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.

Therelationship 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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