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Opinion: The Diagnosis and Treatment of Sleep Disorders in Brazil by Dr. Geraldo Rizzo

January 10, 2017

capa geraldo rizzo_ eng

Neurovirtual News: Could you please introduce yourself and tell us a little about your professional career?

Geraldo Rizzo: I am a Neurologist specializing in Sleep Medicine. I graduated in 1976 at UFRGS and completed my residency in Clinical Medicine and Neurology there as well. Subsequently, I completed a fellowship in Neurology at Duke University in North Carolina.

Years later, during a Neurology congress in the United States, I had the opportunity to speak with the Dean of Harvard University, who encouraged me to consider other areas of medicine, especially Family Medicine and Sleep Medicine. I realized that Family Medicine was not within my field of study, and as you well know, sleep is one of the functions of the brain, so I considered Sleep Medicine more closely related to Neurology.

With that goal in mind, I started my training in Memphis, Tennessee, with Dr. Helio Leme; since the 1990s we have opened and operated a sleep lab here in Porto Alegre, at Moinhos de Vento Hospital, where I work to this day. It is a small lab that currently has two beds. Our goal is to provide very personalized assistance and a high quality of care to our patients, besides conducting some clinical research. The research branch is also greatly limited by the type of patients that we receive. In short, that was my path from Neurology to Sleep Medicine.

Neurovirtual News: What is the main difficulty that doctors and patients find to treat sleep disorders in Brazil?

Geraldo Rizzo:  I would say that the main difficulty for doctors and patients to treat sleep disorders would not be the lack of sleep labs nor the lack of doctors, but an indifference to quality of sleep. People today care about diet, they try to maintain their weight, they worry about physical activity and hire a personal trainer… Everyone has a professional to take care of their physical body, but very few people worry about sleep.

We live in a 24-hour society; In Brazil, more-so than in developed countries, our lifestyle leads to very late nights. We rarely have dinner before 10 pm; a performance does not start before midnight, and the same can be said about discos and nightclubs; everything is scheduled to postpone sleep. This cultural disregard of normal sleeping times is the main obstacle to treat or recognize sleep disorders, both for physicians and patients.

Neurovirtual News: How do you evaluate public policies and research in the field of Sleep Medicine in Brazil?

Geraldo Rizzo: Well, in my view, these things are still in their early stages. Sleep research in Brazil is still underdeveloped. Only a few institutions are actively conducting clinical research in the country, and even then, the research is much more clinical than exploratory.

As for public policy, new controls set for obese drivers, or drivers who tend to have sleep apnea, brought great hope to doctors specializing in sleep medicine. In cases where a car accident may have been caused by a sleep disorder, the attending physician must conduct a series of tests, including polysomnography. However, it was observed that doctors who work at traffic institutions, and places where driver’s licenses are renewed, rarely ask for the patient´s clinical history of sleep. The possibility of falling asleep while driving is alarming, and affects up to 30% of drivers, but there is still little regulation aimed at properly assessing an individual and preventing an accident caused by a sleep disorder. Therefore, I consider that public policies are also too underdeveloped in relation to sleep disorders.

Neurovirtual News: Do you believe that the majority of the population has access to treatment for sleep disorders?

Geraldo Rizzo: On the one hand, we must consider that a large part of the Brazilian population does not have access to education nor to healthcare in general, and much less to sleep medicine. On the other hand, I would say that larger cities in the country offer the population access to treatment centers for sleep disorders.

So, what is the problem? I believe that only 1 in 10 individuals with sleep problems seek a doctor to treat the problem. There is no outreach that encourages people to seek diagnosis or treatment of sleep disorders. The greatest demand is for the treatment of sleep-disordered breathing, which is one of the disorders that requires no equipment to diagnose. A doctor with good judgment and a detailed clinical history of the patient can diagnose and treat this particular disorder without specialty devices or training.

However, other disorders require diagnostic equipment, and for these, there is a limited demand. I believe that this brings up the question of whether most people have access to a proper sleep study, and I would say that the answer is no. The people do have access to sleep specialists, however, as has been argued, they do not seek them.


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