In short
- The 2023 US atrial fibrillation guideline says sleep-disordered breathing is found in more than 20% of people with AFib when they're formally tested, and sometimes more than 50%.
- In the Sleep Heart Health Study, people with severe sleep-disordered breathing had about four times the odds of atrial fibrillation during sleep as people without it.
- In the same study, the odds of an abnormal rhythm were about 18 times higher in the 90 seconds after a breathing disturbance than after normal breathing, though the absolute risk per event was very low.
- The American Heart Association recommends screening for sleep apnea in people whose AFib returns after cardioversion or ablation.
- A 2015 meta-analysis of seven cohort studies linked CPAP use with a 42% lower risk of AFib coming back, but randomized trials have not found a significant benefit.
- In a 2021 randomized trial of 108 people with paroxysmal AFib and sleep apnea, five months of CPAP did not significantly reduce the time spent in AFib.
Sleep apnea and atrial fibrillation (AFib) often go together. Sleep apnea is found in a large share of people with AFib, is linked to a higher chance of developing it, and breathing pauses can trigger episodes during the night. Heart guidelines now say screening for sleep apnea may be reasonable in people with AFib. Whether treating sleep apnea keeps AFib away is still uncertain: observational studies look promising, but randomized trials so far haven't shown a clear benefit.
What is atrial fibrillation?
Atrial fibrillation is an irregular heart rhythm in which the heart's upper chambers beat out of step with the lower ones. The NHLBI says it affects more than 2 million adults in the US and is one of the most common heart rhythm problems. It can make you feel tired, lightheaded or dizzy, or feel like your heart is skipping, fluttering or pounding. Some people have chest pain.
AFib matters because of what it can lead to. The NHLBI explains that blood may pool in the heart, raising the risk of clots that can cause a stroke. AFib can also happen with no symptoms at all, which makes it easy to miss. The NHLBI lists sleep apnea and other sleep problems among the medical conditions that raise the risk of AFib, alongside high blood pressure, overweight and obesity, diabetes and heart failure.
How common is sleep apnea in people with AFib?
Research: moderate (what this means)Sleep apnea is very common in people with AFib. The 2023 US guideline on atrial fibrillation, written by the American College of Cardiology, American Heart Association and other groups, says sleep-disordered breathing is found in more than 20% of people with AFib when they're formally tested, and sometimes more than 50%. It notes that it's often undetected, and because the usual symptoms may be absent, a sleep study may be needed to find it.
The American Heart Association's 2021 scientific statement puts the figure as high as 40% to 80% across people with several heart conditions, including AFib, high blood pressure and heart failure. The numbers vary because studies use different tests and groups, but they all point the same way.
A Norwegian trial gives a real-world example. Of 579 people with paroxysmal AFib, meaning episodes that come and go, who had a sleep breathing test called respiratory polygraphy, 244 (42%) had moderate to severe sleep apnea. The results were published in 2021 in the American Journal of Respiratory and Critical Care Medicine.
Does sleep apnea raise the risk of AFib?
Sleep apnea is linked with a higher risk of AFib, though the evidence comes from observational studies. In a 2006 analysis from the Sleep Heart Health Study, researchers compared 228 people with severe sleep-disordered breathing to 338 people without it. AFib showed up during sleep in 4.8% of the first group and 0.9% of the second. After adjusting for age, sex, body mass index and coronary heart disease, people with severe sleep-disordered breathing had about four times the odds of AFib.
A 2007 study in the Journal of the American College of Cardiology followed 3,542 adults in Olmsted County, Minnesota, who'd been referred for a sleep study and had no history of AFib. Over an average of 4.7 years, 133 developed AFib. In a simple analysis, sleep apnea predicted new AFib, but the picture got more complicated once other factors were included. In people under 65, obesity and the size of overnight drops in oxygen were independent risk factors. In people 65 and over, neither obesity nor sleep apnea predicted AFib, while heart failure did.
