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

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

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.

Publication types

  • Review

MeSH terms

  • Animals
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / physiopathology
  • Atrial Fibrillation* / therapy
  • Continuous Positive Airway Pressure
  • Humans
  • Risk Factors
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / therapy
  • Sleep Wake Disorders* / diagnosis
  • Sleep Wake Disorders* / epidemiology
  • Sleep Wake Disorders* / physiopathology
  • Sleep Wake Disorders* / therapy
  • Sleep*