Obstructive sleep apnea and atrial fibrillation: understanding the connection

Abstract

There is a high incidence of atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA). Whether this represents a causative relationship or is merely an association remains to be determined. This review describes the current understanding of pathophysiologic links supporting a causative relationship between OSA and AF. The management of AF with antiarrhythmics, cardioversion and ablation success depends on compliance with OSA treatment. OSA worsens every risk factor resulting in a higher stroke risk in AF patients. Strategies for early screening and compliance with OSA treatment are the need of the hour.

Keywords::

• atrial fibrillation
• management
• obstructive sleep apnea
• pathophysiology
• stroke

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are highly prevalent with enormous healthcare costs.

• The incidence of AF is threefold higher in the OSA population than the general population.

• Although causality is unclear, the sympathetic activation, hypertension, inflammatory states and changes in intrathoracic pressure associated with sleep apnea have been strongly related to development of AF.

• OSA independently increases the risk of congestive heart failure, hypertension and diabetes, which are associated with higher stroke risk in AF patients.

• The OSA treatment status is a major determinant in recurrence of AF on antiarrhythmic drugs, after cardioversion and ablation.

Notes