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
“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
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
“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
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
From Research to Practice
Designing an ideal sleep environment
Sleep plays a vital role in good health and quality sleep can protect both your physical and mental health. Creating a positive sleep environment can help promote quality sleep to allow your body to recharge at night. Try these tips to help you hit the hay:
Aim for seven to eight hours of sleep per day – limiting naps to only 20 minutes to allow for longer sleep at night.
Turn off technology to avoid the blue light and stimulation from electronics that can disrupt the ability to fall asleep.
Choose breathable fabrics for both your bed sheets and pyjamas.
Ensure your bedroom is dark, cool and quiet – consider adding ear plugs, blackout curtains or white noise to facilitate this environment.
Clean out all the clutter to reduce stress and create a sleep sanctuary that promotes rest.
Keep a sleep schedule by going to bed and waking up within 20 minutes of the same time every day.