Can Sleep Apnea Cause AFib or Heart Palpitations?

Quick Takeaways:

• Sleep apnea and atrial fibrillation (AFib) are closely linked — each can contribute to the other and increase the risk of heart related complications.²
• Interrupted breathing during sleep causes oxygen drops and stress on the heart, which may lead to irregular heartbeats or palpitations over time.^19,20
• Continuous positive airway pressure (CPAP) therapy can help improve breathing pauses among people with obstructive sleep apnea (OSA) and is associated with a lower chance of AFib coming back when used consistently.^4,21
• Managing both sleep apnea and heart health together — through treatment, lifestyle changes and regular doctor check-ins — can support better sleep and long-term heart health.^{4, 16, 17, 22}

Did you know sleep apnea doesn’t just affect your sleep — it can impact your heart, too? For some people, sleep apnea can lead to heart problems such as palpitations (irregular heart rhythms) and atrial fibrillation (AFib).¹ Let’s explore the connection between sleep apnea and the heart, and how treating sleep apnea may play a role in supporting better heart health.

The relationship between sleep apnea and atrial fibrillation

Research shows a strong connection between sleep apnea and AFib. Having one of these conditions can put you at an increased risk of developing the other.² When someone has both conditions, they may be more likely to experience additional health challenges, such as inflammation and damage within the body.²³

What is sleep apnea?

Sleep apnea is a condition where breathing stops and restarts many times throughout the night. These interruptions can make it harder for your body to get enough oxygen.²⁴

People with sleep apnea may experience:^25,36

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating, struggling to feel present during the day
• Snoring or gasping for air while you sleep

There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA, the more common of the two, occurs when the throat relaxes during sleep, narrowing their airways.²⁴ This restricts airflow to the lungs, causing a person to briefly wake up so they can resume breathing. This may happen multiple times throughout the night, preventing a person from getting restorative sleep.²⁵

CSA occurs when the muscles that control breathing don’t function properly. As with OSA, an individual with CSA repeatedly stops breathing while they sleep. However, instead of blocked airways, the problem stems from a lack of communication between the brain and breathing muscles.²⁴ A person with CSA may wake up multiple times throughout the night, resulting in disrupted sleep.²⁶

What is atrial fibrillation?

Atrial fibrillation, also called AFib, refers to an irregular heartbeat. Under normal circumstances, the heart contracts and relaxes to a regular beat. In someone living with AFib, the upper chambers of the heart beat irregularly. AFib can cause blood to build up inside the heart rather than pumping it through the body as smoothly as it should. This condition can lead to a range of heart-related complications, including heart failure, stroke and blood clots.³

What studies show

While sleep apnea and AFib are different conditions, they can contribute to and worsen one another. Research suggests that people with sleep apnea are up to four times more likely to have AFib than the general population. This remains true even when researchers account for an individual’s age, body mass, and the presence of other heart-related conditions.²⁷ Similarly, nearly half of people living with AFib also have OSA.¹ Some researchers believe that OSA may trigger AFib, and AFib may contribute to OSA development.²

OSA and AFib share several risk factors:

• Age. Aging causes blood vessels to stiffen and airway muscles to lose tone.^28,30 This increases the risk of an irregular heartbeat and contributes to the upper airway collapsing during sleep.^{29, 30}
• Excess body fat. Excess fat around the neck and upper airway increase the blockage risk associated with obstructive sleep apnea (OSA).³¹ It contributes to AFib by causing high blood pressure and heart enlargement. This may result in stretching and scarring in the heart.³²
• Gender. Both conditions are more common in males.³³

While OSA and AFib often occur together, research shows that central sleep apnea (CSA) is more frequently seen in people with heart failure and AFib.^6,15 Heart failure causes the heart to pump poorly, leading to fluid buildup. This fluid can affect blood-gas affecting how the brain regulates breathing.^15,26 Repeated breathing pauses during sleep may cause changes in oxygen and carbon dioxide levels, which can stress the heart and contribute to AFib.⁶ In studies, CSA has been observed in up to 37% of men with heart failure.¹⁵

