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

Christopher J. Lettieri, MD


December 19, 2012

In This Article


Despite any ongoing controversy regarding the role of OSA in the development of cardiovascular disease, it seems that AF is a well-established consequence of sleep-disordered breathing. The physiologic derangements in cardiopulmonary hemodynamics, sympathetic tone, and physical structure of the left atrium that result from OSA seem well suited as causative factors for AF. In addition, numerous studies have found a higher-than-expected prevalence of AF among patients with OSA and more OSA among patients with AF. The presence of untreated OSA seems to decrease the efficacy of chemical cardioversion, electrical cardioversion, and catheter ablation; similarly, recurrence of AF is significantly more common among patients with untreated OSA, whereas CPAP therapy seems to mitigate this risk.

Given the prevalence of OSA among patients with AF and its impact on outcomes, clinicians should assess individuals with AF for sleep-disordered breathing. If OSA is clinically suspected these patients should be referred for polysomnography.