The 2023 guideline sums it up: sleep-disordered breathing is a risk factor for developing AFib, and more severe sleep-disordered breathing acutely raises the risk of an AFib episode. It also says poor sleep quality is linked with a higher risk of AFib on its own.
Can a breathing pause trigger AFib during the night?
A breathing pause can trigger an abnormal heart rhythm shortly afterward, according to a 2009 study from the Sleep Heart Health Study. Researchers screened 2,816 overnight sleep recordings for episodes of AFib or a short run of fast rhythm from the lower chambers. They then compared the 90 seconds before each episode with periods of normal rhythm in the same person.
They found 62 episodes in 57 people, about three-quarters of them from the lower chambers. The odds of an abnormal rhythm were about 18 times higher after a breathing disturbance than after normal breathing. The absolute risk was low, though: roughly one extra rhythm problem for every 40,000 breathing disturbances. The authors concluded that the results support a direct timing link between sleep apnea events and these rhythm problems.
This helps explain why sleep apnea and AFib are so tightly linked. The AHA statement describes what happens in each event: oxygen dips, the nervous system swings and sleep is broken up. Our guide to sleep apnea and the heart covers these effects in more detail.
What do heart guidelines say about screening?
Heart guidelines now suggest that many people with AFib should be checked for sleep apnea. The 2023 US guideline makes a weak recommendation (class 2b) that among people with AFib, it may be reasonable to screen for obstructive sleep apnea, given how common it is. In the same sentence it notes that the role of treating sleep-disordered breathing to maintain a normal rhythm is uncertain.
The American Heart Association's 2021 statement is firmer for one group. It recommends screening for sleep apnea in people whose AFib comes back after cardioversion or ablation, the procedures used to reset or correct the rhythm.
| Source | What it says about AFib and sleep apnea |
|---|---|
| 2023 US AFib guideline | Screening may be reasonable in people with AFib (class 2b); benefit of treatment for rhythm control uncertain |
| 2021 AHA scientific statement | Screen for sleep apnea when AFib returns after cardioversion or ablation |
| 2015 meta-analysis of 7 cohort studies | CPAP use linked with 42% lower risk of AFib recurrence |
| 2021 randomized trial, 108 people | Five months of CPAP didn't significantly reduce time in AFib |
| 2022 randomized trial after ablation, 83 people | 57% had AFib recurrence in both the CPAP and usual care groups |
Does treating sleep apnea help AFib?
Treating sleep apnea may help AFib, but the evidence is mixed and not yet proven by randomized trials. The observational studies are encouraging. A 2015 meta-analysis in JACC: Clinical Electrophysiology combined seven prospective cohort studies with 1,087 people. CPAP use was linked with a 42% lower risk of AFib coming back, both in people treated with ablation and in those managed with medicines. Studies like these can't rule out that people who stick with CPAP differ from those who don't in other healthy ways.
The randomized trials haven't confirmed it. In the Norwegian trial, 108 people with paroxysmal AFib and moderate to severe sleep apnea were randomly assigned to five months of CPAP plus usual care or usual care alone, with their rhythm tracked by a small implanted monitor. Time spent in AFib fell from 5.6% to 4.1% with CPAP and from 5.0% to 4.3% without it, a difference that wasn't statistically significant. A quarter of the people who tried CPAP during the run-in period couldn't tolerate it.
A 2022 trial in Heart Rhythm by the same group tested CPAP after ablation in 83 people with paroxysmal AFib and sleep apnea. CPAP brought the AHI down from about 27 to under 2 events an hour. Even so, 57% of people in both groups had at least one AFib episode 3 to 12 months later. Ablation cut AFib burden in both groups, with no extra benefit from CPAP.
The 2023 guideline offers a reason for caution in reading these trials. It says they weren't large enough to show a relationship, and tended to exclude the people who might benefit most, such as those with sleepy, symptomatic sleep apnea, severe heart disease or severe obesity. So the honest answer is that treating sleep apnea hasn't been shown to keep AFib away, but it hasn't been ruled out either.
