The Relationship Between Obstructive Sleep Apnea and Atrial Fibrillation: Guidance for Clinicians

Christopher J. Lettieri, MD


December 19, 2012

In This Article


A clear and significant association exists between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Similar to other cardiovascular disorders, there is continuing controversy as to whether OSA is merely a common coexisting condition among patients with AF or whether it is a true causative factor. This article is part 1 of a 5-part series exploring more recently identified consequences of OSA.

Both conditions are very common. Over 2 million adults in the United States have AF, and at least 1 in 15 has moderate to severe OSA.[1,2] It would therefore be expected that several individuals would have both conditions purely by a matter of chance (ie, 1/15th, or 6.7%, of those with AF would also have OSA).

Furthermore, patients with AF and those with OSA share several similar demographic and patient-specific features. Hypertension is common in both conditions, both occur more frequently in men, both increase in incidence with older age, and increasing body mass index plays an important role in development of both AF and OSA in both men and women.[3,4,5] It could be, and frequently is, argued that each disorder occurs independently in susceptible patients.

However, numerous studies have established that patients with OSA, particularly those with more severe disease, are significantly more likely to develop AF, and patients with AF have a higher prevalence of OSA than would be explained by random chance. After adjustment for multiple variables commonly observed in both conditions, OSA consistently has been shown to be an independent predictor for both the development of AF and its recurrence after cardioversion. In addition, the hemodynamic and sympathetic consequences of OSA can conceptually explicate the development of AF. As such, it seems clear that OSA is an independent predictor of, and causative factor in, the development of AF.