Sleep Apnea and Arrhythmias: Those Who Cannot Change Their Minds Cannot Change Anything

Announcing a new article publication for Cardiovascular Innovations and Applications journal. Sleep apnea, a highly prevalent disorder characterized by recurrent episodes of airflow limitation and intermittent hypoxia, has emerged as a significant modifier of cardiovascular risk, particularly in patients with cardiac arrhythmias. Affecting more than half of individuals with atrial fibrillation (AF), sleep apnea contributes to arrhythmogenesis through mechanisms including chronic sympathetic activation, repetitive intrathoracic pressure shifts, hypoxia-driven myocardial remodeling, and autonomic imbalance.

Although observational studies suggest that treatment of sleep apnea may reduce arrhythmia recurrence and adverse cardiovascular outcomes, large randomized trials of continuous positive airway pressure (CPAP) and adaptive servo-ventilation have yielded neutral or unexpected results, giving rise to the so-called “sleep apnea treatment paradox.” These findings underscore limitations in current diagnostic and therapeutic algorithms, which rely heavily on the apnea-hypopnea index without adequately accounting for cardiovascular phenotypes. Emerging evidence supports a more individualized, precision-medicine approach that integrates arrhythmic risk, hemodynamic effects, and patient-specific tolerance to therapy. Novel interventions, including implantable phrenic nerve stimulation, illustrate the promise of mechanistically informed innovation. Advancing the understanding of the complex interactions among sleep-disordered breathing, cardiac substrate remodeling, and autonomic regulation may improve long-term arrhythmia outcomes and enable more targeted cardiovascular care.

CVIA is available on the ScienceOpen platform and at Cardiovascular Innovations and Applications. Submissions may be made using ScholarOne Manuscripts. There are no author submission or article processing fees. Cardiovascular Innovations and Applications is indexed in the EMBASE, EBSCO, ESCI, OCLC, Primo Central (Ex Libris), Sherpa Romeo, NISC (National Information Services Corporation), DOAJ, Index Copernicus, Research4Life and Ulrich’s web Databases. Follow CVIA on Twitter @CVIA_Journal; or Facebook.

Thomas Konecny, Susheela Hadigal and Ramil Goel et al. Sleep Apnea and Arrhythmias: Those Who Cannot Change Their Minds Cannot Change Anything. CVIA. 2026. Vol. 11(1). DOI: 10.15212/CVIA.2025.0043

CVIA Journal