Does CPAP Make Atrial Fibrillation Worse? What the Research Shows

Unpacking the link between CPAP therapy and atrial fibrillation to empower heart health decisions.

By Medha deb

Created on Sep 25, 2025

Unpacking the link between CPAP therapy and atrial fibrillation to empower heart health decisions.

Continuous positive airway pressure (CPAP) therapy is the most widely prescribed treatment for moderate to severe obstructive sleep apnea (OSA). Atrial fibrillation (AFib or AF), the most common sustained arrhythmia, affects millions of adults worldwide. Because sleep apnea and AF commonly occur together, people with both conditions often wonder if treating sleep apnea with CPAP could inadvertently worsen their heart rhythm—especially AF. This article comprehensively explores current research on the relationship between CPAP and AFib, addressing the benefits, risks, and clinical recommendations for those navigating both conditions.

Understanding Atrial Fibrillation and Sleep Apnea

Atrial fibrillation (AFib) is a type of arrhythmia—an irregular or rapid heartbeat—that elevates the risk for stroke, heart failure, and other cardiac complications. Obstructive sleep apnea (OSA) is a disorder in which breathing repeatedly stops and starts during sleep, causing drops in oxygen and sleep fragmentation. OSA is now recognized as a significant risk factor for developing AF, as both disorders disrupt the cardiovascular system in intertwined ways.

Estimates suggest up to half of all people with AFib also have OSA, underscoring the importance of exploring their interplay.
OSA increases AFib risk by promoting high blood pressure, systemic inflammation, increased sympathetic activity, and anatomical changes in heart structure.
AF can in turn worsen sleep quality and further increase risk for other cardiovascular conditions.

What Is CPAP and How Does It Work?

CPAP therapy uses a machine to deliver a steady stream of pressurized air via a mask, keeping the upper airway open during sleep. This ventilation prevents airway collapse, reduces apneas and hypopneas, and improves nocturnal oxygenation. CPAP is the gold-standard therapy for moderate to severe OSA and is associated with reduced daytime sleepiness, improved quality of life, and better cardiovascular outcomes for many patients.

CPAP usage is measured in average hours per night. Adherence to more than 4 hours/night is typically considered effective for therapeutic benefit.
Side effects may include nasal congestion, dry mouth, skin irritation, and discomfort with the mask or pressure.

Does CPAP Therapy Make Atrial Fibrillation Worse?

The central concern of this topic: Does using CPAP increase the risk, severity, or recurrence of atrial fibrillation? According to the most current scientific evidence, CPAP therapy does not make AFib worse in people with coexisting OSA. In fact, much of the research suggests the opposite—CPAP may help stabilize or improve heart rhythm abnormalities for some patients with AF.

Current Research: CPAP and AFib Risk

Several observational studies have found that people with OSA who use CPAP have lower rates of AF recurrence following cardioversion or ablation compared to those who do not treat their OSA.
CPAP may help reduce the triggers and structural changes in the heart that promote AF, including by lowering left atrial size and decreasing sympathetic nerve activity.

However, not all research finds dramatic benefit:

A landmark randomized controlled trial published in 2021 found that CPAP therapy did not significantly decrease the burden of AF (measured by % time spent in AF) after 5 months of treatment in people with moderate-to-severe OSA and paroxysmal AF, compared to usual care alone.
The same study reported no difference in quality of life or daytime sleepiness between CPAP users and the control group.
Serious adverse events were more frequent in the CPAP group (though most were not likely caused by CPAP specifically).

Does CPAP Trigger or Aggravate Arrhythmias?

Theoretical concerns about CPAP include whether the positive pressure could:

Increase pressure on the heart, potentially affecting atrial filling or cardiac output.
Trigger arrhythmias by stimulating the autonomic nervous system.

To-date, clinical evidence does not show that CPAP increases the risk or severity of AFib episodes for most people with OSA. In fact, several physiological studies suggest that CPAP can:

Reduce the number of apneic/hypopneic episodes which themselves may trigger arrhythmias.
Reverse some of the atrial remodeling (structural changes in heart tissue) associated with sleep-disordered breathing.

How CPAP May Impact Heart Rhythms in OSA

CPAP therapy’s direct effects on the heart have been studied in people with OSA and AFib:

A randomized study with invasive electrophysiologic mapping demonstrated that 6 months of CPAP led to reversal of abnormal electrical propagation in the atria and partial normalization of heart tissue in patients with AF and OSA.
Other studies show that CPAP can reduce left atrial volume and improve measures of heart relaxation and conduction, possibly making the heart less prone to developing or sustaining AF.
Despite these promising physiological findings, clinical benefits (such as prevention of AF recurrence or reduction in time spent in AF) have not been consistently proven in randomized controlled trials to date.

Potential Risks and Side Effects of CPAP Therapy

CPAP is generally safe but can cause side effects, particularly when first starting therapy. Reported issues include:

Nasal dryness and congestion
Skin irritation at the mask interface
Bloating or mild stomach discomfort from swallowed air
Difficulty tolerating the mask or pressure, which may lead to poor adherence

Serious adverse effects from CPAP specific to heart rhythm, such as worsening AF, are rare and not well-documented in the literature. Some trials have noted more frequent serious adverse events among CPAP groups, but causality is unclear and events are usually unrelated to arrhythmia or cardiac function.