What can you do if you have both?
If you have both AFib and sleep apnea, work with your doctors on both conditions rather than treating them separately. The AHA says everyone with obstructive sleep apnea should be considered for treatment, including behavior changes and weight loss where needed, with CPAP offered for severe sleep apnea and oral appliances an option for mild to moderate cases or for people who can't tolerate CPAP. It also advises follow-up testing to check that treatment is working.
Several things on the NHLBI's list of AFib risk factors overlap with sleep apnea care, including overweight and obesity, high blood pressure and heavy alcohol use. Our guides to sleep apnea and weight loss, sleep apnea and alcohol and sleep apnea and high blood pressure look at each one. If CPAP feels hard to live with, getting used to CPAP has practical help.
When should you see a doctor?
See a doctor if you have AFib and signs of sleep apnea, such as loud snoring, pauses in breathing that someone has noticed, gasping at night or daytime sleepiness. Mention it even if you don't feel sleepy, since the 2023 guideline notes that sleep apnea symptoms may be absent in people with AFib. A home sleep apnea test is often the first step.
See a doctor too if you notice a racing, fluttering or irregular heartbeat, or feel unusually tired, dizzy or short of breath. Chest pain or fainting needs urgent medical help. Because AFib raises the risk of stroke, learn the stroke warning signs; our guide to sleep apnea and stroke explains them. If you're pregnant and notice palpitations or new snoring, tell your clinician.
This article is general information, not medical advice. Talk to your doctor or cardiologist about your own heart rhythm and sleep.
Read next
Common questions
Can sleep apnea cause atrial fibrillation?
Sleep apnea is strongly linked with AFib and may help trigger it. The 2023 US guideline calls sleep-disordered breathing a risk factor for developing AFib, and says more severe sleep apnea acutely raises the risk of an episode. Studies can't fully prove cause, since the two share risk factors such as obesity.
How common is sleep apnea in people with AFib?
Very common. The 2023 US guideline says that when people with AFib are formally tested, sleep-disordered breathing turns up in more than 20% and sometimes more than 50%. It's often missed, because the usual symptoms such as daytime sleepiness may be absent.
Should people with AFib be tested for sleep apnea?
Many should. The 2023 guideline says it may be reasonable to screen people with AFib for sleep apnea. The American Heart Association recommends screening when AFib returns after cardioversion or ablation. Anyone with AFib and snoring, breathing pauses or daytime sleepiness should ask about a sleep test.
Does CPAP stop atrial fibrillation?
It hasn't been proven. Observational studies link CPAP use with fewer AFib recurrences, but randomized trials, including a 2021 trial and a 2022 trial after ablation, found no significant difference. The guideline notes those trials were small and tended to leave out the people who might benefit most.
Can sleep apnea trigger AFib at night?
It can. In the Sleep Heart Health Study, the odds of an abnormal heart rhythm were about 18 times higher shortly after a breathing disturbance than after normal breathing. The absolute risk was low, at about one extra rhythm problem per 40,000 breathing disturbances.
Is AFib dangerous?
It can be. The NHLBI says blood can pool in the heart during AFib, raising the risk of clots and stroke, and that untreated AFib can lead to serious and even life-threatening complications. Many people have no symptoms, so it can go unnoticed. See a doctor about any irregular or racing heartbeat.
Sources
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
- Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association
- Association of Nocturnal Arrhythmias with Sleep-disordered Breathing: The Sleep Heart Health Study
- Triggering of nocturnal arrhythmias by sleep-disordered breathing events
- Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation
- Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis
- Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial
- Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after pulmonary vein isolation in patients with obstructive sleep apnea: A randomized controlled trial
- What Is Atrial Fibrillation?
- Atrial Fibrillation Causes and Risk Factors
About this article
- Research
- 10 published sources, listed above.
- Evidence
- Moderate. How we rate it
- Last checked
- November 2, 2026
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.