Live Well

Is This Common Sleep Disorder Causing Your AFib?

January 5, 2022

Exhaustion. Brain fog. Weight gain. Headaches. Irritability. You may have shared these symptoms with your doctor and been told that you have depression. Instead, you might be one of the 80 percent of the population living with undiagnosed obstructive sleep apnea. If you have AFib, your odds of developing sleep apnea are even higher. You won’t want to sleep through this one!

What is obstructive sleep apnea?

Do you walk through life feeling like you are never well-rested, no matter how much you sleep? If so, you may be one of the 936 million adults worldwide who have obstructive sleep apnea (OSA). This common disorder causes a person’s airway to become blocked during sleep.

Sleep apnea occurs when the soft tissues in the nose, mouth, and back of the throat collapse. When this occurs, air cannot flow in and out of the lungs, resulting in frequent pauses of breathing, also called apnea. Individuals with sleep apnea rarely get the restorative sleep needed for health.

How do I know if I have sleep apnea?

Those with OSA often experience disrupted sleep, and many don’t even know it. Chronic snoring is the hallmark symptom of sleep apnea, though snoring is not the only indicator of disease. Other signs include:

Daytime fatigue
Sudden or startled awakening from sleep
Disrupted breathing while sleeping
Waking with a sore throat or dry mouth
Morning headaches
Mood changes, such as anxiety, depression, or irritability
Concentration difficulty
Decreased sex drive

What causes sleep apnea?

The most significant risk factor for sleep apnea is obesity. Extra weight around the neck can cause compression of the upper airway. Just a 10 percent gain in weight is associated with a six-fold increased risk of sleep apnea. Unfortunately, the relationship between OSA and obesity is cyclical. The additional weight contributes to sleep apnea, and sleep apnea then contributes to weight gain.

Other risk factors for sleep apnea include smoking, alcohol use, or airway abnormalities such as enlarged tonsils. In addition, there is evidence that OSA may have some genetic components, and older males are more prone to OSA than females.

The gold standard for diagnosing OSA is a sleep study test called a polysomnogram (PSG). This test, typically conducted overnight in a sleep lab, monitors sleep cycles, oxygen levels, and vital signs to determine an OSA diagnosis.

Sleep apnea and the heart

Oxygen is life, and depriving the body can create many problems. The decreased oxygen levels that occur due to obstructive sleep apnea result in more than just morning grogginess.

Sleep apnea has detrimental effects on the heart. The lack of oxygen that occurs at night causes an increase in blood pressure as the body tries to compensate. According to research, OSA increases the risk of heart failure by 140 percent, stroke by 60 percent, and coronary heart disease by 30 percent.

For some, sleep apnea also impacts the lungs, contributing to pulmonary hypertension or high blood pressure in the lungs’ blood vessels. If left untreated, pulmonary hypertension can lead to heart failure.

AFib and sleep apnea

The relationship between sleep apnea and abnormal heart rhythms, such as AFib, is well established. A 2020 study of patients with atrial fibrillation found that nearly 83 percent also had sleep apnea. The same researchers found that those with more advanced OSA had more severe AFib symptoms.

While it’s not entirely clear if sleep apnea causes AFib directly, increasing evidence suggests a possible link. Lower levels of oxygen, increased inflammation, and changes in chest pressure could all cause changes to the heart that contribute to AFib. Regardless of the cause, it’s abundantly clear that sleep apnea affects AFib. Individuals with both conditions are more likely to experience additional episodes of AFib compared to those who don’t have OSA.

How do I treat sleep apnea?

As with all diseases, it’s best to identify the root cause and start there. By doing this, you not only treat the condition but could actually cure it. If you have a modifiable risk factor for OSA, begin by eliminating the risk. For example, if you are obese or carry excess weight around the neck, you should focus efforts on losing those extra pounds. If sinus congestion contributes to your sleep apnea, you may consider lowering inflammation by changing your diet. Other lifestyle changes include eliminating tobacco or alcohol.

The most common treatment for sleep apnea is a positive airway pressure device. These machines use pressure to keep the airway open with a mask, thus allowing air into the lungs. The most common is the continuous positive airway pressure or CPAP.

Other treatments of sleep apnea include:

Oral appliances – Similar to an orthodontic retainer or bite guard, these appliances help hold the jaw or tongue in place and prevent them from obstructing the airway.
Positional therapy – Many individuals eliminate apnea by adjusting their sleeping position. As opposed to on the back, sleeping on one’s side is sometimes enough to fix the problem. Raising or supporting the head, such as with a wedge pillow, is often a successful remedy.
Upper airway stimulator – This small device, surgically implanted in the chest, sends electrical signals to the nerve that controls the tongue. The gentle stimulation pushes the tongue forward and keeps it from blocking the airway.
Surgery – In severe cases of OSA that don’t respond to other therapies, surgery is sometimes considered. This last-resort option addresses abnormalities of the body, such as extra tissue in the throat.

Can CPAP make AFib worse?

While CPAP is used by over 8 million people each year, many struggle with compliance with this cumbersome device. Additionally, new research is calling into question the effectiveness of CPAP as a tool to lower cardiac complications. For example, a recent report from the Agency for Healthcare Research and Quality found little evidence to prove that CPAP reduces the rates of stroke, heart attack, or other cardiovascular problems, including death.

So the question remains: Does CPAP reduce the risk of AFib? While some research illustrates the positive benefits of CPAP for heart problems, not all experts agree. For example, a 2021 study examined the relationship between CPAP and atrial fibrillation and concluded that the use of the device did not reduce or prevent AFib.

As with all medical interventions, there are risks to using a CPAP machine, and some of those risks could worsen AFib symptoms. To make the CPAP more comfortable to use, the air is heated and moistened, creating a welcoming environment for organisms such as fungus, yeast, and mold. There have been cases where individuals have become ill from their CPAP machine. As mold and other microorganisms are sometimes the cause of AFib, it is possible that CPAP could make your AFib worse.

Address the cause, heal the problem

The link between sleep apnea and AFib is indisputable. The two work hand in hand to destroy health. Quality sleep is essential for the heart, giving your systems a chance to rest and repair. Sleep apnea withholds life-giving oxygen from the body, setting off a whole host of health problems, possibly including AFib.

The good news is that many of the things you can do to heal sleep apnea may also help AFib. Weight loss, dietary changes to reduce inflammation, and ensuring that the air you breathe is clean, are all strategies to minimize the risk of both conditions. Our bodies are designed for optimum health given the right conditions.

Next steps

It’s important to get a clear picture of your sleep quality. As mentioned above, the symptoms of sleep apnea aren’t always obvious. Consider a test such as the WatchPat One Sleep Test, the first and only disposable home sleep apnea test that provides immediate access to sleep data for interpretation. Getting your sleep right is a huge step toward your 100 Year Heart — make it a priority.

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Medical Review 2022: Dr. Lauren Lattanza NMD