When Might CPAP Not Help with AFib?

Although CPAP is strongly recommended for OSA, its direct impact on AF outcomes shows wide individual variation. Reasons why CPAP might not lead to improvements in AF include:

Mild OSA or central (not obstructive) sleep apnea
Poor adherence to CPAP (using device for less than recommended hours or inconsistently)
Advanced or persistent AF with longstanding atrial remodeling
Coexisting cardiac risk factors (e.g., uncontrolled hypertension, diabetes, underlying heart disease) that drive AF risk independently

Ultimately, for many with OSA and AF, CPAP remains an important adjunct to other heart rhythm management strategies (like medications, ablation, or cardioversion), but it should not be expected to eliminate AF on its own.

Who Should Use CPAP?

Current guidelines recommend CPAP for people with moderate to severe OSA (apnea-hypopnea index ≥15) based on substantial benefits for sleep quality, daytime alertness, mood, and long-term health.

Those with heart rhythm disorders—including AF—need individualized advice from their sleep and cardiology teams.
Even in the absence of major changes in AF with CPAP, CPAP can help reduce blood pressure, lower cardiovascular risk, and improve symptoms of sleep-disordered breathing.

Benefits of CPAP Therapy for People with OSA and AFib

Improves sleep quality and reduces excessive daytime sleepiness.
Decreases apneas and hypopneas, and stabilizes nighttime oxygen levels.
May help reduce the risk of hypertension, heart failure, and other cardiovascular diseases in OSA patients.
Observational studies suggest it may reduce recurrence of AF following procedures like ablation or cardioversion.
Early evidence points to normalization of heart tissue and electrical conduction with regular use.

What To Discuss With Your Healthcare Provider

If you have both OSA and AFib (or are being evaluated for either condition), discuss the following with your doctor:

The severity and type of your sleep apnea
Best strategies to start and adhere to CPAP therapy
The potential benefits of CPAP not only for sleep, but also for cardiovascular health
Any symptoms or concerns experienced while using CPAP, especially relating to palpitations or new/worsening arrhythmias

Your care team may include a cardiologist, sleep specialist, and a primary care provider. Together, they can tailor therapies based on your health needs and latest evidence.

Table: Summary of Key Findings on CPAP and AFib

Aspect	Findings
CPAP and AF Recurrence	Observational studies: Lower rates of AF recurrence in OSA patients using CPAP; RCTs: No significant reduction in AF burden
Adverse Effects	CPAP rarely linked directly to worsening AF or serious arrhythmias. Common side effects are non-cardiac (nasal dryness, mask discomfort).
AFib Mechanisms Impacted	CPAP may reverse atrial remodeling, improve heart conduction, decrease triggers for AF.
Who Benefits Most	People with moderate to severe OSA and recent-onset or paroxysmal AF seem to benefit most from consistent CPAP usage.
Limitations	Benefits for AF reduction not seen in all patients; adherence to CPAP and comorbidities impact outcomes.

Frequently Asked Questions (FAQs)

Can CPAP therapy make my atrial fibrillation worse?

Current evidence suggests that CPAP does not make AF worse. CPAP is generally safe for people with both OSA and AFib, and some research shows it may stabilize heart rhythm or reduce recurrence for some individuals.

Are there heart-related side effects of using CPAP?

Serious heart-related side effects are rare. Common side effects are discomfort, congestion, or dryness. If you experience new or worsening palpitations or dizziness, contact your healthcare provider.

Can CPAP help reduce my AFib episodes?

Some studies have found that CPAP reduces AF recurrence after procedures like ablation, but robust randomized trials did not find a significant reduction in AF burden. Individual response varies. Consistent CPAP usage for OSA can improve sleep quality and general cardiovascular health.

If I cannot tolerate CPAP, are there alternatives for OSA?

Yes. Alternatives include dental devices, position therapy, weight loss, avoiding alcohol before bed, and, for some, upper airway surgery. For people with both OSA and AF, it’s important to address sleep health as part of arrhythmia care.

Should everyone with AF and OSA use CPAP?

Not everyone benefits equally. CPAP is most critical for patients with moderate to severe OSA. Always follow individualized guidance from your healthcare provider based on your sleep study, heart rhythm, and symptoms.

Key Takeaways

CPAP is the first-line treatment for moderate to severe sleep apnea and is generally safe for people with atrial fibrillation.
Evidence does not support that CPAP worsens AFib; it may help in some cases, but not all people will see heart rhythm improvement.
Consistent use, addressing side effects, and ongoing communication with your clinic team are essential for best outcomes.

If you live with both OSA and AFib, coordinated care among your sleep and cardiology specialists will ensure the safest and most effective management plan. While CPAP may not cure AFib, it remains crucial for many people’s overall cardiovascular health and quality of life.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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