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Afib & Obstructive Sleep Apnea

Posted by AB Page 
Afib & Obstructive Sleep Apnea
June 04, 2018 01:24PM
I haven't seen much here lately about the link between obstructive sleep apnea and afib, and I've seen some recent posts from those newly diagnosed, so I thought this might be a good time to post this.

There is a connection between sleep apnea and atrial fibrillation. For anyone new to this forum and newly diagnosed with afib, I would like to strongly suggest that you be checked in some way for any type of breathing obstruction during sleep. I believe the gold standard is an overnight, in lab stay where a technician hooks up electrodes to you and records your sleep digitally and observes/records it on video, then a sleep doc interprets the results. I was one of those who was absolutely certain I didn’t have SA as I’m not obese or a heavy snorer and always slept quite fitfully. Yet I was wrong, and in the year since diagnosis and treatment using a CPAP machine I’ve felt so much better and had much higher energy levels. And the benefit to my heart cannot be understated, yet this is often overlooked and not emphasized as part of a treatment plan that might include an expert ablation by an expert EP at a top-tier center. I was diagnosed 10 days prior to my Natale ablation at TCAI, and I believe my sleep machine use has been a strong ally to my expert ablation, and deserves some of the credit to my continued NSR. Dr. Natale and the first rate staff at St. David’s and TCAI got me here, and the CPAP device has been a tool, part of my arsenal that includes supplements, regular cardiovascular exercise, healthier eating and proper rest in conjunction of course with my expert ablation.

If your insurance doesn’t/won’t cover a full blown sleep study, there are MUCH cheaper alternatives that are used. One approach is to acquire a low cost pulse oximeter that records your pulse and O2 levels while you sleep. It’s a simple device that attaches to your finger and you do in the comfort of your own home and bed. I know Carey used this approach in the last year or so just to confirm his belief he didn’t have OSA. Perhaps if others are interested, he’ll share this in a little more detail.

Even if you don’t believe you have OSA, please consider getting this confirmed, for your peace of mind and better health as you tackle afib.

I believe there’s enough reputable journal articles out there referencing the connection between OSA and afib, so I’ll let others link to them if they’d like, but I know the leading EP’s all recognize the connection and importance of being checked and/or treated for potential OSA.
Re: Afib & Obstructive Sleep Apnea
June 04, 2018 02:17PM
OSA will make your heart work harder at night and, over time, enlarge it thus contributing to the atrial "stretch" that we all know is an important pre-cursor to a-fib.

I've done the at-home study using the pulse oximeter and electrodes. That is what most insurers will pay for versus an in-lab study. Mine showed mild apnea, which I chose to treat with sinus surgery which I believe has helped and thus eliminated the need for a CPAP. I have not repeated the study post surgery so that is a guess on my part.
Re: Afib & Obstructive Sleep Apnea
June 04, 2018 03:22PM
The pulse ox Andy referred to in the first post is this one.

The software is a little funky and non-intuitive, and keeping it on all night while you sleep requires a bit of tape to make sure it stays on, but it's hard to beat the price.

I wore it for five nights and my SpO2 never dropped below 92%. Although that's not a rigorous test, it was enough to satisfy me that a more rigorous test wouldn't show anything different.
Re: Afib & Obstructive Sleep Apnea
June 04, 2018 04:42PM
I bought an O2 sensor (this ), and wore it nightly. It's been about two months now. Occasionally I found my SPO2 would drop to as low as 80% during sleeping. Most of time dropped to about 88%. But interestingly, even when I lay in bed awake, the SPO2 could drop to 92% and trigger the vibration alert. Then I could normally do a few deep breaths to bring up the SPO2 level. If I wear it for couple hours awake and sit around the room, the SPO2 level could be up and down between 92% ~ 98%.

Thought it was misreading. So I had my wife wear it for two nights, the results came out very steady, purely 97% ~ 98%. I'm going to have an in lab sleep study and I'll bring up those results beforehand.



Edited 1 time(s). Last edit at 06/04/2018 04:43PM by kong2018.
Re: Afib & Obstructive Sleep Apnea
June 04, 2018 05:48PM
Quote
kong2018
Occasionally I found my SPO2 would drop to as low as 80% during sleeping. Most of time dropped to about 88%.

