Al Rizzo, MD: Treating Poor Sleep in Lung Health

The risk factors for sleep issues among respiratory patients are clinically obvious, yet complicated in care. Rather than resort to pharmacological agents, physicians may do better to respond with comprehensive care measures.

In an interview with MD Magazine®, Al Rizzo, MD, chief medical officer of the American Lung Association, described the established metrics designated for sleep apnea diagnosis, as well as the major drivers of poor sleep health in respiratory patients.

MD Mag: How would you advise primary care physicians help improve monitoring and care for sleep apnea?

Rizzo: Well as I mentioned, there are some risk factors. There are some simple scores—there's something called the Epworth score looking at sleepiness during the day. There's the STOP-BANG questionnaire that many anesthesiologists and anesthesia nurses use as a preoperative assessment for sleep apnea, because we know that anesthesia can make sleep apnea worse.

So I think individuals, physicians, and certainly electronic medical records should incorporate some simple screening questions that can be asked to an individual if an individual already has some risk factors such as an increased weight or obesity, if they have a thick neck, and if they have a history of snoring or being tired.

Those are things that would prompt further investigation, maybe one of the more specific questionnaires, to see if a sleep study is indicated.

MD Mag: How can physicians help break the cycle of poor sleep, poor lung health?

Rizzo: Many patients with chronic lung disease have stress, for a lot of reasons. Sometimes they have not been able to maintain their livelihood. They’re worried about bills, they're worried about the cost of the drugs that are being given to them to help them at least stay symptom-free, if they can. That can lead to disturbed sleep.

Often, patients who tell me that they're having trouble sleeping, it is a combination of stress related to finances, work, family, discord, things of that nature. So at least talking about that and trying to manage the COPD the best we can with medications, pulmonary rehab, things of that nature, can help if they have the signs of sleep apnea—which many of them will. Because if they've gained weight by being more sedentary, they may have sleep apnea as well as COPD that has to be treated.

I think it's important not to just rush to giving them a sleep aid or a sedative to help them deal with that. If there's true stress that requires counseling, that should be referred out to psychological counseling, if there is something to that degree. So I think it is more a matter of awareness that this is a condition, like a lot of medical conditions, can make individuals depressed, can make them feel stressed out, because of what's happened to their lifestyle.