AFib and Sleep Apnea
Sleep apnea (SA) is an abnormal sleep condition in which an individual frequently stops and starts breathing because of the disruption in oxygen supply. SA is problematic because it can lead to conditions such as high blood pressure, heart disease, type 2 diabetes, metabolic syndrome, liver injury and complications after undergoing major surgery. So, is there a relationship between AFib and sleep apnea? Read on to find out.
The three main types of SA are:
- Obstructive, which happens because the throat muscles relax.
- Central, which occurs when the brain does not send the correct signals to the muscles responsible for breathing.
- Complex, meaning that the individual has both obstructive and central SA.
The primary symptoms of SA include:
The Risk Factors of Atrial Fibrillation and SA
Atrial fibrillation (AF) has several risk factors that can cause the development of the condition, and one of these is SA. If SA is present and untreated long-term, it can lead to AF.
SA increases the risk for stroke, which is a known risk for people with AF. Research estimates that about half of people with AF also have sleep apnea, and people with SA who have no evidence of AF have roughly a four times greater chance of developing the condition.
Sleep studies prove that SA is a direct trigger for AF while an individual is sleeping. The cycle of jolting awake by not getting enough oxygen causes physical stress and chemical changes within the heart, often leading to AF.
According to an article in the January 2014 issue of the Journal of the American Heart Association, many studies show that SA carries a higher risk of recurrent AF after electrical or chemical cardioversion or catheter ablation. However, research demonstrates that continuous positive airway pressure (CPAP) can remove this risk.
A commentary published in the December 2020 issue of the American Journal of Medical Care discussed how patients with AF often have an accompanying severe level of sleep disrupted breathing and that just over 42% of those people exhibited moderate to extreme SA. Additionally, those people with severe sleep disrupted breathing had worse AF symptoms.
Additional studies show that SA can interfere with the ability to control AF because medications used to manage heart rate are ineffective in people with SA. People with SA also have a greater tendency for a return of AF after a corrective procedure, like cardioversion or catheter ablation.
How People With AF Can Manage SA
If you have AF, it is wise to talk with your physician to find out if you have any risk factors linked with SA, such as:
- Obesity.
- High blood pressure.
- Alcohol use.
- Smoking.
- Narrowed airway.
- Chronic nasal congestion.
- You are over 40 years old.
- You are male.
- You have a history of SA in your family.
If any of these conditions are present, your physician may want you to set up an appointment with a sleep specialist. The sleep specialist will have you fill out the screening form to gather information about any symptoms you are experiencing that could indicate SA and will also have you undergo a sleep study for a definitive diagnosis.
If testing shows that you have SA, the sleep specialist or your primary physician will recommend using a CPAP machine each night to ensure that you receive enough oxygen while you are sleeping.
The CPAP can reverse some of these changes your heart experiences due to not getting enough oxygen when you sleep.
Bilevel positive airway pressure (BiPAP) is another option for your physicians to recommend. A BiPAP machine changes the airflow when you breathe in and out and can help you breathe without difficulty when you sleep.
How to Prevent SA Before It Starts
If you have AF with risk factors for SA but do not have the condition yet, some action steps to take can reduce the chances of developing it:
- Weight loss. Talk to your physician about a realistic weight loss strategy that is right for you. Your plan could include a visit with a dietitian to develop a healthy eating guideline and a visit with an exercise professional to design a realistic exercise plan.
- If changing your eating and exercise habits is not an option, your physician may recommend weight loss surgery. The side benefit of losing weight is that it can also help reduce your blood pressure.
- Stop smoking. Regular tobacco use can cause swelling in the upper part of your airway, which will decrease your oxygen flow and make snoring worse.
- Cut alcohol out of your lifestyle entirely because it will weaken the muscle tone of the back of your throat, and that will disrupt your airflow. This one change can also have positive benefits for your heart.
- Change your body position when you sleep. If you are a back sleeper, it can be easier to breathe if you start sleeping on your side.
- Stop using sleeping pills because they have the same effect on the muscles in the back of your throat as alcohol does.
- If you have allergies, consult with an EENT physician or allergist to get them treated. Allergies cause swelling of the tissue in your airways, reducing airflow space, making it harder to breathe.
If you have AF and think you may have SA or worry about developing the condition in the future, talk to your primary physician to find out about your best course of action. Your primary physician is most familiar with your health condition and will be able to make the recommendations that are the right fit for you.