Dr. Owen Lyons

A Good Night’s Sleep

Research that’s helping improve sleep quality and health outcomes

We spend approximately one-third of our lives sleeping, but there isn’t a lot of information about what happens during these quiet hours of the night and how sleep impacts our health. One of the most common sleep disorders, sleep apnea, affects an estimated 5.4 million Canadians. The disorder occurs when muscles in the airway relax during sleep, blocking the flow of air and resulting in snoring and choking that causes the body to wake itself up.

“Sleep apnea has huge impacts on patients’ day-to-day lives. It affects their mood, relationships, capacity to do work and even increases the risk of motor vehicle accidents and workplace injuries,” notes Dr. Owen Lyons, scientist at Women’s College Research Institute (WCRI) and respirologist at Women’s College Hospital (WCH). “We also worry about the long-term risks associated with sleep apnea including an increase in the risk of heart attack, stroke, atrial fibrillation and hypertension.”

Unfortunately, the process of getting a sleep apnea diagnosis – obtaining OHIP coverage of a Continuous Positive Airway Pressure (CPAP) machine to treat the condition – can be difficult due to long wait times for assessment and diagnosis. Part of this process involves an in-hospital sleep study, which is also costly to the healthcare system and has long wait times. A solution to this problem is increasing the use of at-home sleep apnea diagnosis devices. To investigate how these at-home devices could be implemented within our healthcare system, Dr. Lyons has been studying a new care pathway with patients from the Acute Ambulatory Care Clinic (AACU) at WCH who have atrial fibrillation.

“Our colleagues in the AACU reached out to discuss how we could work together to have their patients be seen more quickly in our sleep clinic, as they know sleep apnea is a major risk factor for atrial fibrillation,” says Dr. Lyons. “We saw the opportunity to fulfill an unmet clinical need by improving the care pathway within our own hospital, as well as conduct research that is needed to fully understand the link between the two conditions.”

Traditionally, patients would need to receive a referral to set up an initial clinic visit, participate in a sleep study and have a follow-up appointment, with wait times of up to two months between each of these steps. In Dr. Lyons’ study, patients in the AACU are seen in his clinic on the same day and are also given an at-home sleep apnea diagnosis device during this appointment. To analyze the results, patients can mail back a microchip from the device. All of this reduces the number of times that patients need to come into the hospital, saving them both time and money.

“We have had very positive feedback from the patients who have participated in the study, suggesting that this new way of delivering care could help us cut down on a large percentage of people currently on wait lists for sleep studies,” adds Dr. Lyons.

Through this research, Dr. Lyons and his colleagues have also obtained new information about the link between sleep apnea and atrial fibrillation. When they looked at patients who have had to visit their family physician or the emergency department for their atrial fibrillation, they found that the individuals who have sleep apnea were more likely to have an episode of atrial fibrillation at night, compared to patients without sleep apnea who tend to have attacks during the day. By treating these patients’ sleep apnea, clinicians may also be able to reduce the chance of further attacks of atrial fibrillation.

Beyond research on sleep disorders, there is still much we don’t know about sleep in general. A new area of sleep research that WCRI scientists are investigating is focused on sleep quality after surgery and its role in recovery. Approximately one-third of the population has trouble sleeping, making it essential to understand how sleep impacts how patients feel after receiving surgery. 

Dr. Mandeep Singh and Dr. Richard Brull

“Sleep is so important to health in general, so it only makes sense that sleep quality would have implications on the perioperative experience,” says Dr. Richard Brull, senior scientist at WCRI and anesthesiologist at WCH. “However, no one has looked at how your sleep before and after surgery impacts your pain, recovery, quality of life and maybe even the outcome of the surgery.”

Last year, WCH launched its ambulatory joint replacement surgery program, which allows patients to recover at home after a joint replacement surgery while staying connected to their healthcare team using virtual technology. The virtual app reminds them to stay ahead of their pain and nausea during recovery, with reminders to take their medication even during sleep.

“Right now, we don’t have any information on what patients’ sleep quality is like when they go home after surgery, and if there is a problem,” adds Dr. Mandeep Singh, anesthesiologist and sleep medicine specialist at WCH and University Health Network. “The benefit of conducting this research at WCH is the unique ambulatory setting where we can actually measure patients’ recovery and sleep after they go home the same day as their surgery.”

While participating in the TRANSlating sleep health into QUaLity of recovery (TRANQUIL) study led by Dr. Singh, patients will be asked to wear a tracking device before and after their procedure to measure their sleep health. The device measures sleep quality metrics such as how long they sleep, what time of day they sleep and how many disruptions they experience while sleeping – all affecting how patients feel the next day.

“If we are able to show that patients are experiencing disrupted sleep that is associated with poorer outcomes, we can start by implementing simple interventions like providing ear plugs,” notes Dr. Brull. “This research will provide us with a better understanding of sleep after surgery, with findings that can be expanded to other procedures as we build upon our ambulatory surgery program.”