Sleep position and AF

Came across an interesting study which correlated the frequency of AF events with one's sleep position.  Posting a part of it here, with link to full article below it.  Bottom line, sleeping on your right side has fewer AF events, with prone having the fewest.  Works for me, having my PM on my left side (as do most folks).

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Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients.

Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France.

Results: Ninety-four symptomatic paroxysmal AF patients were included [mean age 61 ± 11 years, median AF history of 29(48) months, 31% were females]. Twenty-two percent of patients reported a specific body position as a trigger of their AF symptoms. The triggering body position was left lateral position in 57% of cases, supine position in 33%, right lateral position in 10%, and prone position in 5% (p = 0.003 overall difference in prevalence). Patients with positional AF had a higher body mass index compared to patients without nocturnal/positional AF [28.7(4.2) and 25.4(5.2) kg/m2, respectively, p = 0.025], but otherwise resembled these patients.

Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.

https://www.frontiersin.org/articles/10.3389/fphys.2021.708650/full

3 Comments

Completely agree

by Gemita - 2022-04-17 16:16:35

Hello Daedalus, thank you so much for your post.  I have no problems at all understanding that I can sometimes control my arrhythmias from a mere change of position, from lying to standing, from standing to lying, from lying on the left side to lying on the right side.  I know this because it has worked so many times for me.  There are times when my Atrial Fibrillation starts and would continue for longer periods if I did not change my position.  Similarly, by taking sips of water or solids, I may halt, or indeed start an AF episode.

Of course we all know that AF has a mind and a will of its own and there are times when whatever we try it will not stop.  But it is good to know that there are things that we can do to try to stop it.  We have to find what works for us.  Similarly, bending forward may quickly trigger a tachy event and then AF.

My tips too, get any sleep apnea treated, as well as any high blood pressure (two important causes), treat any infection or acute illness, check electrolytes and treat any anaemia, thyroid disease.  Finally, get stress under firm control and take any meds to calm high heart rates and anticoagulation to protect from an AF related stroke.  Oh and don't get dehydrated and try to reduce caffeine/alcohol if these are triggers.  They are for me.

Thank you again and good luck with your AF control

Position

by AgentX86 - 2022-04-18 00:29:53

Sleep apnea is also position dependent.  It's more likely with back sleepers and less common with stomach sleepers.  It's easy to see why.  As gemita said, sleep apnia is a strong indicator of AF, so....

Sleep Positions and Afib Triggers

by Marybird - 2022-04-18 13:37:50

I guess I might fall into the category of possibly right lateral side sleepers triggering at least tachycardia, if not afib. My afib incidents tend to be shortlived, ( mostly a few seconds, a minute or two- at least what's felt by me, would be a long time,) thanks to the medication I take, and I think, the action of the pacemaker. There have been a few longer incidents, but these are rare. I'm still trying to figure out the triggers, but seems to me almost anything can trigger an incident, from a glass of wine ( sometimes a few hours later) to sneezing, to reaching up to get something off a shelf, to an emotional response to something ( which for me, if it's bad enough, raises my blood pressure dramatically and comes with its own nosebleed). Or sometimes for no reason I can figure out. 

But I've noticed for probably two years now, maybe more, that when I flip over to my right side at night, my heart rate increases, sometimes up to 110 or so, sometimes in the low 100's, or high 90's, lasts a few minutes and then goes back down. It doesn't do the same, or at least not nearly as often, when I flip to a back or left side position at night. I always thought the reason for the heartrate increase upon flipping over to my right side might be the pacemaker  rate response doing its thing, and I'm still not sure that this might not be the reason. My pacemaker is placed in a position where I'm comfortable sleeping in any position, though when I am in the left lateral position, I think I can feel the edge of the pacemaker's left edge right up against my shoulder. It's not uncomfortable, but I wonder if that might have something to do with the rate response and increase in my heart rate. For some reason I don't notice this on my left side. Though if I'm having an "afib" day/night anyway, it seems the action of moving to a different position, getting up, getting a drink of water, getting back in bed, thinking and stewing about something I have no control over will bring about those afib incidents, more so than already being in a given position. 

It's an interesting study, Daedalus, and I'm not surprised that more people feel their being in the left lateral position might trigger afib events, with the atrial stretch and all. I'm surprised though, that more people- those with tendencies towards sleep apnea, as Agent mentioned, didn't report afib events while sleeping on their backs. That's when they'd tend to have their airways more blocked, evidenced by snoring. 

 

 

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