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Kendzerska T, Murray BJ, Colelli DR, Dela Cruz GR, Gershon AS, Povitz M, Talarico R, Boulos MI. The relationship between the morningness-eveningness questionnaire and incident cancer: A historical clinical cohort study. Sleep Med 2024; 117:139-145. [PMID: 38537521 DOI: 10.1016/j.sleep.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE We conducted a retrospective cohort study to explore the relationship between chronotype measured by the total Morningness-Eveningness Questionnaire (MEQ) score and incident cancer. METHODS We used clinical and provincial health administrative data on consecutive adults who underwent a Level 1 Polysomnography (PSG) and completed the MEQ between 2010 and 2015 in an academic hospital (Ontario, Canada) and were cancer-free at baseline. Cancer status was derived from the Ontario Cancer Registry. Individuals were followed until death or March 31, 2020. We used multivariable Cox cause-specific regressions to address the research objective. RESULTS Of 3,004 individuals, 1,781 were analyzed: a median age of 54 years (IQR: 40-64) and 838 (47.1%) men. The median total MEQ score was 63 (IQR: 55-69); 61 (3.4%) were classified as evening (≤41), 536 (30.1%) as intermediate (42-58), and 1,184 (66.5%) as morning chronotypes (≥59). Over a median of 7 years (IQR: 5-8), 120 (6.7%) developed cancer. A U-shape relationship was found between the total MEQ score and an increased hazard of incident cancer, controlling for PSG measures of sleep apnea severity and sleep architecture, demographics, and comorbidities. Compared to the median of 63.0, a total MEQ score greater or less than the median was associated with an increased hazard of incident cancer, with the largest effect for those with a total score ≥76 (e.g., HR of a MEQ total score of 78 vs. 63: 2.01, 95% CI: 1.09-3.71). CONCLUSION The U-shaped curve may reflect deviations from a standard circadian tendency, which may stress biological systems and influence malignancy risk.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada; ICES, Ottawa, Toronto, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Brian J Murray
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gio R Dela Cruz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada
| | | | - Mark I Boulos
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kendzerska T, Radhakrishnan D, Amin R, Narang I, Boafo A, Robillard R, Talarico R, Blinder H, Spitale N, Katz SL. Obstructive Sleep Apnea and Mental Health Disorders in the Pediatric Population: A Retrospective Population-based Cohort Study. Ann Am Thorac Soc 2024. [PMID: 38669619 DOI: 10.1513/annalsats.202311-933oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/25/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Information is limited about the association between obstructive sleep apnea (OSA) and mental disorders in children. OBJECTIVES In children, (1) to evaluate the association between OSA and new mental healthcare encounters; (2) to compare mental healthcare encounters two years post- to pre-OSA treatment initiation. METHODS We conducted a retrospective longitudinal cohort study using Ontario health administrative data (Canada). Children (0-18 years) who underwent diagnostic polysomnography (PSG) 2009-2016 and met criteria for definition of moderate-severe OSA (PSG-OSA) were propensity score weighted by baseline characteristics and compared to children who underwent a PSG in the same period but did not meet the OSA definition (PSG-No-OSA). Children were followed until March 2021. Weighted cause-specific Cox Proportional Hazards and Modified Poisson regression models were used to compare time from PSG to first mental healthcare encounter and frequency of new mental healthcare encounters per person time, respectively. Among those who underwent adenotonsillectomy (AT) or were prescribed and claimed positive airway pressure therapy (PAP), we used age-adjusted conditional logistic regression models to compare two years post- to pre-treatment odds of mental healthcare encounters. RESULTS Of 32,791 children analyzed, 7,724 (23.6%) children met criteria for moderate-severe OSA. In PSG-OSA group, 7,080 (91.7%) were treated (AT or PAP). Compared to PSG-No-OSA, the PSG-OSA group had a shorter time from PSG to first mental healthcare encounter (HR: 1.08; 95%CI: 1.05-1.12), but less frequent mental healthcare encounters in follow-up (RR: 0.92; 95% CI: 0.87-0.97). OSA treatment (AT or PAP) was associated with lower odds of mental healthcare encounters two years post-treatment initiation compared to two years prior (OR: 0.69; 95% CI: 0.65-0.74). CONCLUSION In this large population-based study of children who underwent PSG for sleep disorder assessment, OSA diagnosis/treatment was associated with an improvement in some mental health indicators, such as fewer new mental healthcare encounters compared to no OSA, and lower odds of mental healthcare encounters compared to pre-OSA treatment.
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Affiliation(s)
- Tetyana Kendzerska
- University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada;
| | | | - Reshma Amin
- The Hospital for Sick Children, Department of Paediatrics, Toronto, Ontario, Canada
| | - Indra Narang
- Hospital for Sick Children, Respiratory Medicine, Toronto, Ontario, Canada
| | | | | | | | | | - Naomi Spitale
- Royal Ottawa Mental Health Centre, 26624, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario, Respiratory Medicine, Ottawa, Ontario, Canada
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Allen AJH, Kendzerska T, Bhatti P, Jen R, Myers R, Hajipour M, van Eeden SF, Ayas N. Obstructive sleep apnea severity, circulating biomarkers, and cancer risk. J Clin Sleep Med 2024. [PMID: 38648119 DOI: 10.5664/jcsm.11170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES To determine if obstructive sleep apnea (OSA) severity and/or biomarkers of inflammation/angiogenesis are associated with incident cancer in this clinical cohort. METHODS Consenting adult patients at the University of British Columbia Hospital between 2003-2014 completed a questionnaire about their medical history and sleep habits prior to undergoing a polysomnogram (PSG). Blood samples were collected the morning after PSG and processed for biomarkers of inflammation and angiogenesis. The clinical, PSG, and biomarker data were linked to the British Columbia Cancer Registry to ascertain incident cancer diagnoses. Cox proportional hazard regression were used to assess the association between OSA severity and biomarker concentrations with cancer risk. RESULTS A total of 1,990 patients were included in the analysis with a mean follow-up time of 12.8 years; 181 of them (9.1%) developed cancer after PSG. OSA severity was significantly associated with cancer risk after controlling for relevant covariates (hazard ratio (HR) = 1.08 per 10 events/h apnea-hypopnea index (AHI) increase, CI = 1.02-1.15, p=0.015). In an exploratory analysis, two biomarkers were significantly associated with an increased cancer risk after controlling for relevant covariates (HR per interquartile range (IQR) pg/mL increase of endostatin = 1.45, CI = 1.12-1.87, p=0.01 and HR for IQR pg/mL increase of VCAM-1 = 1.48, CI = 1.04-2.11, p=0.03, respectively). CONCLUSIONS OSA severity was an independent risk factor for cancer. Furthermore, two circulating markers were significantly associated with cancer risk. If these preliminary findings can be reproduced in other cohorts, biomarkers could potentially be used to prognosticate OSA patients with respect to cancer risk.
