The Curious Sleep Apnea and Heart Rhythm Connection
After surgery, a patient with sleep apnea discovered she also had atrial fibrillation, a serious irregular heart rhythm.
By Beth W. Orenstein
Medically Reviewed by Pat F. Bass III, MD, MPH
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Dealing with one chronic condition can be difficult; dealing with two or more amps up the challenge for your heart. That's something all too familiar to Rhonda Marie Clare Harvey-Collens, 52, of Mount Pearl, Newfoundland and Labrador, Canada. She lives with rheumatoid arthritis, sleep apnea, and the abnormal heart rhythm known as atrial fibrillation.
Harvey-Collens was diagnosed with atrial fibrillation in 2007 while recovering from surgery for a life-threatening infection. The biologic drug she was taking for rheumatoid arthritis suppressed her immune system, and an infection took hold. This happened not once, but twice.
“When doing my vital signs, they realized something was not quite right with my pulse and discovered I had atrial fibrillation,” Harvey-Collens says.
Because the infections had nearly killed her, she started seeing a psychiatrist for post-traumatic stress disorder (PTSD). “I was telling her I had a horrible time sleeping, and had anxiety-driven nightmares,” she says. She recalls that she was terribly frightened about what was happening to her.
Her psychiatrist ordered a sleep study, which confirmed obstructive sleep apnea: a sleep disorder in which people stop breathing multiple times when they're asleep.
How Getting Good Sleep Protects Your Heart
Harvey-Collens is not alone in having sleep apnea and atrial fibrillation. The incidence of sleep apnea among people with atrial fibrillation varies from 32 to 49 percent, according to a 2012 report in the journalCurrent Cardiology Reviews. These figures may even be higher because physicians do not routinely screen patients for sleep apnea, says William Abraham, MD, director of the division of cardiovascular medicine at Ohio State University's Wexner Medical Center.
To help her sleep, Harvey-Collens’s doctors first recommended a CPAP machine, which provides a continuous flow of air into nasal passages to keep them open. But she kept setting off its alarms as she slept, so she switched to a BiPAP machine, which delivers two levels of pressure: a high amount when she inhales, and a low amount when she exhales.
“It seems to work well,” she says. “I can’t sleep without it. I use it every night. I still require sleep medicines to stay asleep, but I’m not waking up at night with my heart racing.”
To control her atrial fibrillation, Harvey-Collens relies on rhythm- and rate-control medications. She also does physiotherapy, a combination of movement and exercise. But she still sometimes experiences heart rhythm incidents. In March 2014, during an atrial fibrillation episode, she had to go to the emergency room. “My heartbeat is normally 55 to 60, and it went into the 150s,” she recounts.
When she experienced headaches, a neurologist determined that she'd already had two strokes — a dangerous complication of atrial fibrillation. Having sleep apnea is also linked directly to stroke risk, according to the American College of Cardiology.
How Do You Know if You Have Sleep Apnea?
Waking symptoms of sleep apnea and atrial fibrillation are often similar and not very specific, Dr. Abraham says.
Symptoms that suggest you might have sleep apnea are daytime sleepiness, fatigue, excessive urination, moodiness, and cognitive impairment.
Symptoms of atrial fibrillation often come on suddenly and include shortness of breath and lightheadedness. Other symptoms may include a feeling of weakness, a rapid heart rate, palpitations, or chest pain.
“There are no special symptoms of the two together,” says Robert Rosenberg, DO, medical director of the Sleep Disorders Center of Prescott Valley in Flagstaff, Arizona. “If you’re diagnosed with afib, your healthcare provider should inquire about snoring or any other signs or symptoms of co-existent sleep apnea,” he says. Seeing a sleep specialist is the next step in determining whether you have sleep apnea.
Diagnosing sleep apnea is imperative, Rosenberg says, because your heart treatment is much more likely to succeed when your sleep apnea is treated.
RELATED: 6 Things People With Sleep Apnea Wish You Knew
Treating obstructive sleep apnea reduces the risk for recurrence of an irregular heart rhythm for patients who’ve had a catheter ablation to stop their atrial fibrillation, found a clinical study published in the July 2013Journal of the American College of Cardiology.
“The majority of patients I see are referred to me after their afib has been diagnosed,” Rosenberg says. In his experience, cardiologists often recommend a sleep apnea evaluation after a patient's heart treatment fails to keep the heart in normal rhythm.
Today, Harvey-Collens takes a positive attitude toward her sleep apnea and afib. “I have a cardiologist and a neurologist that I see regularly,” she says.
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