The Atrial Fibrillation and Obstructive Sleep Apnea Connection

Roger Seheult, MD of MedCram explains the relationship between atrial fibrillation and obstructive sleep apnea. See all Dr. Seheult's videos at: www.medcram.com/
(This video was recorded on June 27th, 2024)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
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#atrialfibrillation #osa #sleepapnea

[@Medcram]

Go to medcram.com right now for more educational videos!

[@etmax1]

My wife has had sleep apnoea for decades, and finally about 10 years ago she got help in the guise of a CPAP machine. She still doesn't sleep as well as I do but at least she doesn't damage our house's foundations. I used sleep regardless of the noise and very soundly but the moment she stopped breathing I would wake up and turn her on her side or try whatever else I could and then drop off to sleep within a second or 2 until the next event. Interestingly she has never had atrial fibrillation and all heart tests came up to gold standards. Her BP is around 100/60 when sitting in bed. That to me suggests that there are a multitude of triggers that need to align before the mechanism described here can rear its ugly head. I am a mirror of my wife, I never snore unless I've had a few very short nights, (rarely) and the snoring is like a puff as I intermittently switch form nasal breathing to mouth. When I first had my heart attack an ICU nurse asked if I had sleep apnoea and I said no, and then she said "yes I do!" and I said no I don't, my wife does and she let it go after that 🙂. I also used to have high blood pressure which very much under control since I had a CABG4. Before that tablets didn't work. I only had atrial fibrillation once, in the hours after my bypass and only because the furosimide dropped my potassium too much. BTW, you do marvellous job of cutting through the fluff and making some of the most complex biological systems understandable.

[@bruce2sail]

Doc S - you’re the best explainer. I’ve had sleep apnea for decades and have used CPAP for over 20 years thanks to my ENT. Of late, my care was transferred to a pulmonologist who was literally clueless and who meddled and bungled my care. Speaking with my cardiologist, I became worried about Afib (my mom suffered from it), so I fired the pulmonologist and found one of the best and brightest in my area (who also happens to lead the local ER team, so he’s seen it all). Thanks to him, I’m back on track and I appreciate your piece on this potentially fatal interaction between apnea and Afib. I hope others who may be downplaying the seriousness of sleep apnea take heed. It could save their life! Thank you.

[@stevenveltrie1868]

Wish all doc's were this good at explaining.

[@JC-ce7ud]

I send almost every afib patient i see for a sleep study. Thanks for this excellent video.

[@retaj00]

Years ago I told my parents about my dad’s textbook OSA based on articles I read, but I was a mere twenty year old. Years later he developed afib which led to a stroke, and then he got a CPAP. This video certainly would have helped then if KZbin had been around.

[@JM-vh7oc]

Reallly well explained - as are all your videos - thanks

[@nerd26373]

We appreciate your insights. Keep making an impact on the community.

[@MargaretTovrea]

So well explained & illustrated!

[@andyfpt]

Doctor, as usual excellent content! 62 yo active guy here and started cpap in 2022 due osa diagnosis and periodic afib starting in late 2019. Wish I started cpap sooner. Ended up having ablation in June 2023 because afib episodes became frequent and now afib is completely gone. I didn't want to take anti arythmia meds. Still faithfully using my cpap which is a piece of cake. Thank you for all you do to help educate and help people. Lots of misinformation out there and you are my go to source after my own doctors. Thank you!

[@Medcram]

Congratulations on getting out of atrial fibrillation. That is a great feat. And thanks for the comment.

[@jefferyjeffery1707]

Ok...!! The aFib (not related to sleep apnea)...can also be caused by higher levels of glutamate, signaling in the vegas nerve. That over excites the nerve tissue sinus node...to prematurely stimulate nerve contraction impulses. In addition to... magnesium deficiencies. That's needed to slow down that over excited nerve impulse. All of which causes the atria to contract faster than the ventrical is ready to receive the blood from the atria... Basically...causing the heart contractions to be out of sync.

[@Pickle-up3eh]

Very well explained. Thanks Dr.

[@carldaniel6510]

Any links known between OSA and PVCs/PACs? If so, please do a video on that!

[@nurseSean]

If you don’t want to use C-PAP, this makes a good case to do it anyway.

