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Review
. 2025 Aug 15;137(5):788-808.
doi: 10.1161/CIRCRESAHA.125.325612. Epub 2025 Aug 14.

Sleep Disruption and Atrial Fibrillation: Evidence, Mechanisms and Clinical Implications

Abhishek Deshmukh  1 , Naima Covassin  1 , Yves Dauvilliers  2 , Virend K Somers  1
Affiliations
Review

Sleep Disruption and Atrial Fibrillation: Evidence, Mechanisms and Clinical Implications

Abhishek Deshmukh et al. Circ Res. .

Abstract

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, with its incidence rising due to aging populations, obesity, and advancements in diagnostic modalities. The interplay between sleep disorders and AF is increasingly recognized, with obstructive sleep apnea (OSA) serving as a well-established risk factor. However, emerging evidence implicates additional sleep disturbances-including central sleep apnea, insomnia, and restless legs syndrome-in AF pathogenesis and progression. Despite compelling observational data, interventional studies evaluating the impact of sleep disorder treatment on AF outcomes have yielded mixed results. Although continuous positive airway pressure therapy in patients with OSA mitigates AF recurrence, randomized controlled trials have yet to confirm a definitive causal benefit. This review synthesizes epidemiological, mechanistic, and interventional data linking sleep disorders to AF.

Keywords: atrial fibrillation; continuous positive airway pressure; heart failure; sleep apnea, central; sleep apnea, obstructive.

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Conflict of interest statement

A. Deshmukh consulted for GE Healthcare; V.K. Somers serves on the Sleep Number Scientific Advisory Board and as a consultant for Lilly, Jazz Pharmaceuticals, ApniMed, iRhythm, Mineralys, and Axsome. Y. Dauvilliers received funds for seminars, board engagements, and travel to conferences from Avadel, Bioprojet, Idorsia, Jazz Pharmaceuticals, Centessa, and Takeda. The other author reports no conflicts.

Figures

Figure 1.
Figure 1.
Pathophysiology and progression of atrial fibrillation linking genetic, modifiable, and nonmodifiable risk factors. AF indicates atrial fibrillation; CAD, coronary artery disease; CS, coronary sinus; DM, diabetes; GP, ganglionated plexi; HF, heart failure; HTN, hypertension; IVC, inferior vena cava; LAA, left atrial appendage; OSA, obstructive sleep apnea; PV, pulmonary vein; SVC, superior vena cava; and VOM, vein of Marshall.
Figure 2.
Figure 2.
Link between obstructive sleep apnea and increased risk for cardiovascular diseases and atrial fibrillation. AF indicates atrial fibrillation; HTN, hypertension; OB, obesity; PAP, positive airway pressure; and T2DM, type 2 diabetes.
Figure 3.
Figure 3.
Cardiac autonomic innervation. CN indicates cranial nerve.
Figure 4.
Figure 4.
Role of hypoxia in genesis for atrial fibrillation in patients with obstructive sleep apnea. CPAP indicates continuous positive airway pressure.
Figure 5.
Figure 5.
Holter monitor of a patient showing enhanced atrial ectopy when not wearing a continuous positive airway pressure. PAC indicates premature atrial contraction; PVC, premature ventricular contraction; SVE, supraventricular event; and VE, ventricular ectopy.
Figure 6.
Figure 6.
Putative mechanisms linking insufficient sleep to heightened risk of atrial fibrillation. Created in BioRender.
See this image and copyright information in PMC

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