[Skip to Navigation]
June 2018

Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review

Author Affiliations
  • 1Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
  • 2Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University
  • 3Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
  • 4Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, England
  • 5Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
  • 6Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
  • 7Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
  • 8Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
  • 9HP2 and Sleep Lab, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
  • 10University Grenoble Alpes, Grenoble, France
  • 11Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
  • 12Department of Medicine, University of Melbourne, Melbourne, Australia
JAMA Cardiol. 2018;3(6):532-540. doi:10.1001/jamacardio.2018.0095

Importance  Obstructive sleep apnea (OSA) is the most common clinically significant breathing abnormality during sleep. It is highly prevalent among patients with atrial fibrillation (AF), and it promotes arrhythmogenesis and impairs treatment efficacy.

Observations  The prevalence of OSA ranges from 3% to 49% in population-based studies and from 21% to 74% in patients with AF. Diagnosis and treatment of OSA in patients with AF requires a close interdisciplinary collaboration between electrophysiologists, cardiologists, and sleep specialists. Because the prevalence of OSA is high in patients with AF and most do not report daytime sleepiness, sleep-study evaluation may be reasonable for patients being considered for rhythm control strategy. Acute, transient apnea-associated atrial electrophysiological changes and increased occurrence of AF triggers associated with short episodes of intermittent deoxygenation and reoxygenation, intrathoracic pressure changes during obstructed breathing efforts, and sympathovagal activation combine to create a stimulus for AF triggers and a complex and dynamic substrate for AF during sleep. Repeated episodes of long-term OSA are eventually associated with structural remodeling and changes in electrical conduction in the atrium. Observational data suggest OSA reduces the efficacy of catheter-based and pharmacological antiarrhythmic therapy. Nonrandomized studies have shown that treatment of OSA by continuous positive airway pressure can help to maintain a sinus rhythm after electrical cardioversion and catheter ablation in patients with AF. However, it remains unclear which sleep apnea metric should be used to determine severity and guide such treatment in patients with AF.

Conclusions and Relevance  Data from nonrandomized studies of patients with AF suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Randomized clinical trials are needed to confirm the association between OSA and AF the benefits of treatment of OSA and the need for and cost-effectiveness of routine OSA screening and treatment.

Add or change institution