Dr. John Day, Cardiologist

Does Sleep Apnea Cause Atrial Fibrillation?

Kathy never seemed to get a good night of sleep.  Her husband, John, told me “she snores like a train and then stops breathing.  After a pause, she gasps for air, and then goes back to sleep.”

Does this sound like someone you know?  If so, they likely have a condition called sleep apnea.  Not only does sleep apnea make people feel tired all of the time but it also puts them at high risk for high blood pressure, heart failure, sudden cardiac arrest, and atrial fibrillation.

In this article, I will discuss why sleep apnea is so dangerous and treatment options to avoid this risk.

What is Sleep Apnea?

Sleep apnea is a condition where people stop breathing while they are sleeping.  When this happens, not only is sleep disrupted leaving the person tired the next day, but this drop in oxygen levels can cause many different heart problems.

The most feared complication from sleep apnea is premature death.  For example, the risk of sudden cardiac arrest is increased up to three times in patients with sleep apnea.

How Do I Know if I Have Sleep Apnea?

I have found that the sleeping partner can usually make this diagnosis.  They will tell you that you snore and will often stop breathing throughout the night.

Another good way to tell if you have sleep apnea is to look at your neck size.  If it is 17 or larger for a man or 16 or larger for a woman, then there is a good chance you have sleep apnea.

For people at risk for sleep apnea, we typically order an overnight pulse oximetry test.  In this test, people sleep with a pulse oximetry meter on their finger during the night.  If they have frequent episodes of their oxygen levels dropping below 90%, then they likely have sleep apnea.  Patients with an abnormal overnight sleep oximetry test are then referred for an overnight sleep study to confirm the diagnosis.

What Causes Sleep Apnea?

Most cases of sleep apnea are from being overweight.  The extra tissue in the neck or the back of the tongue collapses the airway during sleep.  The key then, in treating sleep apnea, is to keep this extra body tissue from collapsing the airway at night.

What is the Risk of Atrial Fibrillation with Sleep Apnea?

The stress of going periods of time during the night without breathing takes a significant toll on the heart.  Sleep apnea has been shown to cause enlargement of the left atrium of the heart which is the usual source of atrial fibrillation.  This left atrial enlargement then causes disruption of electrical pathways leading to a four-fold increased risk of atrial fibrillation!

How is Sleep Apnea Treated?

For most people suffering from sleep apnea, it is initially treated with CPAP, or continuous positive airway pressure, to keep the airways from collapsing during sleep.  Some cases may require alternating pressures, BiPAP, to treat sleep apnea.  Your sleep doctor can help you to select the right treatment option for you.

What If I Can’t Tolerate CPAP?

While some people have no problems tolerating CPAP therapy, others cannot.  Particularly, for those with claustrophobia this can be very difficult.

I know that I could never tolerate this therapy.  I have enough difficulties sleeping as it is and CPAP would only further complicate things for me.

If you cannot tolerate CPAP, your physician may elect to just give you oxygen at night.  While this does not solve the problem of the airway collapsing, at least the extra oxygen will help to keep your blood oxygen levels higher while sleeping.

Other patients have considered surgical options to treat sleep apnea.  These surgeries often focus on surgically removing the extra tissue that collapses the airways while sleeping.  Unfortunately, the long-term success rates for these surgeries are either lacking or are unimpressive–not to mention the surgical risks of these procedures.

Natural Ways to Treat Sleep Apnea

Another approach, which is seldom discussed, is a natural approach to treating sleep apnea.  For most people who suffer from this condition, it is much more likely to occur when they are sleeping on their backs.

A simple approach that many of my patients have tried is to sew a tennis ball into the back of a shirt.  These patients then wear this “tennis ball shirt” each night while sleeping.  Every time they roll onto their backs the tennis ball awakens them.  Over time, they subconsciously learn to sleep on their stomach or sides.

Probably the most effective natural treatment approach to sleep apnea is to just lose weight.  As the primary cause of sleep apnea is too much fat deposition in the neck and back of the tongue, weight loss can solve the underlying problem.  I have seen countless patients who have completely reversed their sleep apnea with weight loss alone.

Will Sleep Apnea Treatment Reverse A-Fib?

As sleep apnea and atrial fibrillation go hand-in-hand, many patients ask me if their atrial fibrillation will go into remission with sleep apnea treatment.

A recent study showed that treating sleep apnea decreased the risk of atrial fibrillation by 42%.  Even if sleep apnea treatment does not make your A-Fib go away, at least it will make your A-fib much easier to treat.

For example, if you and your physician ultimately decide on a catheter ablation procedure to treat your A-Fib, having your sleep apnea under control doubles your chances of a successful procedure.  In this study, if you had sleep apnea, and refused treatment for the sleep apnea, your chances of a successful ablation procedure was only 37%.

Clearly, if you want to successfully treat your A-Fib, you cannot ignore underlying sleep apnea!

Action Steps

What should you do if you have been diagnosed with A-Fib and are at risk for sleep apnea?  Below are my three action steps:

1. Get Tested

The screening test for sleep apnea is so simple.  You just sleep at home with a pulse oximetry device on your finger.  If you have not yet been tested then call your physician today to schedule this test.

2. Get Treated

If you have sleep apnea, get treated.  Many patients cannot tolerate CPAP on their first try.  Don’t give up.  Work with your sleep physician to find the right equipment for you.

3. Reverse Sleep Apnea

Even if you tolerate CPAP just fine, wouldn’t it be even better if you could just reverse this condition?  I have found that most patients can reverse sleep apnea naturally with weight loss and by not sleeping on their backs (the tennis ball in the back of the shirt trick works really well for this).

The important thing to remember is you cannot stop using CPAP until you are sure you have completely reversed the sleep apnea.  Work with your physician and, after sufficient weight loss, repeat the overnight sleep oximetry test to make sure your oxygen levels never drop at night.

Do you have sleep apnea and atrial fibrillation?  What has worked for you?