In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient’s risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation. 1. Introduction Obstructive sleep apnea, a common breathing disorder, is characterized by recurrent episodes of airway collapse resulting in occlusion of airflow during sleep. These episodes of hypopnea and apnea can manifest as transient or prolonged hypoxemia, sleep arousals, and sympathetic nervous system activation, resulting in symptoms such as snoring, headaches, daytime sleepiness, and impaired alertness [1]. Approximately 3–7% percent of the adult population in the United States is affected by OSA, and that number is likely an underestimate as it goes undiagnosed in many cases [2–4]. Another condition which is also prevalent as well as undiagnosed in many circumstances is atrial fibrillation (AF). It is predicted that by 2050, more than 10 million Americans will have AF and possibly up to 16 million if the increase in incidence continues on the same trajectory [5]. The question has been posed, on more than one occasion, how these two common entities of OSA and AF impact one another. Although the relationship between sleep-disordered breathing and arrhythmias was proposed a few decades ago [6], only recently has it been recognized that OSA seems to be correlated with AF (see Table 1) [7–15]. Table 1: Risk of AF in OSA patients. The studies in Table 1 suggest the increased risk of AF in OSA patients, but the quality of the data is limited [7–15]. Known risk factors for AF include age, male gender, smoking, obesity, hypertension, diabetes mellitus, myocardial infarction, congestive heart failure, and cardiac surgery [15]. Of the six studies evaluated in Table 1, only two adjusted for male gender [8, 11], one for hypertension [9], and none controlled for diabetes mellitus, or heart failure [8, 16]. In the Sleep Heart Health Study, Mehra et
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