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Affiliation(s)
- A J Hirsch Allen
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Parveen Bhatti
- BC Cancer Research Institute, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachel Jen
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Canada
| | - Renelle Myers
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- BC Cancer Research Institute, Vancouver, Canada
| | - Mohammadreza Hajipour
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephan F van Eeden
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Najib Ayas
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Canada
- Canadian Sleep and Circadian Network, Canada
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Kendzerska T, Szyszkowicz M, Saymeh M, Mallick R, Carlsten C, Ayas NT, Laratta CR, Orach J, Dales R. Air pollution, weather and positive airway pressure treatment adherence in adults with sleep apnea: a retrospective community-based repeated-measures longitudinal study. J Sleep Res 2024:e14183. [PMID: 38439127 DOI: 10.1111/jsr.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
We assessed the relation between air pollution, weather, and adherence to positive airway pressure (PAP) therapy in a retrospective community-based repeated-measures study of adults with obstructive sleep apnea who purchased PAP devices from a registered provider between 2013 and 2017 (Ottawa, Ontario, Canada) and had at least one day of data. Daily PAP-derived data, air pollution, and weather databases were linked using postal code. The exposures were mean nocturnal (8:00 p.m. to 8:00 a.m.) (i) residential concentrations of nitrogen dioxide (NO2 ), fine particulate matter <=2.5 μm (PM2.5 ), ozone (O3 ), and Air Quality Health Index (AQHI), and (ii) temperature, relative humidity, and barometric pressure. Covariates in the main model were demographics, season, exposure year, and PAP therapy mode. We analysed 8148 adults (median age of 54 years and 61% men) and 2,071,588 days of data. Based on daily data, the median (interquartile range) daily PAP usage was 416 (323-487) min. Using mixed-effect regression analyses to incorporate daily data and clustering by individuals, we found a statistically significant decrease in adherence for increased levels of NO2 , PM2.5 , and AQHI. The largest effect was for NO2 : a decrease in daily PAP use while comparing the highest versus lowest quartiles (Qs) was 3.4 (95% confidence interval [CI] 2.8-3.9) min. Decreased PAP adherence was also associated with increased temperature (Q4 versus Q1: 2.6 [95% CI: 1.5-3.7] min) and decreased barometric pressure (Q1 versus Q4: 2.0 [95% CI 1.5-2.5] min). We observed modest but statistically significant acute effects of air pollution and weather on daily PAP adherence.
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Affiliation(s)
- Tetyana Kendzerska
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mieczysław Szyszkowicz
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Healthy Canada, Ottawa, Ontario, Canada
| | - Mouaz Saymeh
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Christopher Carlsten
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl R Laratta
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juma Orach
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Dales
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Healthy Canada, Ottawa, Ontario, Canada
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Veitch MR, Jairam S, Gurges P, Cohen E, Kendzerska T, Murray BJ, Boulos MI. Cannabinoid Use and Obstructive Sleep Apnea: A Retrospective Cohort Study. Can J Neurol Sci 2024:1-8. [PMID: 38383993 DOI: 10.1017/cjn.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a sleep disorder with no widely accepted pharmacological therapy. Cannabinoids have been suggested to reduce OSA severity in small human studies. The purpose of this retrospective cohort study was to explore the association of self-reported cannabis use on OSA severity and sleep parameters in a large cohort of adults undergoing in-laboratory polysomnography. METHODS Sleep and medication data were collected for all consecutive adults who completed diagnostic polysomnography at Sunnybrook Health Sciences Centre from 2010 to 2022. Multivariable linear regression models were employed that adjusted for age, sex, and BMI (minimally adjusted model), as well as medication and comorbidity data (maximally adjusted model). An exploratory subgroup analysis was additionally run in patients with moderate to severe OSA. RESULTS Of 6,958 individuals (mean age 54.7 ± 16.3, BMI 29.1 ± 6.8, 51.0% female), 71 reported cannabis use. In our minimally adjusted models, cannabis use predicted a reduced respiratory disturbance index (RDI) (β: -4.8 [95% CI: -9.4, -0.2]; p = 0.042); this association became nonsignificant in the fully adjusted models. In an exploratory analysis of patients with moderate to severe OSA (n = 613), cannabis use (n = 7) predicted increased stage N3 sleep (β: 33.5 [95% CI: 15.6, 51.4]; p < 0.001) and decreased REM sleep (β: 16.0 [95% CI: 0.3, 31.7]; p = 0.046). CONCLUSION Self-reported cannabis use was not associated with OSA severity after adjusting for confounders. In an exploratory subgroup analysis of patients with moderate to severe OSA, cannabis use impacted sleep architecture. Future studies should further explore these findings.
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Affiliation(s)
- Matthew R Veitch
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sean Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick Gurges
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elliott Cohen
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Kwok C, Thavorn K, Amjadi K, Aaron SD, Kendzerska T. Resource Use and Costs of Indwelling Pleural Catheters vs Pleurodesis for Malignant Pleural Effusions: A Population-based Study. Ann Am Thorac Soc 2024. [PMID: 38381853 DOI: 10.1513/annalsats.202304-333oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
RATIONALE Malignant pleural effusions (MPE) are associated with significant health service use and healthcare costs, but the current evidence is limited. OBJECTIVES To compare 12-month post-procedure: (1) health service utilization, and (2) healthcare costs following indwelling pleural catheter (IPC) insertion with at-home drainage performed by homecare nursing services, versus in-hospital chemical pleurodesis. METHODS We performed a retrospective population-based study on a cohort of adults with MPE who underwent IPC insertion or chemical pleurodesis between January 1, 2015 and December 31, 2019 using provincial health administrative data (Ontario, Canada). Patients were followed from the procedure date until death or until 12-month post-procedure. Inverse probability of treatment weighting (IPTW) was performed to adjust for imbalances in baseline characteristics. Differences in length of stay (LOS), readmissions, emergency department visits, home care visits, and healthcare costs were estimated using weighted regression analysis. RESULTS Of 5,752 included individuals, 4432 (77%) underwent IPC insertion and 1320 (23%) had pleurodesis. In the weighted sample, individuals who received an IPC had fewer inpatient days (12.4 days vs 16 days, standardized mean difference 0.229), but a higher proportion of subsequent admissions for empyema (2.7% vs 1.1%, p=0.0002) compared to those undergoing pleurodesis. IPC individuals received more hours of nursing home care (41 hours vs 21.1 hours, standardized mean difference 0.671) but overall had lower average healthcare costs ($40,179 vs $46,640 per patient, standardized mean difference 0.177) than those receiving pleurodesis. CONCLUSIONS IPCs with home nursing drainage are associated with reduced health resource use compared to pleurodesis in adults with MPE even after controlling for important baseline and clinical characteristics. Given that both procedures have similar health outcomes, our findings support the ongoing promotion of IPCs to increase outpatient management of patients with MPEs. Primary source of funding: TOHAMO Innovation Fund grant.
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Affiliation(s)
- Chanel Kwok
- Ottawa Hospital, 27337, Department of Medicine, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada;
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, 10055, Ottawa, Canada
- ICES, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Kayvan Amjadi
- Ottawa Hospital, 27337, Medicine, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital, 27337, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
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Youssef M, Sundaram ANE, Veitch M, Aziz A, Gurges P, Bingeliene A, Tyndel F, Kendzerska T, Murray BJ, Boulos MI. Obstructive sleep apnea in those with idiopathic intracranial hypertension undergoing diagnostic in-laboratory polysomnography. Sleep Med 2024; 114:279-289. [PMID: 38245928 DOI: 10.1016/j.sleep.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
RATIONALE The association of obstructive sleep apnea (OSA) with idiopathic intracranial hypertension (IIH) remains unclear, and few studies have used objective in-laboratory polysomnography (PSG) data. Thus, we used PSG data to examine the: 1) association between OSA, and its severity, with IIH and 2) sex differences in OSA severity in those with and without IIH. METHODS We retrospectively analyzed diagnostic PSG data from January 2015 to August 2023 for patients who were diagnosed with IIH by a neuro-ophthalmologist using the modified Dandy criteria. We selected three age, sex, and body mass index (BMI) matched controls for each IIH patient. We examined potential associations of IIH with OSA using regression. Sex differences were analyzed using ANOVA. RESULTS Of 3482 patients who underwent PSG, we analyzed 78 IIH patients (16 males) and 234 matched controls (48 males). Five (6.4 %) IIH and 39 (16.7 %) control patients had OSA, defined as AHI≥15. After adjusting for age, sex, BMI, and comorbidities, IIH was negatively associated with the presence of OSA (OR 0.29, 95%CI 0.10-0.87, p = 0.03). However, models that adjusted for acetazolamide use, with or without comorbidities, showed no significant relationship with OSA (OR 0.31, p = 0.20). Males with IIH had a significantly higher age (p = 0.020), OSA severity (p = 0.032), and arousal index (p = 0.046) compared to females with IIH. CONCLUSIONS IIH treated with acetazolamide was not an independent risk factor for OSA presence or severity. The presence of IIH treated with acetazolamide likely does not warrant routine screening for OSA, but related risk factors may identify appropriate patients.
