AFib and its silent but deadly parent Afib is one of the commonest heart rhythm disturbances which is associated with an increased risk of stroke.
Whilst we know of many risk factors which increase the likelihood of Afib such as high blood pressure, diabetes or precasting heart disease. However, there is one risk factor which is extremely common yet rarely ever diagnosed. This risk factor is a condition called sleep apnoea.
Sleep apnoea affects 100 million people worldwide and 85% of these people go undiagnosed because not many people recognise its symptoms. 1 in 5 people in the western world now have sleep apnoea and I in 2 people with Afib are subsequently found to have sleep apnoea.
The reason there is so much sleep apnoea about is largely due to the high prevalence of obesity. The commonest form of sleep apnoea is called obstructive sleep apnoea.
So what happens with this condition is that the airways collapse during deep sleep. We know that people go initially into light sleep (where they are still aware of bit of what’s going on around them) and then go into deep restful sleep.
In sleep apnoea, people are ok going into light sleep but when they progress to deep restful sleep, their airways collapse and they don’t get enough oxygen. This lack of oxygen is sensed by the brain which then pushes them back into light sleep to take a breath in and they can do this 50-60 times an hour all night long.
Often the partner of the patient will say that they have noticed them stopping breathing at night and often have to give them a nudge just to make sure that they are still breathing.
You can only imagine how stressful this must be for the body. Sleep is our natural treatment for stress and if we are essentially waking up for 50-60 times every hour, the inflammation this causes in the body is huge! People with sleep apnoea have a much higher risk of developing high blood pressure, diabetes, a 4 x increased risk of developing Afib, heart artery disease, strokes, and sudden death.
Sleep apnoea is also a leading cause for road traffic accidents, depression and tiredness We also know that if you have untreated sleep apnoea, and you have fib, the Afib is far more difficult to control unless the sleep apnoea is treated. If you have had an ablation fora fib it is less likely that the ablation will be successful long term unless the sleep apnoea is treated first.
If you have sleep apnoea and fib your risks of stroke are greater than if you have AF without the sleep apnoea. So I think every patient who is diagnosed with AF should be screened for underlying sleep apnoea.
Some of the symptoms that you should look out for are:
Waking up in the morning with a headache
Waking up in the morning not feeling refreshed
Loud persistent snoring at night
Pauses in breathing and gasping when asleep
How do you diagnose it? It is diagnosed by an overnight sleep test which can be done at home or more commonly in a sleep laboratory. How do you treat it? CPAP…which is a machine that blows high-pressure air into the airways and therefore keeps them open.
Having this will give the patient more energy. In the longterm, however, I think the solution for most patients is to embark on a journey of weight loss.
The great news is that you will feel more energetic, your Fib will be better controlled, your future risk will fall substantially, you will have more confidence, you will be happier and your overall quality of life will improve substantially and we know ..that quality of life is all that matters:-)