How sleep apnea affects the heart

Sleep apnea can take a toll on the heart when left untreated. This condition can lead to reduced oxygen levels during the night, putting stress on the body and triggering inflammation.^6,20 Disrupted sleep negatively impacts the nervous system and raises stress, which is a risk factor for high blood pressure and heart disease.¹⁹

Breathing pauses due to sleep apnea can cause pressure changes in the chest, putting greater strain on the heart.¹⁴ Over time, OSA can cause structural changes in the upper chambers of the heart, which may include enlargement, stretching and the development of scar tissue.²

Sleep apnea has been linked to AFib and other heart rhythm problems, but many factors can play a role. It’s a good idea to talk to a doctor if you experience irregular heartbeats or palpitations (noticeable heart pounding in the chest).¹³

The role of inflammation

People living with OSA and atrial fibrillation (AFib) typically have higher levels of inflammation in their bodies.²³ While inflammation is a normal part of the body’s defense against an injury or infection, it can be damaging when it occurs in healthy tissue and lasts too long.¹⁰

Conditions that are commonly associated with sleep apnea, such as high blood pressure, can also contribute to plaque buildup in the cardiovascular system.⁹ This can trigger inflammation as the body sends immune cells to the site where plaque is building up.⁹ Inflammation can change the heart’s electrical system and structure, increasing the risk of an irregular heartbeat.⁸

What this means for diagnosis and treatment

For people living with sleep apnea and heart problems, early diagnosis and treatment are important steps in supporting better health, maintaining quality of life and helping reduce the risk of future complications.

How to get diagnosed

To determine the likelihood of a person having sleep apnea, doctors have scoring systems and checklists. These tools look at factors such as a person’s:⁷

• Age
• Body mass
• Symptoms
• Medical history

While these tools alone aren’t enough to diagnose sleep apnea, they can help doctors decide who should undergo further testing. For example, a study in people diagnosed with AFib showed that scoring tools can be useful to screen for OSA.¹¹

While symptoms such as morning headaches and daytime sleepiness may be signs of sleep apnea,²⁵ only a doctor can provide a diagnosis and outline the best treatment options. In most cases, doctors confirm sleep apnea through sleep studies.⁵ This may be done through a home sleep test,⁵¹ which can be conveniently completed from the comfort of your own bed. However, if you have been diagnosed with other medical conditions, such as AFib, your doctor may recommend an overnight sleep study in a sleep lab, where a trained lab technician can monitor your sleep.⁵¹

The equipment used in a sleep study depends on the type of test a doctor orders. It may include a nasal breathing sensor, a pulse oximeter to measure the amount of oxygen in the blood and a microphone to measure snoring. If the doctor suspects AFib, your heart rhythm may also be monitored during the study.²⁵

Treatment options

Sleep apnea and atrial fibrillation (AFib) are serious conditions. Fortunately, treatments are available. Continuous positive airway pressure (CPAP) therapy is often the recommended treatment for obstructive sleep apnea (OSA) and may be helpful for some types of central sleep apnea (CSA).^12,49 This therapy relies on a CPAP device, a machine that delivers continuous airflow through tubing and a mask that fits over the individual’s nose or mouth, or both. This airflow prevents the airways from collapsing during sleep in people with OSA.²¹

For people living with CSA, CPAP therapy may help reduce breathing pauses and encourage a natural breathing rhythm while sleeping.¹² Adaptive servo-ventilation (ASV)* machines may offer alternative treatment for CSA, though is less widely used.⁵⁰ Like CPAP, ASV therapy works by delivering air pressure to stabilize breathing. ASV machines adjust air pressure automatically, depending on a person’s breathing patterns, while CPAP delivers a steady stream of air.⁴⁹

Consistent CPAP use is important for those living with obstructive sleep apnea (OSA).⁴⁸ It can take some time to adjust to CPAP,
but there are some strategies which may help a person get used to the machine. These include:

• Begin by using the CPAP machine for only a few hours the first night, then gradually increase the time using the device.
• Wear the CPAP mask for a few minutes each day to get used to the sensation.
• Set a reminder on your mobile device to promote consistent usage.
• Regularly check in with your doctor to discuss challenges and side effects.
• Join a CPAP support group.