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Affiliation(s)
- Mark Youssef
- Department of Medicine, Division of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Arun N E Sundaram
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Matthew Veitch
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arpsima Aziz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick Gurges
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arina Bingeliene
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Felix Tyndel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Division of Respirology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Sleep Center, The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Hajipour M, Hirsch Allen AJ, Beaudin AE, Raneri JK, Jen R, Foster GE, Fogel S, Kendzerska T, Series F, Skomro RP, Robillard R, Kimoff RJ, Hanly PJ, Fels S, Singh A, Azarbarzin A, Ayas NT. All Obstructive Sleep Apnea Events Are Not Created Equal: The Relationship Between Event-related Hypoxemia and Physiologic Response. Ann Am Thorac Soc 2024. [PMID: 38252424 DOI: 10.1513/annalsats.202309-777oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/22/2024] [Indexed: 01/23/2024] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) severity is typically assessed by the apnea-hypopnea index (AHI), a frequency-based metric that allocates equal weight to all respiratory events. However, more severe events may have a greater physiologic impact. OBJECTIVE The purpose of this study was to determine whether the degree of event-related hypoxemia would be associated with the post-event physiologic response. METHODS OSA patients (AHI>5/h) from the multi-center Canadian Sleep and Circadian Network cohort were studied. Using mixed-effect linear regression, we examined associations between event-related hypoxic burden (HBev) assessed by the area under the event-related oxygen saturation recording with heart rate changes (ΔHRev), vasoconstriction (vasoconstriction burden (VCBev) assessed with photoplethysmography), and electroencephalographic responses (power ratio before and after events). RESULTS Polysomnography recordings from 658 patients (Median [IQR] age= 55.00 [45.00, 64.00] years, AHI= 27.15 [14.90, 64.05] event/h, 42% female) were included in the analyses. HBev was associated with an increase in all physiologic responses after controlling for age, sex, body mass index (BMI), sleep stage, total sleep time, and study centers; for example, one standard deviation (SD) increase in HBev was associated with a 0.21 [95% CI: 0.2, 0.22], 0.08 [0.08, 0.09] and 0.22 [0.21, 0.23] SD increase in ΔHRev, VCBev and Beta power ratio respectively). CONCLUSION Increased event-related hypoxic burden was associated with greater responses across a broad range of physiologic signals. Future metrics that incorporate information about the variability of these physiologic responses may have promise in providing a more nuanced assessment of OSA severity.
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Affiliation(s)
- Mohammadreza Hajipour
- The University of British Columbia, 8166, Experimental Medicine, Vancouver, British Columbia, Canada
| | - A J Hirsch Allen
- The University of British Columbia, 8166, Experimental Medicine, Vancouver, British Columbia, Canada
| | - Andrew E Beaudin
- University of Calgary, 2129, Clinical Neurosciences, Calgary, Alberta, Canada
| | - Jill K Raneri
- University of Calgary, 2129, Medicine, Calgary, Alberta, Canada
| | - Rachel Jen
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Glen E Foster
- The University of British Columbia, 8166, Health and Exercise Science, Vancouver, British Columbia, Canada
| | - Stuart Fogel
- University of Ottawa, 6363, Ottawa, Ontario, Canada
| | | | - Fréderic Series
- Laval University Faculty of Medicine, 12369, Quebec, Quebec, Canada
| | - Robert P Skomro
- University of Saskatchewan, 7235, Division of Respirology, Critical Care and Sleep Medicine, Saskatoon, Saskatchewan, Canada
| | | | | | - Patrick J Hanly
- University of Calgary, 2129, Medicine, Calgary, Alberta, Canada
| | - Sidney Fels
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Amrit Singh
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Ali Azarbarzin
- Brigham and Women's Hospital, 1861, Boston, Massachusetts, United States
| | - Najib T Ayas
- The University of British Columbia, 8166, Medicine, Vancouver, British Columbia, Canada;
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Vargas ME, Gershon AS, Pugliese M, Gotfrit RJ, Manuel D, Sadatsafavi M, Stukel TA, To T, Kendall CE, Thavorn K, Robillard R, Kendzerska T. Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study. Can J Neurol Sci 2023:1-11. [PMID: 38115804 DOI: 10.1017/cjn.2023.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death. METHODS Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models. RESULTS In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction p-values <.0001). CONCLUSION We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.
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Affiliation(s)
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Ryan Jason Gotfrit
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada
| | - Therese A Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire E Kendall
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study. Front Public Health 2023; 11:1251020. [PMID: 38169852 PMCID: PMC10759216 DOI: 10.3389/fpubh.2023.1251020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs). Methods We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates. Results Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year. Conclusion This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - David T. Zhu
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Therese A. Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Melanie Chin
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Claire E. Kendall
- ICES, Ottawa, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- The Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Andrea S. Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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11
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Fakhraei R, Matelski J, Gershon A, Kendzerska T, Lapointe-Shaw L, Kaneswaran L, Wu R. Development of Multivariable Prediction Models for the Identification of Patients Admitted to Hospital with an Exacerbation of COPD and the Prediction of Risk of Readmission: A Retrospective Cohort Study using Electronic Medical Record Data. COPD 2023; 20:274-283. [PMID: 37555513 DOI: 10.1080/15412555.2023.2242493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Approximately 20% of patients who are discharged from hospital for an acute exacerbation of COPD (AECOPD) are readmitted within 30 days. To reduce this, it is important both to identify all individuals admitted with AECOPD and to predict those who are at higher risk for readmission. OBJECTIVES To develop two clinical prediction models using data available in electronic medical records: 1) identifying patients admitted with AECOPD and 2) predicting 30-day readmission in patients discharged after AECOPD. METHODS Two datasets were created using all admissions to General Internal Medicine from 2012 to 2018 at two hospitals: one cohort to identify AECOPD and a second cohort to predict 30-day readmissions. We fit and internally validated models with four algorithms. RESULTS Of the 64,609 admissions, 3,620 (5.6%) were diagnosed with an AECOPD. Of those discharged, 518 (15.4%) had a readmission to hospital within 30 days. For identification of patients with a diagnosis of an AECOPD, the top-performing models were LASSO and a four-variable regression model that consisted of specific medications ordered within the first 72 hours of admission. For 30-day readmission prediction, a two-variable regression model was the top performing model consisting of number of COPD admissions in the previous year and the number of non-COPD admissions in the previous year. CONCLUSION We generated clinical prediction models to identify AECOPDs during hospitalization and to predict 30-day readmissions after an acute exacerbation from a dataset derived from available EMR data. Further work is needed to improve and externally validate these models.