Both numbers indicate probable OSA and that first number is pretty severe. 80% would buy you high-flow oxygen by mask in an ambulance or hospital.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 05:36AM
What Carey says.

80% is waaay low. Do all of your AF episodes occur at night??
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 06:17AM
Question, why do some, not all, with OSA continue to wear a mask after successful ablations? Is there a fear that they will go out of NSR or are there other issues with OSA not related to Afib? I realize there are other issues, but was the mask script due to a diagnosis that OSA caused afib?
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 07:05AM
hwkmn05,

The other big concerns with OSA are atrial stretch (leading to atrial dilation) encouraging return of AF or other atrial arrhythmias as well as a significantly increased risk of dementia owing to the brain being starved of oxygen. Mighty wise to keep one's BMI in check and, if in any doubt, check things out with a SPO2 monitor.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 09:31AM
Quote
hwkmn05
Question, why do some, not all, with OSA continue to wear a mask after successful ablations? Is there a fear that they will go out of NSR or are there other issues with OSA not related to Afib? I realize there are other issues, but was the mask script due to a diagnosis that OSA caused afib?

I wear mine every night because my afib was treated, but not my OSA. It was categorized as mild at diagnosis. I used to get very tired and lethargic in the mid to late afternoons, and my energy was low. 2 weeks in to my CPAP therapy and that overwhelming desire to nap every afternoon was gone. I was waking up refreshed and rested every day. It's fair to say the difference in how I felt was almost as dramatic as the difference between afib/flutter and NSR. I'm aware that the time frame I was diagnosed and started CPAP overlapped with my Natale ablation, but I think I could tell/feel the difference each made. So while I'm getting cardiovascular benefit and perhaps helping to ward off cognitive issues, I also get the everyday benefit of feeling great. I was shocked at the difference it made. And as I said, I'm not a big snorer or obese. I do carry 10-15 extra lbs I am constantly fighting a battle with.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 02:26PM
Quote
kong2018
I bought an O2 sensor (this ), and wore it nightly. It's been about two months now. Occasionally I found my SPO2 would drop to as low as 80% during sleeping. Most of time dropped to about 88%. But interestingly, even when I lay in bed awake, the SPO2 could drop to 92% and trigger the vibration alert. Then I could normally do a few deep breaths to bring up the SPO2 level. If I wear it for couple hours awake and sit around the room, the SPO2 level could be up and down between 92% ~ 98%.

Thought it was misreading. So I had my wife wear it for two nights, the results came out very steady, purely 97% ~ 98%. I'm going to have an in lab sleep study and I'll bring up those results beforehand.

I wonder if we afibbers, when we're awake, are not used to hold our breath from time to time just to hear how our heart is beating... Can this have an incidence on our SPO2 ?
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 02:47PM
Quote
mwcf
What Carey says.

80% is waaay low. Do all of your AF episodes occur at night??

Yes, only and exclusively at night while I was sleeping. Woke me up every time. However I was able to terminate the last two episodes by exercising.

As I tested, my afib doesn’t react to any food or activity I do in daytime. But if I felt too relax before fall asleep that was the time afib happened.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 03:22PM
Quote
Pompon

I bought an O2 sensor (this ), and wore it nightly. It's been about two months now. Occasionally I found my SPO2 would drop to as low as 80% during sleeping. Most of time dropped to about 88%. But interestingly, even when I lay in bed awake, the SPO2 could drop to 92% and trigger the vibration alert. Then I could normally do a few deep breaths to bring up the SPO2 level. If I wear it for couple hours awake and sit around the room, the SPO2 level could be up and down between 92% ~ 98%.

Thought it was misreading. So I had my wife wear it for two nights, the results came out very steady, purely 97% ~ 98%. I'm going to have an in lab sleep study and I'll bring up those results beforehand.

I wonder if we afibbers, when we're awake, are not used to hold our breath from time to time just to hear how our heart is beating... Can this have an incidence on our SPO2 ?

