2015-11-06

The Canadian Sleep and Circadian Network (CSCN) has been awarded close to $4 million to mobilize the healthcare community towards an integrated approach to improving outcomes and treatment of patients with obstructive sleep apnea (OSA).

A grant just under $2 million from the Canadian Institutes of Health Research (CIHR) was equally matched by funds from the faculties of dentistry and medicine at the University of British Columbia, other Canadian universities and various industry sources.

Dr. Fernanda Almeida

Dr. Fernanda Almeida, UBC Dentistry associate professor, dental sleep medicine expert and a co-investigator with CSCN, says the network’s research plan will involve multidisciplinary teams from 19 universities* and include investigators in sleep medicine, respiratory medicine, dentistry, cardiology, genetics, nephrology, neurology, pediatric medicine, kinesiology, behavioral sciences, epidemiology, neuropsychology, brain imaging, circadian rhythms, public health, health services, and health economics.

Obstructive sleep apnea (OSA) affects over 1 million Canadians. OSA leads to significant cardiovascular and metabolic health problems and patients with untreated OSA are at higher risk of stroke and Alzheimer’s disease. Eighty to 90 percent of patients with moderate to severe OSA have not been clinically diagnosed due to poor access to therapy and lack of resources for diagnosis.

“The network will provide a comprehensive integrated ‘basic science to clinical practice model’ to understand the mechanisms relating to adverse health consequences for OSA patients,” Almeida says.

Four research project areas have already been outlined to respond to several pressing OSA challenges: the difficulty in identifying vulnerable OSA patients, the rise of OSA in obese children and youth most at risk of OSA, the increased rate of OSA in the aging population—especially those with mild cognitive impairment, and of the issue of poor access and adherence to OSA treatment.

Almeida is particularly excited by the creation of databases for CSCN projects. One of which will be the first adult multi-site OSA database in the world that will incorporate polysomnographic sleep patterns, biological samples (genetic, serum), and cognitive measures. “By having these data, we hope to determine whether inflammatory and genetic markers predict the occurrence of negative cardiovascular, metabolic, and cognitive outcomes and to evaluate how shift work schedules interact with inflammatory biomarkers in OSA patients,” she says.

Another data collecting and sharing project earmarked because of the CIHR matched funding includes the creation of the Canadian Obese OSA Children and Youth Database. For this population group Almeida’s contribution will focus on understanding craniofacial structures, which, she notes, is important in identifying possible adjunct therapies for children and youth.

These databases will facilitate interaction and collaborative projects between clinical and research groups. Almeida is no stranger to large database sharing scopes: she is steering committee chair of the Oral Appliance Network of Global Effectiveness, a multinational study involving worldwide data collection to evaluate the long-term effectiveness of oral appliance therapy in patients with OSA. Almeida also has several studies underway investigating adherence to different OSA therapies.

The aging population also holds special interest for Almeida. Despite the decline in edentulism (tooth loss), it is estimated that 24 percent of individuals aged 55 to 65 years will need one or two dentures in 2020. She notes that previous studies found an aggravation of OSA while not wearing dentures during sleep, a common recommendation by dentists. Therefore, a group study of elderly people will certainly include the evaluation of dentures and its use.

Complementing the research, the CSCN will consult with OSA patients to focus research on patients’ priorities, reinforce participative research, facilitate knowledge translation, and ensure strong links with community-based groups. The network will also deploy a national plan of knowledge exchange between patient groups, researchers, the healthcare community and industry to provide affordable home-based diagnostic technologies, clinical practices guidelines and provide lay information to patients on research outcomes and therapies.

Over the course of the CIHR grant, anticipated outcomes include: identification of OSA patients at greater risk of adverse cardiovascular, metabolic, and cognitive effects; earlier OSA diagnosis in vulnerable populations; development of personalized OSA treatments; and improvement strategies for patient adherence to OSA treatment.

The CIHR grant also provides for the CSCN to develop a national training and career development program in sleep and circadian research for a broad range of health care providers.

Collaborations among CSCN investigators also include stakeholder engagement from professional and scientific groups, provincial government agencies, private companies, CIHR institutes and patient advocacy groups.

* Brock University, Concordia University, Dalhousie University, McGill University, Queen’s University, Simon Fraser University, Université de Montréal, Université de Sherbrooke, Université d’Ottawa, Université du Québec à Montréal, Université Laval, University of Alberta, University of British Colombia, University of Calgary, University of Guelph, University of Saskatchewan, University of Toronto, University of Waterloo, and Western Ontario University.

For more information about the Canadian Sleep and Circadian Network, visit www.cscnweb.ca