OSA a factor in atrial fibrillation, but CPAP treatment can help
It’s no secret that there is a significant association between obstructive sleep apnea (OSA) and atrial fibrillation (AF), the most common type of heart arrhythmia. Both conditions are common, with over 2 million adults in the United States suffering from AF, and approximately one in 15 Americans with OSA. About 18 percent of U.S. patients with AF also have OSA.
Doctors also know that having OSA increases one’s risk for developing AF. In one Sleep Heart Health Study, patients with severe OSA had a four-fold increased risk for AF. This high risk is partially because OSA produces structural changes in the heart that can subsequently lead to AF.
Not only does OSA appear to be one cause of AF, the sleep disorder also creates complications for treating AF.
Studies have shown that untreated OSA decreases the likelihood of successful cardioversion1, the procedure (through prescription or electrical therapy) that can restore a fast or irregular heartbeat to a normal rhythm.
OSA also complicates the efficacy of radiofrequency catheter ablations2, the treatment used when medicines or cardioversion prove ineffective. Catheter ablations use radio waves transmitted through a wire inserted into the patient’s vein to destroy small areas of heart tissue where abnormal heartbeats may cause an arrhythmia. OSA also increases the risk for AF recurrence after catheter ablation.3
Patients with OSA and AF also show a 12 percent higher rate of hospitalizations than patients without OSA.
But that’s for untreated OSA.
New analysis shows that the proper OSA treatment can actually decrease the rate of progression of AF in patients.
During the annual 2014 meeting of the American College of Cardiology, Dr. Johnathan P. Piccini Sr. stated that patients who have OSA and AF and are treated with continuous positive airway pressure (CPAP) showed a 34 percent relative drop in the rate of AF progression.4
CPAP is in many cases the gold standard for treating OSA. A CPAP machine includes a mask to cover the nose or nose and mouth, a motor that blows air and a tube from the machine to the mask. When worn by the patient, the CPAP machine creates air pressure that prevents the airway from collapsing or becoming blocked during sleep. This results in continuous airflow to the lungs and oxygen-rich blood being delivered to the heart and the rest of the body.
“We know that if obstructive sleep apnea is treated (with CPAP), the AF burden can be dramatically reduced,” Piccini said.
If you’ve been diagnosed with or have received treatment for AF, talk to your doctor about scheduling a non-invasive at home or in-lab sleep study to determine if you are also suffering from a form of sleep apnea. The link between OSA and AF presents an important opportunity for potential CPAP treatment.
1. Dublin S, French B, Glazer NL, et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med. 2006;166:2322-2328.
2. Jongnarangsin K, Chugh A, Good E, et al. Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19:668-672.
3. Naruse Y, Tada H, Satoh M, et al. Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy. Heart Rhythm. 2012 Nov 22.
4. CHEST Physician Vol 9, No 5 May 2014 40-41