People with atrial fibrillation (AFib) must go in for a sleep study, says Kamala Tamirisa, MD, FACC, FHRS, a cardiac electrophysiologist with ProMedica Physicians Cardiology. Sleep studies are done to check for sleep apnea, which is the cessation of breathing for at least 10 seconds while sleeping.
“Multiple studies have shown a strong link between obstructive sleep apnea (OSA) and AFib,” Dr. Tamirisa says. “The studies have shown that OSA can contribute to the incidence of AFib, and therefore, people with AFib should have a sleep study done.”
Why does AFib affect sleep?
AFib causes the heart’s two upper chambers to beat wildly and out of coordination with the two lower chambers. AFib symptoms include shortness of breath, heart palpitations and weakness.
“AFib can be very dangerous,” Dr. Tamirisa warns. “It can lead to complications, such as blood clots in the heart that might move to the brain and cause a stroke. These episodes can be sporadic or happen often and for long periods of time.”
Treatments for AFib include medications, blood thinners and other interventions to try to change the heart’s electrical system and prevent strokes.
Dr. Tamirisa, who sees patients at the new Heart Rhythm Center at ProMedica Toledo Hospital, says of the patients she sees with AFib, at least 60-70% are undiagnosed for sleep apnea, and OSA tends to be more common in men than in women. “I usually ask their spouses if they snore and stop breathing in between. Many assume that snoring is normal – and it most definitely is not. It is always an indication that there is an obstruction, which puts pressure on the heart’s top chambers,” she says.
What are the treatments?
For those diagnosed with sleep apnea, Dr. Tamirisa says continuous positive airway pressure (CPAP) therapy or similar gadgets or treatments help keep the airway from collapsing during sleep in these patients.
Treating OSA this way not only reduces Afib burden, but improves outcomes in patients with AFib.
“Also, patients with AFib who have an ablation procedure or cardioversions have a higher success rate if they are being treated for sleep apnea,” Dr. Tamirisa says.
There are two types of ablations that are done to help people with AFib:
- Catheter ablation is a nonsurgical procedure done by cardiac electrophysiologists. A thin tube is inserted in a blood vessel in the leg or neck and is guided to the neck. The doctor uses cold, heat or radio energy to scar tissue inside the heart, where the irregular beats are triggered. The scarring helps to stop the irregular heartbeat.
- Surgical ablation involves cutting into the chest by cardiac surgeons. The doctor will insert either a video camera or tiny robot to guide the ablation to create scar tissue that helps the heartbeat stay regular.