Untreated Afib & Sleep Apnea? An interview with STOPAFIB.org's Mellanie Hills

Have you ever experienced heart palpitations and were unsure if it warranted speaking to your doctor? Has your doctor placed you on statins for rising cholesterol based on a family history of heart disease? What does sleep apnea have to do with heart palpitations?  The American Heart Association issued a statement in June 2021 that “between 40% and 80% of people in the U.S. with cardiovascular disease also have obstructive sleep apnea (OSA), yet it is under recognized and undertreated in cardiovascular practice.”1 Sleep Apnea Pathfinders set out to find out more about Atrial Fibrillation (A-fib).  AF is defined as an irregular, often rapid heart rate where the hearts upper chamber (atria) beat out of coordination with the lower chambers (ventricles) and causes poor blood flow.

In this interview with CEO of STOPAFIB.org, Mellanie True Hills, we discuss a wide range of topics from what is Afib to how does it overlap with sleep apnea.  Ms. Hills is an award winning author for her book A Woman’s Guide to Saving Her Own Life: The Heart Program for Health and Longevity.   

40% of individuals don’t have observable symptoms; roughly 6 million people affected by Afib.  "When you have Afib, you have a 500% increase risk of stroke.”   Heart failure is a big issue as is cognitive issues.

She discusses the way to diagnose Afib: Electrocardiogram or loop recorder.

 The risk factors for Afib involve people with high blood pressure, underlying heart disease, diabetes, congestive heart failure, as well as sleep apnea.  For those she encounters who wake up with their heart racing, a common question is have they had a sleep study.  “The two (Afib and Sleep Apnea) go hand in hand”, according to Ms. Hills.

 Crossover issues of women not being referred based on language.  Women tend to be diagnosed with mild sleep apnea.  The research is also showing that women may experience hypopneas, (partial closures of the airway) more than apneas (full closure of airway)2.  David discusses the impact of the American Academy of Sleep Medicine guidelines of defining desaturation with a 3% or 4% measurement (2 & 3).

Triggers are discussed.  The sympathetic nervous system is engaged (for those with sleep apnea, this is nightly).  She posits that Afib runs in families and also added that so does sleep apnea.  

Paroxysmal, Persistent and Long standing.

 They discuss typical treatment.

Intrathoracic pressure of sleep apnea can cause a stretching of the atria of the heart.  Results in remodeling of the heart and also electrical signaling.

 Ms. Hills shared her story of how she experienced Afib and how her surgical procedure helped her get rid of Afib. 

 Ms. Hills was gracious to share her sleep apnea story and how diagnosed with sleep apnea, she had to reframe how treating her condition as a means to keep her Afib managed.  She learned of the connection through research done by Drs. Susan Redline and Virend Somers in 2008 showing the connection between Afib and sleep apnea.

David shared family history with heart conditions and sleep apnea.

Treating Afib early is key.

1.      Newsroom.heart.org Statement published online June 21, 2021 “Sleep Apnea worsens heart disease, yet often untreated”; A scientific statement by the American Heart Association in their associations journal Circulation

2.      Prolonged partial upper airway obstruction during sleep-an underdiagnosed phenotype of sleep disordered breathing; Anttalainen, U; et al

3.      Cardiovascular and somatic comorbidities and sleep measures using three hypopnea criteria in mild obstructive sleep-disordered breathing: sex, age and body mass index differences in a retrospective sleep clinic cohort; Johnson, K; et al