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Affiliation(s)
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Andrea Gershon
- University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Respirology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Tetyana Kendzerska
- Division of Respirology, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lauren Lapointe-Shaw
- University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | | | - Robert Wu
- University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
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12
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Iskander A, Jairam T, Wang C, Kendzerska T, Murray BJ, Boulos MI. Corrigendum to "Normal multiple sleep latency test values in adults: A systematic review and meta-analysis" [Sleep Med 109 (2023) 143-148]. Sleep Med 2023; 110:179. [PMID: 37611489 DOI: 10.1016/j.sleep.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Andrew Iskander
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christine Wang
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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13
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Colelli DR, Dela Cruz GR, Kendzerska T, Murray BJ, Boulos MI. Impact of sleep chronotype on in-laboratory polysomnography parameters. J Sleep Res 2023; 32:e13922. [PMID: 37150591 DOI: 10.1111/jsr.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
Morningness-eveningness preference, also known as chronotype, is the tendency for a person to sleep during certain hours of the day and is broadly categorised into morning and evening types. In-laboratory polysomnography (iPSG) is the gold-standard to assess sleep, however, an individual's chronotype is not accounted for in current protocols, which may confound collected sleep data. The objective of our study was to assess if chronotype had an association with sleep physiology. Patients who completed the diagnostic iPSG and the Morningness-Eveningness Questionnaire (MEQ), which categorises patients into morning type, neither or evening type, were assessed. Multivariable linear regression models were used to assess if chronotype was associated with sleep quality, duration, and physiology during iPSG. The study sample included 2612 patients (mean age of 53.6 years, 48% male) recruited during 2010-2015. Morning type, compared with neither type, was significantly associated with an increase in total sleep time and rapid eye movement (REM) sleep, and a decrease in sleep onset latency and the arousal index. Evening type, compared with neither type, was significantly associated with a decrease in total sleep time, sleep efficiency, and REM sleep, and an increase in sleep onset latency and wake after sleep onset. Additionally, iPSG lights out time was significantly different between the different chronotypes. Overall, a morningness chronotype was associated with favourable sleep quality and duration while an eveningness chronotype was associated with reduced sleep quality. Our study quantifies the association of chronotype with iPSG metrics and suggests that laboratory protocols should consider chronotype in their evaluations.
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Affiliation(s)
- David R Colelli
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Gio R Dela Cruz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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14
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Kendzerska T, Povitz M, Gershon AS, Ryan CM, Talarico R, Franco Avecilla DA, Robillard R, Ayas NT, Pendharkar SR. Association of clinically significant obstructive sleep apnoea with risks of contracting COVID-19 and serious COVID-19 complications: a retrospective population-based study of health administrative data. Thorax 2023; 78:933-941. [PMID: 36717242 DOI: 10.1136/thorax-2022-219574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
RATIONALE/OBJECTIVES Despite plausible pathophysiological mechanisms, more research is needed to confirm the relationship between obstructive sleep apnoea (OSA) and the risk of COVID-19 infection or COVID-19-related serious complications. METHODS We conducted a retrospective population-based cohort study using provincial health administrative data (Ontario, Canada). Adults with physician-diagnosed OSA who received positive airway pressure therapy in the 5 years prepandemic (OSA group) were propensity score matched by baseline characteristics to individuals in the general population at low risk of OSA (non-OSA group) using inverse probability of treatment weighting. Weighted HRs of (1) a positive COVID-19 test and (2) COVID-19-related emergency department (ED) visits, hospitalisations, intensive care unit (ICU) admissions and mortality, within 12 months of pandemic onset, were compared between groups. We also evaluated the impact of comorbid cardiometabolic or chronic airways disease. RESULTS We identified and matched 324 029 individuals in the OSA group to 4 588 200 individuals in the non-OSA group. Compared with the non-OSA group, those in the OSA group were at a greater hazard of testing positive for COVID-19 (HR=1.17, 95% CI 1.13 to 1.21), having a COVID-19-related ED visit (HR=1.62, 95% CI 1.51 to 1.73), hospitalisation (HR=1.50, 95% CI 1.37 to 1.65) or ICU admission (HR=1.53, 95% CI 1.27 to 1.84). COVID-19-related 30-day mortality was not different (HR=0.98, 95% CI 0.82 to 1.16).We found that for the OSA group, comorbid airways disease but not cardiometabolic conditions increased the hazards of COVID-19-related outcomes, including mortality. CONCLUSION In this large population-based study, we demonstrated that a recent diagnosis of OSA requiring treatment was associated with an increased hazard of testing positive for COVID-19 and serious COVID-19-related complications, particularly in those with co-existing chronic airways disease.
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Affiliation(s)
- Tetyana Kendzerska
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea S Gershon
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sleep Research Laboratory, Toronto Rehabilitation Institute University Health Network, Toronto, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | | | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Kendzerska T, Murray BJ, Gershon AS, Povitz M, McIsaac DI, Bryson GL, Talarico R, Hilton J, Malhotra A, Leung RS, Boulos MI. Polysomnographic Assessment of Sleep Disturbances in Cancer Development: A Historical Multicenter Clinical Cohort Study. Chest 2023; 164:517-530. [PMID: 36907376 PMCID: PMC10475821 DOI: 10.1016/j.chest.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk. RESEARCH QUESTION What is the association between polysomnographic measures of sleep disturbances and incident cancer, and what is the validity of cluster analysis in identifying polysomnography phenotypes? STUDY DESIGN AND METHODS We conducted a retrospective multicenter cohort study using linked clinical and provincial health administrative data on consecutive adults free of cancer at baseline with polysomnography data collected between 1994 and 2017 in four academic hospitals in Ontario, Canada. Cancer status was derived from registry records. Polysomnography phenotypes were identified by k-means cluster analysis. A combination of validation statistics and distinguishing polysomnographic features was used to select clusters. Cox cause-specific regressions were used to assess the relationship between identified clusters and incident cancer. RESULTS Among 29,907 individuals, 2,514 (8.4%) received a diagnosis of cancer over a median of 8.0 years (interquartile range, 4.2-13.5 years). Five clusters were identified: mild (mildly abnormal polysomnography findings), poor sleep, severe OSA or sleep fragmentation, severe desaturations, and periodic limb movements of sleep (PLMS). The associations between cancer and all clusters compared with the mild cluster were significant while controlling for clinic and year of polysomnography. When additionally controlling for age and sex, the effect remained significant only for PLMS (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.06-1.50) and severe desaturations (aHR, 1.32; 95% CI, 1.04-1.66). Further controlling for confounders, the effect remained significant for PLMS, but was attenuated for severe desaturations. INTERPRETATION In a large cohort, we confirmed the importance of polysomnographic phenotypes and highlighted the role that PLMS and oxygenation desaturation may play in cancer. Using this study's findings, we also developed an Excel (Microsoft) spreadsheet (polysomnography cluster classifier) that can be used to validate the identified clusters on new data or to identify which cluster a patient belongs to. TRIAL REGISTRY ClinicalTrials.gov; Nos.: NCT03383354 and NCT03834792; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; ICES, Ottawa, ON, Canada.
| | - Brian J Murray
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrea S Gershon
- ICES, Ottawa, ON, Canada; Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada; Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marcus Povitz
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; ICES, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada
| | - Gregory L Bryson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada
| | | | - John Hilton
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada
| | - Atul Malhotra
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Richard S Leung
- Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Mark I Boulos
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Sharma S, Dolean V, Jolivet P, Robinson B, Edwards JD, Kendzerska T, Sarkar A. Scalable computational algorithms for geospatial COVID-19 spread using high performance computing. Math Biosci Eng 2023; 20:14634-14674. [PMID: 37679152 DOI: 10.3934/mbe.2023655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
A nonlinear partial differential equation (PDE) based compartmental model of COVID-19 provides a continuous trace of infection over space and time. Finer resolutions in the spatial discretization, the inclusion of additional model compartments and model stratifications based on clinically relevant categories contribute to an increase in the number of unknowns to the order of millions. We adopt a parallel scalable solver that permits faster solutions for these high fidelity models. The solver combines domain decomposition and algebraic multigrid preconditioners at multiple levels to achieve the desired strong and weak scalabilities. As a numerical illustration of this general methodology, a five-compartment susceptible-exposed-infected-recovered-deceased (SEIRD) model of COVID-19 is used to demonstrate the scalability and effectiveness of the proposed solver for a large geographical domain (Southern Ontario). It is possible to predict the infections for a period of three months for a system size of 186 million (using 3200 processes) within 12 hours saving months of computational effort needed for the conventional solvers.