I tested holding my breath for one and half minutes until I felt really really uncomfortable but the SPO2 would only drop to 94%. Now I know how severe 80% is. That might not be even tolerable while awake.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 04:50PM
Quote
kong2018
I tested holding my breath for one and half minutes until I felt really really uncomfortable but the SPO2 would only drop to 94%. Now I know how severe 80% is.

And now you know the likely cause of your afib as well.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 05:53PM
Quote
Carey

I tested holding my breath for one and half minutes until I felt really really uncomfortable but the SPO2 would only drop to 94%. Now I know how severe 80% is.

And now you know the likely cause of your afib as well.

But the two nights I got afib while wearing the O2 sensor, it doesn't how a very low SPO2 level before the onset. Both nights were only down to about 88%. But the other days when SPO2 were even lower I didn't have an episode. May there be coincident?

Looking back, I might have the sleep apnea for more than a decade. I've been feeling very tired throughout the day for so many years that I've got used to it. I had to drink couple 'wake up coffee' each day when I entered my office to clear out my cloudy head, then in the afternoon I had to drink another cup of coffee to push through away the tiredness. Now after afib, I reallize I've been pushing the body too much for so many years and the apnea had never been treated. Hopefully treating sleep apnea can eliminate or at least put afib away for a long time.



Edited 1 time(s). Last edit at 06/05/2018 07:01PM by kong2018.
Re: Afib & Obstructive Sleep Apnea
June 05, 2018 08:25PM
Quote
kong2018
But the two nights I got afib while wearing the O2 sensor, it doesn't how a very low SPO2 level before the onset. Both nights were only down to about 88%. But the other days when SPO2 were even lower I didn't have an episode. May there be coincident?

Looking back, I might have the sleep apnea for more than a decade. I've been feeling very tired throughout the day for so many years that I've got used to it. I had to drink couple 'wake up coffee' each day when I entered my office to clear out my cloudy head, then in the afternoon I had to drink another cup of coffee to push through away the tiredness. Now after afib, I reallize I've been pushing the body too much for so many years and the apnea had never been treated. Hopefully treating sleep apnea can eliminate or at least put afib away for a long time.

OSA doesn't just trigger afib episodes when your O2 sats get low. It is a cause of afib on a long-term basis. People with afib and OSA usually continue to experience afib even after getting treatment for their OSA. They often have fewer episodes, but they don't usually go away entirely. So yeah, if you've had OSA for years, that is very likely why you have afib now. Your episodes are fairly few and far between, so if you get treatment for the OSA it's likely you'll experience fewer afib episodes, and it's possible the afib will go away entirely (but don't count on that).

If I were you, I would make the OSA a priority and do nothing further about the afib until you've got the OSA under control.
Re: Afib & Obstructive Sleep Apnea
June 06, 2018 05:57AM
From what I understand and research has shown, CPAP does NOT improve cardiovascular outcomes, nor does it cure afib. And most that wear a mask do not have afib. Im not sure which came first. It appears to help some get a better nights rest which is vital to good health. I refused the mask because I believe it could be a vice to ignore greater issues causing poor breathing and interrupted sleep.
Re: Afib & Obstructive Sleep Apnea
June 06, 2018 06:05AM
Quote
Carey
I tested holding my breath for one and half minutes until I felt really really uncomfortable but the SPO2 would only drop to 94%. Now I know how severe 80% is. That might not be even tolerable while awake.

Ha ! Interesting !
But when I was talking about holding our breath when awake just to hear or feel our heart rhythm, I wasn't thinking about so long periods. Just something around 20", but repeatedly. I wonder if this might make our SPO2 dropping as low as 90%...

In my early afib days, I spent some time in the ER, as you might guess. There, I had electrodes everywhere and lots of devices hanging around. I remember having been surprised by the number of "ding-ding-ding" I was frequently hearing, seeing an orange light flashing on the edge of the monitor and the display saying "sleep apnea". I was awake, but holding my breath from time to time, and the instantaneous result was the "ding-ding-ding". As the nurses didn't bother about it, I understood the device was very sensitive. Nevertheless, this made me realize the number of times I was shortly holding my breath: it might be for changing position (a challenging thing to do when you have wires everywhere) or while concentrating on some sensation...
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