While CPAP therapy is the standard in OSA treatment,⁴⁹ there are other options that may promote restful sleep and uninterrupted breathing. These may include oral appliances (such as mandibular advancement devices), changing sleep positions or surgery.^46,47

Treating AFib often involves medications and lifestyle changes.⁴⁵ In some cases, doctors may recommend surgical and nonsurgical approaches.⁴⁴ This may include administering electrical cardioversion, a treatment that involves using a small electrical shock to restore a regular heart rhythm.⁴⁴ In other cases, a pacemaker may be a treatment option.⁴³ A pacemaker is an implantable electronic device that helps regulate the heartbeat at a steady rate.⁴³ These treatments help manage AFib and control symptoms.

CPAP therapy benefits

For individuals living with OSA, continuous positive airway pressure (CPAP) is designed to help keep the airways open during sleep.²¹ While this therapy isn’t a treatment for atrial fibrillation (AFib), research suggests it may help support maintenance of normal heart rhythm in people who have been treated for AFib. In fact, one analysis suggests that consistent CPAP use may reduce AFib recurrence by about 42%.⁴

Additionally, regular CPAP use may help support improved sleep quality and a better quality of life. Among people with OSA who use it for at least six hours every night, many report less daytime sleepiness, and improved memory.^16,42

While CPAP therapy doesn’t treat AFib directly, it can help manage sleep apnea symptoms by supporting overall heart and circulatory health. Also, when OSA is successfully managed, people may be less likely to have AFib come back after treatment.¹⁷

Broader management

Sleep apnea and AFib are complex conditions with a variety of personal risk factors and symptoms. The best strategy for long-term management is to talk to a doctor about treatment plans to support heart health. If you have both conditions, your medical team may include both a heart doctor and a sleep doctor to help coordinate care.

Regardless of the treatment plan that’s right for you, lifestyle changes can also play a role in supporting your overall health. Managing your weight, incorporating a consistent exercise program and limiting alcohol consumption may benefit heart health and sleep quality. Managing other health conditions, such as diabetes and high blood pressure, can further support your health.^22,41

Planning for what’s ahead

High-quality treatment plans combined with cutting-edge research and technology may help support a better quality of life for those living with atrial fibrillation (AFib) and sleep apnea.²² From wearable technology to personalized treatments, changes in how these chronic health conditions are identified and managed may empower individuals to take a more proactive role in their care.

What to expect from successful treatment plans

For people living with both OSA and AFib, treating OSA is linked to fewer hospital admissions.⁴⁰

According to studies, continuous positive airway pressure (CPAP) improves symptoms of OSA, including daytime sleepiness and poor sleep quality at night, which can have a positive impact on quality of life.³⁹ Research also shows that CPAP use is associated with fewer AFib episodes, which may support improved overall well-being.¹⁸

New research and innovations

Early diagnosis and treatment are recommended in people with sleep apnea and heart conditions. Leaving either condition untreated can lead to long-term health complications. Fortunately, new tools are being developed to help spot potential risks earlier.

Additionally, researchers and clinicians are developing treatment plans based on a person’s individual risk factors. Rather than taking a one-size-fits-all approach, doctors can create tailored treatments for people living with chronic conditions.

Special considerations

When recognizing sleep apnea and heart conditions, there are a few things to consider. For example, older adults living with obstructive sleep apnea (OSA) and atrial fibrillation (AFib) may face unique health risks, such as an increased risk of stroke.³⁷ Men and women often have different symptoms, which might affect diagnosis and treatment approaches.³⁶ Additionally, athletes may be at an increased risk of developing AFib.³⁵ For women who are pregnant, careful management of these coexisting conditions is recommended.

Sleep apnea has been linked to AFib and other heart rhythm problems, but many factors can play a role. Talk to a doctor if you notice irregular heartbeats or palpitations.

*ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea.³⁴

This information is for educational purposes only and isn’t a substitute for medical advice. If you notice sudden or severe symptoms such as chest pain, dizziness, or fainting, seek medical attention immediately.

To learn more about your sleep health, take our online sleep assessment.

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