[@ASpectacular3777]

Thank you for this video! This is me! I have MILD OSA (from a very narrow trachea) and developed AFib. CPAP was too harsh/not tolerated well during sleep study so they ordered a BiPap which, after time, I developed Treatment Emergent CSA so now I’m on ASV. My trachea is so narrow that the Anesthesiologist at Northwestern cancelled the PVI surgery the night before so she could order a smaller GI Tube after looking at a CT of head/neck. I’m almost at the 3-month mark post-ablation and so far no AFib/SVT/Flutter; which is great as AFib is a BEAST of a condition. What’s interesting/worrying/concerning is a recent Chest CT picked up MILD CENTRILOBULAR EMPHYSEMA which only developed during the last 2 years I’ve been on BiPap. I have never smoked, so how did I get emphysema? No 2nd hand smoke either. Part of me wonders if some sort of Barotrauma/Volumetrauma happened from over expansion due to high settings from the BiPap? Just a hunch. My Sleep Pulmonologist said I’m not a standard OSA patient; I’m complex.

[@theancientsancients1769]

CPAP and Bipap killed my dad . Look into alternative treatments like Airnergy

[@tomdaigon8707]

I was diagnosed with a fib several years ago. After switching to a new cardiologist who prescribed me Flecanide, I have not had an a fib event for a year. It's been a wonderful experience.

[@Medcram]

Awesome!

[@meripederson8379]

Thanks very informative

[@ryanerickson3063]

thanks for the vid

[@terriyoung2205]

Very informative video.

[@Medcram]

Glad it was helpful!

[@TheDazy37]

Super interesting topic

[@tomlauritzen9522]

I wonder if that's why I've just found I have Narrow Complex Tachycardia? I've been on my CPAP for years... hummm...

[@cathyjennings5580]

Important information 😮😊

[@jani7089]

I'm making my own 1-graph 24-hour Holters, and it's always interesting, if not even scary, to read the sleep-data, in a form of "what the h* is going on..." Two patterns repeat every time: after falling asleep, there's about one-hour-period of a heart beat going so wildely between 40 and 80 bpm that the heart-rate-graph doesn't know what to draw, so it just spray-paints that period of time with pulses between 40-80 bpm. Then a short surge of high pulses up to 100 bpm occur, probably something that you mention in your video: the brain trying to reset the situation. And then there's a period of very stabile 65 bpm pulse which can last for several hours. As an ex electrician, I can't read ECG other than frequency and amplitude, (and I just learned about a P-pulse from one of your short videos), so I can see that falling asleep happens in a few seconds, in a few heart beats the frequency lowers, and an amplitude, too. And there's a significant amount of time in the ECG where the graph is turned up-side-down, meaning that the positive wave is shorter than a negative one; the "surge" goes down instead of up. And every period of certain patterns is interrupted by a few seconds of a high heart-rate. Maybe I shoould use a night-vision camera, too, and a microphone sensitive enough to record breathing.

[@terraflow__bryanburdo4547]

In the 2000s, age 40s and 50s i i had some serious in bouts of a fib. I made a connection of inflammation and metabolic illness, switched to keto then carnivore diet, and both conditions cleared up and i have been asymptomatic for 15 years now. I didnt know about the connection of the two, just as most doctors dont know about the dietary connection of either.

[@Orvulum]

Sleeping on one's side can help prevent obstructive apnea from occurring in some individuals, though it would be necessary to make some arrangement to that a person couldn't roll on to their back while asleep. CPAP doesn't work for everyone. If one spends a great many months trying to habituate to the CPAP, but is unable to sleep at all, then clearly some other approach would be indicated.

[@eleanorfowser4705]

My sister-in-law law sewed a pocket on the back of my brother’s pajama tops and put a tennis ball in the pocket when he went to bed. It kept him off his back and greatly reduced his snoring.

[@RICDirector]

If you have fat around the neck, side sleeping sucks, as I know....

[@Dr_b_]

There are other treatments for sleep apnea, including surgery, that do not involve CPAP, MAD, or nerve stim. Should get checked out by an ENT to understand whats actually happening.

[@Medcram]

Some surgical procedures are effective but others like UPPP are not so much.

[@47retta]

If your body's answer to less oxygen coming in is to raise BP and HR, why do doctors prescribe beta blockers to slow HR and BP?

[@etmax1]

That's a really good question, and is probably either because of having to deal with multiple evils, or not understanding root causes. High blood pressure leads to thickening of the heart muscle (left ventricle) and damage to the coronary arteries. The raising of BP in your mentioned case is a result of the increased heart rate due to a transient event. Transient events are not necessarily a major drama (depending on duration) but sustained high blood pressure is. The problem is to narrow down the cause of the high BP and you end up with a lot of circular arguments as to what is cause and what is effect. Doctors don't have an easy job, which is why their stint at medical school is so long. Add to that there isn't one build plan for a human, there are few million (or even billion) different build plans all needing a slightly different approach.

