Obstructive Sleep Apnoea and Atrial Fibrillation: Current Evidence and Emerging Research Directions

This review summarizes current knowledge on the coexistence of obstructive sleep apnoea and atrial fibrillation. A narrative review of the literature was conducted to identify relevant clinical and mechanistic studies. Obstructive sleep apnoea is highly prevalent among patients with atrial fibrillation and adversely affects rhythm-control outcomes. The interplay between these two conditions is of significant clinical importance, as obstructive sleep apnoea contributes to the development and progression of arrhythmias through multiple pathophysiological mechanisms: mechanical atrial stretch, immune activation and low-grade inflammation, autonomic dysregulation, oxidative stress, and systemic hypoxia. These mechanisms promote the initiation, maintenance, and treatment resistance of atrial fibrillation. Multimodal management strategies aimed at this harmful interplay may improve outcomes in patients with atrial fibrillation and include lifestyle and dietary interventions, pharmacometabolic therapies, particularly glucagon-like peptide-1 receptor agonists, continuous positive airway pressure therapy, and, in selected cases, catheter ablation strategies, potentially extended to the ganglionated plexi. Collectively, these approaches may contribute to the restoration and maintenance of sinus rhythm.