Atrial fibrillation (AFib) may co-occur in people with sleep apnea. Continuous positive airway pressure (CPAP) therapy is a common sleep apnea treatment. There is mixed research on the effects of CPAP treatment on AFib.

According to past studies cited by a 2021 article, there is a strong link between obstructive sleep apnea (OSA) and AFib. The article states that people with OSA are 2–4 times more likely to develop AFib than people without it.

It also suggests that around 3–5% of people with OSA may have nighttime AFib, which is a higher rate than those without OSA. In people with AFib, 21–74% may also have OSA.

This article will explain the relationship between CPAP machines and AFib in more detail.

A person in bed using a CPAP machine.Share on Pinterest
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CPAP is a treatment for sleep apnea that keeps the airways open during sleep.

A 2021 study found no evidence to suggest CPAP significantly affected AF for those with moderate to severe OSA. The researchers found no difference in people receiving standard treatment alone for AFib compared with those receiving standard care and CPAP treatment.

They state that there was also no effect on daytime sleepiness or quality of life. Additionally, there was no reduction or prevention of paroxysmal AFib with CPAP treatment. Paroxysmal atrial fibrillation is when a rapid, erratic heart rate begins suddenly and stops on its own within 7 days.

Read more about CPAPs for sleep apnea.

Research findings on the effect of CPAP treatment in AFib have been mixed. One 2015 study suggests that people with AFib and OSA who received treatment with CPAP had less progression to permanent atrial fibrillation.

However, the 2021 study found that CPAP treatment had no significant effects on reducing the effects of AFib. Researchers found that serious side effects were higher in participants using CPAP than in the control group.

The researchers note that some side effects were unlikely due to using CPAP. Other side effects may have a causal relationship with CPAP use, which requires further investigation.

A 2021 article states sleep triggers AFib due to OSA and high vagal nervous activity.

The vagus nerve is a cranial nerve connecting the brain and body. A change in body position may also contribute to AFib during sleep.

According to a 2018 review, apnea-related changes in sleep may contribute to AFib triggers, such as:

  • short, irregular episodes of deoxygenation and reoxygenation
  • changes of pressure in the chest area due to obstructed breathing
  • activity affecting the sympathetic nervous system and vagus nerve

Research suggests that OSA is associated with AFib and AFib recurrence after a person has received certain AFib treatments. This suggests that CPAP treatment may be beneficial in managing AFib. However, studies into this have found mixed results.

According to a 2018 review, CPAP treatment for sleep apnea may help maintain sinus rhythm in people with AFib after undergoing treatment with electrical cardioversion and catheter ablation. Sinus rhythm is the heartbeat the sinus node generates. The sinus node is the body’s natural pacemaker.

The review notes that researchers need to perform randomized controlled trials to determine CPAP’s potential benefits on AFib.

A 2021 study found that CPAP treatment in people with paroxysmal AFib did not significantly improve AFib.

According to a 2017 article, CPAP treatment may reduce the risk of recurrent AFib. It suggests that untreated OSA may double the risk of AFib recurrence after treatment with cardioversion. People using CPAP treatment may be less likely to develop a more permanent form of AFib.

Potential mechanisms

Researchers are unclear on why using CPAP may benefit AFib. However, it may be due to a reversal of structural changes in the heart that occur due to OSA.

CPAP treatment may also lessen certain risk factors for AFib, such as high blood pressure and changes in pressure in the chest area.

Carrying excess weight is the strongest risk factor for OSA and its severity. Doctors recommend that people with OSA try to maintain a moderate weight and get regular exercise.

The National Heart, Lung, and Blood Institute also recommends the following treatment options for sleep apnea:

  • maintaining healthy sleep habits
  • sleeping on the side rather than the back to help keep the airways open
  • quitting smoking, if applicable
  • limiting alcohol consumption
  • alternative breathing devices, such as an auto-adjusting positive airway pressure machine or a bilevel positive airway pressure machine
  • oral devices, which fit into the mouth during sleep in order to keep the upper airway open, such as mandibular repositioning mouthpieces or tongue-retaining devices
  • orofacial therapy, which uses exercises for the mouth and facial muscles to strengthen muscles and improve tongue position
  • if other treatments are ineffective, people may require surgery to make the upper airway bigger or insert an implant to improve muscle control and open the airways

Read about sleep apnea surgery.

Sleep apnea and AFib can co-occur. Some research suggests CPAP treatment may benefit AFib, while other studies indicate CPAP treatment has no significant positive or negative effect on AFib.

People can talk with a doctor about treatment options available to help manage both conditions.