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Affiliation(s)
- Sudhi Sharma
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Victorita Dolean
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
- Laboratoire J.A. Dieudonné, CNRS, Université Côte d'Azur, Nice, France
| | | | - Brandon Robinson
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa and University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, Division of Respirology, University of Ottawa, Ottawa, Ontario, Canada
| | - Abhijit Sarkar
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
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17
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Hundemer GL, Imsirovic H, Kendzerska T, Vaidya A, Leung AA, Kline GA, Goupil R, Madore F, Agharazii M, Knoll G, Sood MM. Screening for Primary Aldosteronism Among Hypertensive Adults with Obstructive Sleep Apnea: A Retrospective Population-Based Study. Am J Hypertens 2023; 36:363-371. [PMID: 36827468 PMCID: PMC10267649 DOI: 10.1093/ajh/hpad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Hypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice. METHODS We conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling. RESULTS The study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care. CONCLUSIONS The population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.
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Affiliation(s)
- Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
| | - Haris Imsirovic
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
| | - Tetyana Kendzerska
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory A Kline
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rémi Goupil
- Division of Nephrology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - François Madore
- Division of Nephrology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Mohsen Agharazii
- Division of Nephrology, Department of Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Myran D, Milani C, Pugliese M, Hensel JM, Sood M, Kendall CE, Kendzerska T, Tanuseputro P. Physician benzodiazepine self-use prior to and during the COVID-19 pandemic in Ontario, Canada: a population-level cohort study. BMJ Open 2023; 13:e062742. [PMID: 37085307 PMCID: PMC10123848 DOI: 10.1136/bmjopen-2022-062742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate physician benzodiazepine (BZD) self-use pre-COVID-19 pandemic and to examine changes in BZD self-use during the first year of the pandemic. DESIGN Population-based retrospective cohort study using linked routinely collected administrative health data comparing the first year of the pandemic to the period before the pandemic. SETTING Province of Ontario, Canada between March 2016 and March 2021. PARTICIPANTS INTERVENTION: Onset of the COVID-19 pandemic in March 2020. OUTCOMES MEASURES The primary outcome measure was the receipt of one or more prescriptions for BZD, which was captured via the Narcotics Monitoring System. RESULTS In a cohort of 30 798 physicians (mean age 42, 47.8% women), we found that during the year before the pandemic, 4.4% of physicians had 1 or more BZD prescriptions. Older physicians (6.8% aged 50+ years), female physicians (5.1%) and physicians with a prior mental health (MH) diagnosis (12.4%) were more likely than younger (3.7% aged <50 years), male physicians (3.8%) and physicians without a prior MH diagnosis (2.9%) to have received 1 or more BZD prescriptions. The first year of the COVID-19 pandemic was associated with a 10.5% decrease (adjusted OR (aOR) 0.85, 95% CI: 0.80 to 0.91) in the number of physicians with 1 or more BZD prescriptions compared with the year before the pandemic. Female physicians were less likely to reduce BZD self-use (aORfemale=0.90, 95% CI: 0.83 to 0.98) compared with male physicians (aORmale=0.79, 95% CI: 0.72 to 0.87, pinteraction=0.046 during the pandemic. Physicians presenting with an incident MH visit had higher odds of filling a BZD prescription during COVID-19 compared with the prior year. CONCLUSIONS Physicians' BZD prescriptions decreased during the first year of the COVID-19 pandemic in Ontario, Canada. These findings suggest that previously reported increases in mental distress and MH visits among physicians during the pandemic did not lead to greater self-use of BZDs.
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Affiliation(s)
- Daniel Myran
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Christina Milani
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Division of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
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Kendzerska T, Gershon AS. One Size Does Not Fit All: Risk Stratification for COPD Exacerbations. Chest 2023; 163:733-735. [PMID: 37031974 DOI: 10.1016/j.chest.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, Ottawa Hospital Research Institute/University of Ottawa, Ottawa, ON, Canada.
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Center, Toronto, ON, Canada
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20
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Jeffers MS, Pittman AC, Kendzerska T, Corbett D, Hayward KS, Chen Y. Self-reported sleep disturbances among people who have had a stroke: a cross-sectional analysis. CMAJ 2023; 195:E354-E362. [PMID: 36918185 PMCID: PMC10120422 DOI: 10.1503/cmaj.221063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Sleep disturbances and their potential association with stroke remains understudied at a population level. We sought to determine the prevalence of sleep disturbances among people who have effects of stroke compared with the general population. METHODS We used data from people aged 18 years or older who responded to the sleep and chronic disease modules of the 2017-2018 cycle of the Canadian Community Health Survey (CCHS). We measured sleep disturbances by self-reports of having trouble staying awake most or all of the time; either short (< 5 h) or long (> 9 h) nightly sleep duration; having trouble going to or staying asleep most or all of the time; and never, rarely or sometimes having refreshing sleep. We used log-binomial and multinomial regression to investigate prevalence of sleep disturbances among respondents who reported effects of stroke compared with others, adjusting for confounding factors. RESULTS We included 46 404 CCHS respondents, 682 of whom reported effects of stroke. The prevalence of sleep disturbances for those with effects of stroke was higher than among others in the sample with regard to trouble staying awake (13.0% v. 6.1%; adjusted relative risk [RR] 2.16, 95% confidence interval [CI] 1.59-2.94), short or long duration sleep (28.9% v. 10.0%; adjusted RR 1.93, 95% CI 1.57-2.38), trouble going to or staying asleep, (28.1% v. 17.6%; adjusted RR 1.53, 95% CI 1.28-1.83) and lack of refreshing sleep (41.1% v. 37.1%; adjusted RR 1.30, 95% CI 1.14-1.49). The prevalence of at least 1 reported measure of sleep disturbance was 61.6% among those with effects of stroke, compared with 48.2% among others (adjusted RR 1.28, 95% CI 1.18-1.40). INTERPRETATION Self-report of having effects of stroke was associated with increased prevalence of sleep disturbances compared with the general population. Sleep disturbances were reported by a high proportion of respondents with effects of stroke, indicating the importance of screening for related disorders.
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Affiliation(s)
- Matthew S Jeffers
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
| | - Alison C Pittman
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
| | - Tetyana Kendzerska
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
| | - Dale Corbett
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
| | - Kathryn S Hayward
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
| | - Yue Chen
- School of Epidemiology and Public Health (Jeffers, Kendzerska, Chen), University of Ottawa; Clinical Epidemiology Program (Jeffers, Kendzerska), Ottawa Hospital Research Institute; Department of Family Medicine (Pittman), University of Ottawa; Department of Medicine (Kendzerska), Ottawa Hospital Research Institute, University of Ottawa; Department of Cellular and Molecular Medicine (Corbett), University of Ottawa, Ottawa, Ont.; Departments of Physiotherapy and of Medicine, and Florey Institute of Neuroscience and Mental Health (Hayward), University of Melbourne, Melbourne, Australia
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21
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Lee G, Dharmakulaseelan L, Muir RT, Iskander C, Kendzerska T, Boulos MI. Obstructive sleep apnea is associated with markers of cerebral small vessel disease in a dose-response manner: A systematic review and meta-analysis. Sleep Med Rev 2023; 68:101763. [PMID: 36805589 DOI: 10.1016/j.smrv.2023.101763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Cerebral small vessel disease manifests on neuroimaging as white matter hyperintensities, lacunes, cerebral microbleeds, perivascular spaces or subcortical infarcts and is a major contributor to dementia, stroke and incident death. We aimed to determine whether obstructive sleep apnea severity is associated cerebral small vessel disease. A systematic search was conducted for studies examining the association between obstructive sleep apnea and cerebral small vessel disease markers. A random-effects model was used to meta-analyze unadjusted odds ratios derived from event rates. The neuroimaging-derived measures of white matter hyperintensities, lacunes, and cerebral microbleeds were compared against increasing obstructive sleep apnea severity, as measured by apnea-hypopnea indices of <5, 5-15, ≥15 and ≥ 30. Thirty-two observational studies were included: ten reported effect sizes for white matter hyperintensities, nine for lacunes and three for cerebral microbleeds. Compared to patients without obstructive sleep apnea, the odds of possessing white matter hyperintensities were 1.7 [95% confidence interval 0.9-3.6] in mild, 3.9 [2.7-5.5] in moderate-severe and 4.3 [1.9-9.6] in severe obstructive sleep apnea. Moderate-severe obstructive sleep apnea was associated with a higher risk of lacunar infarcts. Obstructive sleep apnea had no association with cerebral microbleeds and an indeterminate association with perivascular spaces and subcortical infarcts due to insufficient data.
