Al Rizzo, MD: The Role of Sleep in Lung Health


How a pattern of poor sleep could begin a cycle of worsened respiratory and cardiovascular health.

Poor sleep can drive worsened pulmonary health. Worsened pulmonary health is associated with symptoms which can drive poor sleep.

The cyclical burden of sleep apnea and respiratory symptoms is one which requires a direct address, from patient to physician. In an interview with MD Magazine®, Al Rizzo, MD, chief medical officer of the American Lung Association, broke down the strain of sleep conditions on pulmonary health, and how most patients present to their physicians.

MD Mag: What is the association of poor sleep with worsened pulmonary conditions?

Rizzo: During the night, all of us tend to slow down a little bit, as far as a metabolism. Heart rate tends to slow a bit, our breathing rate slows a bit, our oxygen may dip a little bit, but usually not to levels that are detrimental.

If we have certain conditions, which could include things as simple as obesity, if we have lung diseases such as COPD, those changes during the night make it a little bit worse. The biggest concern is that there are a lot of individuals that have developed obstructive sleep apnea as a result of the anatomy of their neck not being able to keep the airway open during the night, for a number of reasons.

Certainly, the obesity epidemic has led to an increased incidence of obstructive sleep apnea, because as the weight is gained and the neck becomes fuller, the neck tends to contract during the night, and the airway narrows.

Obstructive sleep apnea been around for a long time. It probably wasn’t until the end of the 20th century where sleep studies were starting to be done pretty regularly to identify what happens during the night with sleep apnea. And we know that instead of just cycling through the normal REM and non-REM sleep, the sleep apnea means that that cycle is disrupted.

Because every time that airway narrows and we work harder to breathe, chemicals are released into the bloodstream that make our body increase the heart rate, increase blood pressure, increase brain activity, and it breaks our cycle of sleep.

And if individuals are doing that 10, 15, 20, 30 times an hour, they end up being tired the next day. They may have been asleep, but they're not getting the quality sleep they need. And every time those chemicals are released in the bloodstream, higher risks of developing hypertension, cardiac disease, stroke, diabetes occurs longer that the sleep apnea is not treated.

So again, it's a matter of looking at risk factors. Certainly, carrying more weight, snoring during the night, being tired during the day, would certainly be a reason to check somebody for sleep apnea.

It's very often that the bed partner is the one who sends the individual in, saying ‘You need to have a sleep study because I can't keep bumping you with my shoulder every time I don't hear you breathing.’

So, that low oxygen level which occurs during the night can lead to what's called pulmonary hypertension, because the blood vessels in the lung tighten as the oxygen level drops down. That's recurring repeatedly through the night for years. The pulmonary hypertension becomes sustained, as well. It makes the heart work harder, leading to symptoms of shortness of breath during the day.

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