Sleep Apnea Causes Atrial Fibrillation

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People with obstructive sleep apnea may be getting cardiac  catheterizations prematurely because doctors often over look a common cause of atrial fibrillations, obstructive sleep apnea. People with obstructive sleep apnea have a high risk for atrial fibrillation.  The two most common complications of atrial fibrillation are stroke and heart failure. 

Last week, I saw a patient diagnosed with obstructive sleep apnea but non-compliant to therapy.  He simply got tired of connecting himself to his CPAP machine.  He hadn’t used his machine for more than 3 years.  He stated that he slept okay and had a good energy level.  He thought everything was going well until he went into heart failure. During his hospitalization, the cardiologist stabilized his cardiac function and referred him to the sleep lab for re-evaluation of obstructive sleep apnea.

At least 3 times a year I hear from patients diagnosed with obstructive sleep apnea  who developed cardiac complications caused by noncompliance to positive airway pressure therapy (PAP, CPAP, BIPAP, APAP therapy)  

 

What is Atrial Fibrillation.

Atrial fibrillation, Afib, is a rapid irregular heat beat. 

Symptoms of Atrial Fibrillation:

Palpitations -- an abnormal rapid heartbeat

Shortness of breath

Weakness or difficulty exercising

Chest pain

Dizziness or fainting

Fatigue

Confusion

 

Treatment Goals

1.      Lowering the risk of a stroke by preventing blood clots from forming

2.      Controlling how fast the heart beats

3.      Restoring a normal heart rate.

How doctors reverse cardiac symptoms of obstructive sleep apnea

Blood Clots

Doctors use medications to thin the blood or decrease the ability for platelets to clump together and form clots.

If your doctor prescribes medication to thin your blood, be sure to inform your doctor of all over the counter vitamins and supplements that you are taking.  Aspirin is an over the counter blood thinner that you want to tell your doctor about. Tell your doctor if you are taking supplements.  Many supplements thin the blood.  Combining these over the counter supplements with prescription blood thinners could put you at risk for another type of stroke called a hemorrhagic stroke.  A hemorrhagic stroke occurs when you bleed into the brain.

Here’s a partial list of natural blood thinners

Supplements

Fish oil

Garlic

Nattokinase

Vitamin E

Bromelain

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Herbs

Arnica

Bilberry

Chamomile

Cinchona

Clove oil

Evening primrose

Feverfew

Kava

Meadowsweet

Motherwort

Papaya

Pumpkin seed

Red clover

Saw palmetto

 

Rate Control

Drugs may be prescribed to control heart rate. The heart rhythm can be more difficult to control. The longer you have untreated atrial fibrillation the less likely it is that normal rhythm can be reestablished. 

The following medications are commonly used the control heart rate:

Beta blockers. These are drugs used to slow the heart rate. Most people can function and feel better if their heart rate is controlled. 

Here is a list of beta blocker medications:
 Atenolol
 Bisoprolol
 Carvedilol
 Metoprolol
 Nadolol
 Propranolol
 Timolol

Calcium channel blockers. These medications have multiple effects on the heart. They are used to slow the heart rate in patients with atrial fibrillation and to reduce the strength of the muscle cell’s contraction.

Here are two types of medications that are calcium channel blockers
Dilitiazem
Verapamil
 

Digoxin. This medication slows electrical currents traveling from atria to the ventricle. 

 

 

Rhythm control

Drugs may be prescribed to control rhythm.  When medications are used to restore heart rhythm it is called chemical/pharmacological cardioversion.

Two classes of medications are used for chemical/pharmacological cardioversion

Sodium channel blockers which help the heart's rhythm by slowing the heart's ability to conduct electricity.

Here are the FDA approved sodium channel blockers used in the USA

Flecainide (Tambocor®), 

Propafenone (Rythmol®)
Quinidine (Various).

Potassium channel blockers help the heart’s rhythm by slowing down the electrical signals that cause AFib.

There are three FDA approved potassium channel blockers used in the USA Amiodarone (Cordarone® or Pacerone®)
   Sotalol (Betapace®)
   Dofetilide 

 

When the rhythm cannot be controlled with medication your doctor may recommend additional therapies:

cardioversions

atrial fibrillation ablation

 pacemakers

What To Do If You Think You Have Atrial Fibrillation

If you have an irregular pulse or wake from sleep with a racing heart, you could have atrial fibrillation.  Call your doctor immediately.  Insist on being evaluated for obstructive sleep apnea.  In many cases the evaluation can be done in your home while you sleep in your own bed wearing a small device to monitor sleep and breathing. 

It is important to have your doctor evaluate you for obstructive sleep apnea because one in every four people with obstructive sleep apnea are undiagnosed and the most common cardiac arrhythmia associated with OSAS is atrial fibrillation.  With treatment of OSAS your atrial fibrillation may resolve without medications or cardioversion treatments.

Find more about atrial fibrillation at the follow websites.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/MakeChangesThatMatter/Types-of-Blood-Pressure-Medications_UCM_303247_Article.jsp#.WqH7zFrwbcs

https://medlineplus.gov/atrialfibrillation.html

https://www.drsinatra.com/the-most-common-blood-thinners