, called episodes of apnea, which can constantly disrupt your sleep and cause symptoms during waking hours.


How do I know if I have OSA? What are the symptoms?


During sleep, symptoms of OSA typically includes repeated waking up, night sweats, restlessness, snoring waking up gasping for air. Potentially, the symptoms that occur during sleep can go unnoticed if you do not realize or remember that they are experiencing them, and typically your partner can be helpful in identifying them.


During waking hours, you may notice excess fatigue, headaches, mood swings, and mental fog. Again, these symptoms are fairly broad and can be applied to a number of sleeping disorders or other issues, so it is important to bring them up with a doctor if they are noticed by yourself or someone else. A formal diagnosis of OSA requires a sleep study, or polysomnography, which is a procedure where you stay overnight in a special sleep clinic and your heart, brain, and lung activity is monitored while you sleep. In some cases, a version of this sleep study can be done at home at the discretion of your doctor.


How can OSA cause atrial fibrillation?


The exact link between OSA and atrial fibrillation is not fully known, but people who have atrial fibrillation are four times more likely to also have OSA. While its cause is not defined, there are valid explanations for the relationship between the two.


The respiratory system and breathing status of a person can impact other organ systems, including the heart. If your oxygen supply is being affected by an issue like OSA, then your heart will need to work harder since the oxygen levels in the blood are affected. In a nutshell, OSA is essentially starving your vital organs, the brain and heart, of oxygen for short intervals, but repeatedly which can cause cumulative damage. This stress of poor oxygen supply can cause long-lasting structural damage to the heart, much like other conditions of hypertension and diabetes.


In atrial fibrillation, the upper chambers of the heart, or atria, quiver instead of beating which disrupts the typical heartbeat. As a result, blood flow and oxygenation to the rest of the body are affected, and blood can pool in the chambers of the heart. Cumulative damage to the atria can indeed cause atrial fibrillation.


Are there treatments for OSA? How can prevent it?


OSA is a common condition but can take time to diagnose. Again, if you are experiencing any of the previously mentioned symptoms, it is important to bring it up with your doctor to get a formal diagnosis and treatment plan. A sleep study will definitively diagnose most sleep disorders.


The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine. As seen below, a mask is worn over the nose and mouth which is attached to the device which continuously delivers pressurized, filtered air. This continuous flow of air into the airway helps to prevent the episodes of apnea.


The risk factors for OSA that are controllable include losing excess weight and avoiding alcohol. Otherwise, the likelihood of developing OSA can increase in people with certain structural characteristics (like having an underbite) and increased age.


References:





University Hospitals - The Connection Between AFib and Sleep Apnea, https://www.uhhospitals.org/blog/articles/2023/08/the-connection-between-afib-and-sleep-apnea


Cleveland Clinic - CPAP Machine: What it is, how it works & side effects, https://my.clevelandclinic.org/health/treatments/22043-cpap-machine


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