Atrial Fibrillation and Sleep Apnea's Bidirectional Impact

Atrial Fibrillation, more commonly known as AFib, is a type of irregular heartbeat or arrhythmia that affects over 2 million people in the US, according to the CDC. Atrial Fibrillation shares a bidirectional relationship with sleep apnea, a serious sleep health disorder defined by breathing interruptions that repeatedly occur during sleep. The correlation between these two closely linked health conditions is best understood by learning about the body's physiological response to both.

During a sleep apnea event, the tongue and the muscles surrounding the upper airway relax and collapse, resulting in obstructed airflow to the lungs. When breathing stops, oxygen levels in the blood drop. Our bodies respond by releasing the stress hormone epinephrine, more commonly known as adrenaline. This "fight or flight" response elevates the heart rate and can lead to high blood pressure. Overall heart function decreases because it becomes less efficient at pumping blood, and the heart itself is affected by pressure changes in the chest. According to the American College of Cardiology, patients with obstructive sleep apnea (the most common type of sleep apnea) are four times more likely to have abnormal heart rhythms, including atrial fibrillation, and are two times more likely to have a heart attack.

In a healthy heart, a normal heartbeat begins with an electrical impulse from the heart's right chamber or atrium. The resulting contractions push the blood from the upper chambers (the atria) to the lower chambers (the ventricles). In a well-orchestrated cycle, the ventricles then push the blood out to the rest of the body. But with AFib, the electrical signal malfunctions, and the atria contract too fast. The ventricles can't keep pace, and blood begins to accumulate in the atria. This increases the risk of a clot forming and releasing into the body. A stroke occurs if the clot reaches the brain.

One area of overlap between these two conditions are their risk factors. Both AFib and Obstructive Sleep Apnea (OSA) are most prevalent in older adults. High blood pressure, obesity, and an additional heart ailment are also common to AFib and OSA. Perhaps the most startling commonality between these two health issues is how often they go untreated. The symptoms of AFib include heart flutters or palpitations and fatigue, but many who suffer from AFib show no symptoms at all. Their diagnosis usually happens at a doctor's visit for another medical need. And with OSA, up to 85% of cases go undiagnosed, according to the Heart Rhythm Society. This is partially due to the fact that the symptoms of OSA—daytime drowsiness, mental fog, and morning headaches—can be attributed to other conditions. Also, with sleep apnea, the sufferer often does not know they are waking up during the night, or they may not have a partner who hears their snoring.

Research connecting AFib and sleep apnea is ongoing, but it is estimated that about half of the patients with AFib also have sleep apnea. And the body's response to sleep apnea has been shown to trigger arrhythmias during the night. Untreated sleep apnea can lead to other serious co-morbidities, including diabetes and hypertension, which predisposes a patient to AFib. Because sleep health is now considered an essential pillar of overall health, sleep disorders like sleep apnea and its co-morbidities are being elevated in discussions and research. The best course of action is to treat both conditions if they exist concurrently. Sleep apnea is diagnosed by a sleep study that your doctor can order. Sleep apnea treatment is critical because it has also been proven to hinder the effectiveness of certain AFib medications. Because these two health conditions are so intertwined, it is important to treat sleep apnea not only for improved quality of sleep, but to reduce the risk of other serious health issues for a better overall quality of life.

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