Atrial fibrillation is a form of cardiac arrhythmia in which the heart begins to beat irregularly and rapidly. It is extremely dangerous and can cause high blood pressure and heart attacks. It is also responsible for 15 to 20 percent of ischemic strokes, in which blood flow and oxygen to the brain are blocked.
The American Heart Association reports that over 2.7 million Americans are living with atrial fibrillation, with 200,000 new cases diagnosed each year. The National Sleep Foundation estimates that over 18 million adult Americans have OSA, but many more individuals go undiagnosed.
OSA and AFIB
Researchers on the study say that patients with obstructive sleep apnea are at risk of developing atrial fibrillation because of oxidative stress, a condition in which the body is unable to eliminate toxic free radicals. Oxidative stress develops when patients are deprived of oxygen, which happens during episodes of OSA.
When a patient has OSA, the muscles of the throat relax during sleep so much that they collapse and block the airway. As a result, patients are unable to breathe and wake up gasping throughout the night. Some OSA patients can stop breathing hundreds of times per night.
Another cause of OSA-induced atrial fibrillation is the stress put on the heart when the patient stops breathing.
OSA can also cause patients to develop metabolic syndrome. Metabolic syndrome is a group of medical conditions that include insulin-resistant diabetes, high blood pressure, obesity and dyslipidemia, a condition characterized by high levels of fat in the blood. Metabolic syndrome is also a contributor to atrial fibrillation, and puts patients at an even greater risk by clogging arteries.
Risk of Cardiac Episodes
The Canadian study examined the health records of 8,256 who were suspected to have OSA but had not yet been diagnosed with cardiac arrhythmia, including atrial fibrillation. Participants in the study were tracked for 13 years. Of the study group, 173 participants developed atrial fibrillation.
Researchers found that OSA patients who developed atrial fibrillation had a higher number of breathing interruptions during the night compared to OSA patients who did not develop the arrhythmia. The biggest factor that study leaders found when examining participants with atrial fibrillation was that they had lower oxygen saturation levels than their peers without atrial fibrillation.
Women in this group were particularly at risk for hospitalization.
Patients in the study who developed atrial fibrillation because of OSA were typically older and were smokers. Many of the individuals in the atrial fibrillation group also had at least two chronic health conditions.
The impact of OSA on the heart is not a new discovery, and not a surprise to many health professionals – including dentists.
Dr. Stefania Caracioni, D.D.S., L.V.I.F, is a Topeka, Kansas, dentist who treats patients with OSA and sees the cardiac impact of the condition on her patients.
“Patients with obstructive sleep apnea are at a greater risk for a cardiac episode than patients who do not have the condition,” she said.
Dental Solutions for Obstructive Sleep Apnea
The most common OSA therapy is the Continuous Positive Airway Pressure, or CPAP, machine. Many patients dislike the CPAP because it is loud and bulky. The continuous airflow of the machine also leaves patients with dry mouth, which puts them at risk for dental complications like cavities and tooth loss.
In many cases of OSA, the jaw is out of alignment and sits too far back. A consequence of this misalignment is the tongue is also very far back. When the patient relaxes during sleep, the tongue falls back and blocks the throat.
Caracioni uses dental orthotics to correct the jaw position to a more forward position, which keeps the tongue from falling backward and blocking the airway.
“Dental orthotics allow obstructive sleep apnea patients to breathe, without the noise and dry mouth of the CPAP machine, which lowers the blood pressure and reduces overall strain on the heart,” Caracioni said.
Dentistry Today. “Sleep Apnea May Increase Atrial Fibrillation Risk.” Dentistry Today. 30 May 2017.
National Sleep Foundation. “Sleep Apnea.” National Sleep Foundation. 2017.
American Heart Association. “What is Atrial Fibrillation?” American Heart Association. 6 February 2017.