[@sapelesteve]

Yet another excellent explainer video Doc! My wife has sleep apnea. She has not been diagnosed with A-Fib but does have HBP for which she takes meds. Hope that alls well on your end! 👍👍

[@Medcram]

Yes. Thanks!

[@toddpeterson5904]

Another great video. I recently had ablation for my AF. So far it seems to have been successful, but it will be a few months until I know. My EP did ask about OSA, but I was never tested for it. My partner doesn't seem to think that I have it, but there have been some odd times where I wake up in the night choking on nothing. I should probably try a sleep study to be sure.

[@Medcram]

Yes. For sure.

[@sophiashakti5638]

In the same key, please explain gastric reflux causing dizziness, please.😊

[@Medcram]

That’s a new one for me. I’ll have to look into that.

[@Ockv74]

❤❤❤

[@theancientsancients1769]

I noticed on my Whoop when I sleep at times my pulse jumps up from 62 to 82 for one minute then returns to like 64 etc a minute later is that normal or fibrillation? At times low oxygen saturation while asleep I see but on my oxymeter for finger it's normal while awake so is that pulse .

[@georgesabikhalil186]

Thank you for this video! I want to ask, would the BiPAP also not help here?

[@Medcram]

Yes!

[@deborahhebblethwaite1865]

Great video, Dr S you’re a wonderful teacher. I have a friend with this problem and so she also speaks of having congestive heart failure. My question is, is thickening around the heart that you are showing on the video considered congestive heart failure? I know sometimes you read these comments , so hopefully you could address this on a video Thank you🇨🇦🙏

[@Medcram]

Thank you. So the thickening that I was showing was enlargement of the muscle. Now this can cause diastolic heart failure and definitely causes enlargement of the atrium.

[@deborahhebblethwaite1865]

@@Medcram thanks for your reply🙏🇨🇦

[@fs3579]

Do you recommend any Cardio EP who do Post Field Ablation? Can be any location. Thank you!

[@Medcram]

I’ve heard Good Samaritan Hospital in So Cal does a good job.

[@Launena100]

Great video 😊 Can pectus excavatum cause sleep apnea?

[@Medcram]

Yes

[@twogsds]

Very interesting, we live in the UK, my OH has A-Fib, he hardly ever snores but sometimes his breath is very shallow, it kind of wakes me up, I don't think that sleep has been looked into although his A-Fib always starts first thing in the morning. His A-Fib seems to be triggered by stressful situations the day before can sleep be affected by stress?

[@Medcram]

Absolutely

[@darkcrystal2198]

What about respiratory therapists? 😢

[@Medcram]

You too!!!

[@tentigers7335]

So, I have not been told I have Atrial Fibrillation issues, but more than once I have had comments that I have an "enlarged heart". Is that the same thing as what you are describing here?

[@bruce2sail]

Yes, it’s one of the precursors to afib and degenerative heart disease. Make sure to stay on the CPAP religiously, take your BP meds, and get an SpO2 recorder online to monitor your nightly oxygen levels to make sure your CPAP is working effectively.

[@samfurman8432]

I have solved my sleeping and snoring problems by taping my mouth shut with a small amount of tape. This then requires breathing though the nose.

[@Lolipop59]

What kind of tape did you use please? Thank you

[@JustAnne4]

Central sleep apnea is when breathing ceases without any airway obstruction. Can this also weaken the heart as you described for obstructive sleep apnea?

[@Medcram]

Possibly but it is often the result weakened heart: Cheyne-Stokes respiration (CSR)

[@tonyagarcia4871]

Please don't forget about us with enlarged tonsils and androids and small nasal passages.

[@njcanuck]

If you have sleep apnea, wear a medical ID. Important for anesthetist if you need emergency surgery and you can't speak for yourself.

[@Medcram]

Yes, many times we need to warn the anesthesiologist that someone may have sleep apnea and to account for that when they take the tube out of their lungs after the operation. Often people are in a deep sleep, and they may obstruct and have complications.

[@444brandy]

I understand that sleep apnea is caused by low vitamin D3 and B1

[@Bigislandrealestatevideos]

Like this comment if you have had positive results with sleep apnea while being on a carnivore diet.

[@terraflow__bryanburdo4547]

I cured both apnea and a-fib on ketovore/carnivore

[@Bigislandrealestatevideos]

@@terraflow__bryanburdo4547 cried? Typo? Idk

[@terraflow__bryanburdo4547]

@@Bigislandrealestatevideos typo, thanx

[@annakramar5088]

Watch Dr Ken Berry on everything Carnivore.🥩