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Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan T Muir
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Carol Iskander
- Faculty of Medicine, The National University of Ireland, Galway, Ireland
| | - Tetyana Kendzerska
- Department of Medicine, Division of Respirology, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Mark I Boulos
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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22
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Chin M, Kendzerska T, Inoue J, Aw M, Mardiros L, Pease C, Andrew MK, Pakhale S, Forster AJ, Mulpuru S. Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation. JAMA Netw Open 2023; 6:e2253692. [PMID: 36729458 PMCID: PMC9896302 DOI: 10.1001/jamanetworkopen.2022.53692] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Frailty is associated with severe morbidity and mortality among people with chronic obstructive pulmonary disease (COPD). Interventions such as pulmonary rehabilitation can treat and reverse frailty, yet frailty is not routinely measured in pulmonary clinical practice. It is unclear how population-based administrative data tools to screen for frailty compare with standard bedside assessments in this population. OBJECTIVE To determine the agreement between the Hospital Frailty Risk Score (HFRS) and the Clinical Frailty Scale (CFS) among hospitalized individuals with COPD and to determine the sensitivity and specificity of the HFRS (vs CFS) to detect frailty. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was conducted among hospitalized patients with COPD exacerbation. The study was conducted in the respiratory ward of a single tertiary care academic hospital (The Ottawa Hospital, Ottawa, Ontario, Canada). Participants included consenting adult inpatients who were admitted with a diagnosis of acute COPD exacerbation from December 2016 to June 2019 and who used a clinical care pathway for COPD. There were no specific exclusion criteria. Data analysis was performed in March 2022. EXPOSURE Degree of frailty measured by the CFS. MAIN OUTCOMES AND MEASURES The HFRS was calculated using hospital administrative data. Primary outcomes were the sensitivity and specificity of the HFRS to detect frail and nonfrail individuals according to CFS assessments of frailty, and the secondary outcome was the optimal probability threshold of the HFRS to discriminate frail and nonfrail individuals. RESULTS Among 99 patients with COPD exacerbation (mean [SD] age, 70.6 [9.5] years; 56 women [57%]), 14 (14%) were not frail, 33 (33%) were vulnerable, 18 (18%) were mildly frail, and 34 (34%) were moderately to severely frail by the CFS. The HFRS (vs CFS) had a sensitivity of 27% and specificity of 93% to detect frail vs nonfrail individuals. The optimal probability threshold for the HFRS was 1.4 points or higher. The corresponding sensitivity to detect frailty was 69%, and the specificity was 57%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, using the population-based HFRS to screen for frailty yielded poor detection of frailty among hospitalized patients with COPD compared with the bedside CFS. These findings suggest that use of the HFRS in this population may result in important missed opportunities to identify and provide early intervention for frailty, such as pulmonary rehabilitation.
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Affiliation(s)
- Melanie Chin
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jiro Inoue
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Aw
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Mardiros
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Pease
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Smita Pakhale
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alan J. Forster
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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23
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Kenny S, Robillard R, Saad M, Kendzerska T, Higginson C, Pennestri MH. Sleep in People with Current and Past Eating Disorders during the COVID-19 Pandemic. Sleep Med 2022. [PMCID: PMC9300189 DOI: 10.1016/j.sleep.2022.05.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Kenny
- McGill University, Educational & Counselling Psychology, Montreal, Canada,Hôpital en santé mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, Canada
| | - R. Robillard
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - M. Saad
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - T. Kendzerska
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - C. Higginson
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - M.-H. Pennestri
- McGill University, Educational & Counselling Psychology, Montreal, Canada,Hôpital en santé mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, Canada
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24
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in all-cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID-19 pandemic: A population-based study. J Hosp Med 2022; 17:726-737. [PMID: 35929531 PMCID: PMC9539068 DOI: 10.1002/jhm.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. OBJECTIVES To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021). DESIGN, SETTING AND PARTICIPANTS We conducted a population-based study using provincial health administrative data on general adul population (Ontario, Canada). OUTCOMES AND MEASURES Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series autoregressive integrated moving-average models. RESULTS Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020-except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64-5433.46]) and then returned to expected in June 2020.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- ICESOntarioCanada
| | - David T. Zhu
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Michael Pugliese
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Douglas Manuel
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical SciencesThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Marcus Povitz
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Therese A. Stukel
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | - Teresa To
- ICESOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
| | - Shawn D. Aaron
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sunita Mulpuru
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Melanie Chin
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Claire E. Kendall
- ICESOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | - Kednapa Thavorn
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOntarioCanada
| | | | - Andrea S. Gershon
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
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25
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Murkar A, Kendzerska T, Shlik J, Quilty L, Saad M, Robillard R. Increased cannabis intake during the COVID-19 pandemic is associated with worsening of depression symptoms in people with PTSD. BMC Psychiatry 2022; 22:554. [PMID: 35978287 PMCID: PMC9382626 DOI: 10.1186/s12888-022-04185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some evidence suggests substance use affects clinical outcomes in people with posttraumatic stress disorder (PTSD). However, more work is required to examine links between mental health and cannabis use in PTSD during exposure to external stressors such as the COVID-19 pandemic. This study assessed mental health factors in individuals with self-reported PTSD to: (a) determine whether stress, anxiety, and depression symptoms were associated with changes in cannabis consumption across the pandemic, and (b) to contrast the degree to which clinically significant perceived symptom worsening was associated with changes in cannabis intake. METHOD Data were obtained as part of a larger web-based population survey from April 3rd to June 24th 2020 (i.e., first wave of the pandemic in Canada). Participants (N = 462) with self-reported PTSD completed questionnaires to assess mental health symptoms and answered questions pertaining to their cannabis intake. Participants were categorized according to whether they were using cannabis or not, and if using, whether their use frequency increased, decreased, or remained unchanged during the pandemic. RESULTS Findings indicated an overall perceived worsening of stress, anxiety, and depression symptoms across all groups. A higher-than-expected proportion of individuals who increased their cannabis consumption reached threshold for minimal clinically important worsening of depression, X2(3) = 10.795, p = 0.013 (Cramer's V = 0.166). CONCLUSION Overall, those who increased cannabis use during the pandemic were more prone to undergo meaningful perceived worsening of depression symptoms. Prospective investigations will be critical next steps to determine the directionality of the relationship between cannabis and depressive symptoms.
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Affiliation(s)
- A. Murkar
- grid.28046.380000 0001 2182 2255University of Ottawa Institute of Mental Health Research at The Royal, Sleep Research Unit, 1145 Carling Ave, ON K1Z 7K4 Ottawa, Canada
| | - T. Kendzerska
- grid.412687.e0000 0000 9606 5108The Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - J. Shlik
- grid.414622.70000 0001 1503 7525The Royal Ottawa Mental Health Centre, Ottawa, ON Canada
| | - L. Quilty
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - M. Saad
- grid.28046.380000 0001 2182 2255University of Ottawa Institute of Mental Health Research at The Royal, Sleep Research Unit, 1145 Carling Ave, ON K1Z 7K4 Ottawa, Canada
| | - R. Robillard
- grid.28046.380000 0001 2182 2255University of Ottawa Institute of Mental Health Research at The Royal, Sleep Research Unit, 1145 Carling Ave, ON K1Z 7K4 Ottawa, Canada ,grid.28046.380000 0001 2182 2255University of Ottawa School of Psychology, ON Ottawa, Canada
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Jiang L, Kendzerska T, Aaron SD, Stukel TA, Stanbrook MB, Tan W, Pequeno P, Gershon AS. Prescription Pathways from Initial Medication Use to Triple Therapy in Older COPD Patients: A Real-World Population Study. COPD 2022; 19:315-323. [PMID: 35946353 DOI: 10.1080/15412555.2022.2087616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Triple therapy with an inhaled corticosteroid (ICS), a long-acting β2-agonist bronchodilator (LABA) and a long-acting muscarinic antagonist (LAMA) is recommended as step-up therapy for chronic obstructive pulmonary disease (COPD) patients who continue to have persistent symptoms and increased risk of exacerbation despite treatment with dual therapy. We sought to evaluate different treatment pathways through which COPD patients were escalated to triple therapy. METHODS We used population health databases from Ontario, Canada to identify individuals aged 66 or older with COPD who started triple therapy between 2014 and 2017. Median time from diagnosis to triple therapy was estimated using the Kaplan-Meier method. We classified treatment pathways based on treatments received prior to triple therapy and evaluated whether pathways differed by exacerbation history, blood eosinophil counts or time period. RESULTS Among 4108 COPD patients initiating triple therapy, only 41.2% had a COPD exacerbation in the year prior. The three most common pathways were triple therapy as initial treatment (32.5%), LAMA to triple therapy (29.8%), and ICS + LABA to triple therapy (15.4%). Median time from diagnosis to triple therapy was 362 days (95% confidence interval:331-393 days) overall, but 14 days (95% CI 12-17 days) in the triple therapy as initial treatment pathway. This pathway was least likely to contain patients with frequent or severe exacerbations (22.0% vs. 31.5%, p < 0.001) or with blood eosinophil counts ≥300 cells/µL (18.9% vs. 22.0%, p < 0.001). CONCLUSION Real-world prescription of triple therapy often does not follow COPD guidelines in terms of disease severity and prior treatments attempted.
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Affiliation(s)
- Lili Jiang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Toronto, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew B Stanbrook
- ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wan Tan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kendzerska T, Szyszkowicz M, Alvarez JV, Mallick R, Carlsten C, Ayas N, Laratta CR, Jovic B, Orach J, Doiron MS, Dales R. Air Pollution and the Effectiveness of Positive Airway Pressure Therapy in Individuals With Sleep Apnea. Chest 2022; 162:1176-1187. [DOI: 10.1016/j.chest.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/18/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
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Alvarez JV, Dales R, Kendzerska T. Demographics, sleep apnea and positive airway pressure (PAP) treatment-related characteristics associated with PAP adherence: A large retrospective community-based longitudinal observational study. Sleep Med 2022; 98:139-143. [DOI: 10.1016/j.sleep.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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Thornton CS, Povitz M, Tsai WH, Loewen AH, Ip-Buting A, Kendzerska T, Flemons WW, Fraser KL, Hanly PJ, Pendharkar SR. Impact of wait times for treatment on clinical outcomes in patients with obstructive sleep apnoea: protocol for a randomised controlled trial. ERJ Open Res 2022; 8:00068-2022. [PMID: 35747231 PMCID: PMC9209848 DOI: 10.1183/23120541.00068-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is a common chronic condition that is associated with significant morbidity and economic cost. Prolonged wait times are increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has prospectively evaluated the impact of wait times on health outcomes in OSA. Objective The purpose of this study is to determine whether treatment outcomes for individuals with OSA differ between patients managed using an expedited versus standard pathway. Methods A pragmatic randomised controlled trial design will be used with a target sample size of 200 adults. Participants with clinically significant uncomplicated OSA will be recruited through referrals to a large tertiary care sleep centre (Calgary, AB, Canada) and randomised to either early management (within 1 month) or usual care (∼6 months) with a 1:1 allocation using a concealed computer-generated randomisation sequence. The primary outcome will be adherence to positive airway pressure (PAP) therapy at 3 months after treatment initiation. Secondary outcomes will include change in sleepiness, quality of life, patient satisfaction, and patient engagement with therapy from baseline to 3 months after PAP initiation, measured using validated questionnaires and qualitative methods. Anticipated results This study will determine whether expedited care for OSA leads to differences in PAP adherence and/or patient-reported outcomes. More broadly, the findings of this study may improve the understanding of how wait time reductions impact health outcomes for other chronic diseases. This study will determine whether expedited care for OSA leads to differences in PAP adherence and/or patient-reported outcomeshttps://bit.ly/38TrkwS
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Affiliation(s)
- Christina S Thornton
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marcus Povitz
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrea H Loewen
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tetyana Kendzerska
- Dept of Medicine, Faculty of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - W Ward Flemons
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kristin L Fraser
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Patrick J Hanly
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sachin R Pendharkar
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Huynh C, Whitmore GA, Vandemheen KL, FitzGerald JM, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed MD, Licskai CJ, Azher T, Ainslie M, Fraser I, Mahdavian M, Alvarez GG, Kendzerska T, Aaron SD. Derivation and Validation of the UCAP-Q Case-finding Questionnaire to Detect Undiagnosed Asthma and COPD. Eur Respir J 2022; 60:13993003.03243-2021. [PMID: 35332067 DOI: 10.1183/13993003.03243-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many people with asthma and COPD remain undiagnosed. We developed and validated a new case-finding questionnaire to identify symptomatic adults with undiagnosed obstructive lung disease. METHODS Adults in the community with no prior history of physician-diagnosed lung disease who self-reported respiratory symptoms were contacted via random-digit dialing. Pre- and post-bronchodilator spirometry was used to confirm asthma or COPD. Predictive questions were selected using multinomial logistic regression with backward elimination. Questionnaire performance was assessed using sensitivity, predictive values, and area under the receiver operating curve (AUC). The questionnaire was assessed for test-retest reliability, acceptability, and readability. External validation was prospectively conducted in an independent sample and predictive performance re-evaluated. RESULTS A 13-item UCAP-Q case-finding questionnaire to predict undiagnosed asthma or COPD was developed. The most appropriate risk cut-off was determined to be 6% for either disease. Applied to the derivation sample (N=1615), the questionnaire yielded a sensitivity of 92% for asthma and 97% for COPD, specificity of 17%, with an AUC of 0.69 (95% CI: 0.64-0.74) for asthma and 0.82 (95% CI: 0.78-0.86) for COPD. Prospective validation using an independent sample (n=471) showed sensitivities of 93% and 92% for asthma and COPD, respectively, specificity of 19%, with AUC's of 0.70 (95% CI: 0.62-0.79) for asthma and 0.81 (95% CI: 0.74-0.87) for COPD. AUC's for UCAP-Q were higher compared to AUC's for currently recommended case-finding questionnaires for asthma or COPD.Conclusions:The UCAP-Q demonstrated high sensitivities and AUC's for identifying undiagnosed asthma or COPD. A web-based calculator allows for easy calculation of risk probabilities for each disease.
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Affiliation(s)
- Chau Huynh
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Canada
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada
| | | | - Samir Gupta
- Department of Medicine, the Li Ka Shing Knowledge Institute of St. Michael's Hospital University of Toronto, Toronto, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Canada
| | | | | | - Tanweer Azher
- Department of Medicine, Memorial University, St. John's, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ian Fraser
- Michael Garron Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Robinson B, Edwards JD, Kendzerska T, Pettit CL, Poirel D, Daly JM, Ammi M, Khalil M, Taillon PJ, Sandhu R, Mills S, Mulpuru S, Walker T, Percival V, Dolean V, Sarkar A. Comprehensive compartmental model and calibration algorithm for the study of clinical implications of the population-level spread of COVID-19: a study protocol. BMJ Open 2022; 12:e052681. [PMID: 35273043 PMCID: PMC8914398 DOI: 10.1136/bmjopen-2021-052681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The complex dynamics of the coronavirus disease 2019 (COVID-19) pandemic has made obtaining reliable long-term forecasts of the disease progression difficult. Simple mechanistic models with deterministic parameters are useful for short-term predictions but have ultimately been unsuccessful in extrapolating the trajectory of the pandemic because of unmodelled dynamics and the unrealistic level of certainty that is assumed in the predictions. METHODS AND ANALYSIS We propose a 22-compartment epidemiological model that includes compartments not previously considered concurrently, to account for the effects of vaccination, asymptomatic individuals, inadequate access to hospital care, post-acute COVID-19 and recovery with long-term health complications. Additionally, new connections between compartments introduce new dynamics to the system and provide a framework to study the sensitivity of model outputs to several concurrent effects, including temporary immunity, vaccination rate and vaccine effectiveness. Subject to data availability for a given region, we discuss a means by which population demographics (age, comorbidity, socioeconomic status, sex and geographical location) and clinically relevant information (different variants, different vaccines) can be incorporated within the 22-compartment framework. Considering a probabilistic interpretation of the parameters allows the model's predictions to reflect the current state of uncertainty about the model parameters and model states. We propose the use of a sparse Bayesian learning algorithm for parameter calibration and model selection. This methodology considers a combination of prescribed parameter prior distributions for parameters that are known to be essential to the modelled dynamics and automatic relevance determination priors for parameters whose relevance is questionable. This is useful as it helps prevent overfitting the available epidemiological data when calibrating the parameters of the proposed model. Population-level administrative health data will serve as partial observations of the model states. ETHICS AND DISSEMINATION Approved by Carleton University's Research Ethics Board-B (clearance ID: 114596). Results will be made available through future publication.
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Affiliation(s)
- Brandon Robinson
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa and University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, Division of Respirology, University of Ottawa, Ottawa, Ontario, Canada
| | - Chris L Pettit
- US Naval Academy, Aerospace Engineering Department, Annapolis, Maryland, USA
| | - Dominique Poirel
- Royal Military College of Canada, Department of Mechanical and Aerospace Engineering, Kingston, Ontario, Canada
| | - John M Daly
- Independent Control Systems Engineer, Ottawa, Ontario, Canada
| | - Mehdi Ammi
- School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Rimple Sandhu
- National Renewable Energy Laboratory, Golden, Colorado, USA
| | - Shirley Mills
- School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, Division of Respirology, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Walker
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Valerie Percival
- School of International Affairs, Carleton University, Ottawa, Ontario, Canada
| | - Victorita Dolean
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
- Laboratoire J.A. Dieudonné, CNRS, Université Côte d'Azur, Nice, France
| | - Abhijit Sarkar
- Department of Civil and Environmental Engineering, Carleton University, Ottawa, Ontario, Canada
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Hoxha O, Jairam T, Kendzerska T, Rajendram P, Zhou R, Ravindran P, Osman S, Banayoty M, Qian Y, Murray B, Boulos M. Association of Periodic Limb Movements with Medication Classes: A Retrospective Cohort Study. Neurology 2022; 98:e1585-e1595. [PMID: 35131908 DOI: 10.1212/wnl.0000000000200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association between various medication classes and the periodic limb movement index (PLMI) in a clinical cohort of adults who completed in-laboratory polysomnography. METHODS A single, diagnostic, overnight, in-laboratory polysomnogram was completed for 3,488 patients consecutively referred from 2010-2015 to determine the PLMI. Medication use and medical comorbidities were collected through patient questionnaires. Associations between medication classes and the PLMI were ascertained using multivariable ordinal logistic regression models. RESULTS The median age of the cohort was 56.0 years (48.2% male). After adjusting for age, sex, body mass index, relevant comorbidities, and sleep parameters, the use of selective serotonin reuptake inhibitors (SSRIs) (OR = 1.52) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (OR = 1.99) were associated with an increased PLMI. Conversely, gabapentinoids (OR = 0.71), stimulants (OR = 0.52), benzodiazepines (OR = 0.79), and dopamine agonists (OR = 0.38) were associated with a decreased PLMI. A non-statistically significant trend for a decreased PLMI with neuroleptic use was observed. No significant associations were found between the PLMI and the use of antihypertensives, statins, tricyclic antidepressants, bupropion, anticoagulants, antiplatelets, modafinil, and antihistamines. CONCLUSION The use of SSRIs and SNRIs was associated with an elevated PLMI while the use of gabapentinoids, stimulants, benzodiazepines, and dopamine agonists was associated with a decreased PLMI. These results can assist physicians in managing PLMs and invite further research into the relationship between PLMs and medications with the modulating effects of dose, formulation type, and time of administration. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that SSRIs and SNRIs are associated with an elevated PLMI while gabapentinoids, stimulants, benzodiazepines, and dopamine agonists are associated with a decreased PLMI.
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Affiliation(s)
- Ortenc Hoxha
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Phavalan Rajendram
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Zhou
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Prashanthan Ravindran
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sinan Osman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monica Banayoty
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - YuChen Qian
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Shaw JF, Mulpuru S, Kendzerska T, Moloo H, Martel G, Eskander A, Lalu MM, McIsaac DI. Association between frailty and patient outcomes after cancer surgery: a population-based cohort study. Br J Anaesth 2022; 128:457-464. [PMID: 35034792 DOI: 10.1016/j.bja.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Frailty is associated with poor postoperative outcomes, but existing data do not describe frailty's interaction with tumour characteristics at the time of cancer surgery. Our objective was to estimate the association between frailty and long-term survival, and to explore any interaction with tumour stage and grade. METHODS This was a population-based cohort study conducted using linked provincial health administrative data in Ontario, Canada (2009-20). Using a cancer registry, we identified adults having elective cancer surgery. Frailty was measured using a validated index (range 0-1; higher score=greater frailty). Associations between frailty and long-term postoperative survival (primary outcome) were estimated using proportional hazards regression. Secondary outcomes were length of stay, discharge destination, days alive at home, and healthcare costs. RESULTS We identified and included 52 012 patients. Mean frailty score was 0.13 (standard deviation 0.07). During follow-up, 19 378 (37.3%) patients died. After adjustment for risk factors, each 10% increase in frailty was associated with a 1.60-fold relative decrease in survival (95% confidence interval: 1.56-1.64). The frailty-survival association was strongest for patients with lower stage and grade cancers. Increased frailty was associated with longer hospital stays (3 days), fewer days alive and at home (42 days yr-1), more frequent discharge to a nursing facility (2.38-fold), and increased healthcare costs ($6048). CONCLUSIONS Patient frailty is associated with decreased long-term survival after cancer surgery. The association is stronger for early-stage and -grade cancers, which would otherwise have a better survival prognosis.
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Affiliation(s)
- Julia F Shaw
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sunita Mulpuru
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Tetyana Kendzerska
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada
| | - Husein Moloo
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada
| | - Guillaume Martel
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Department of Otolaryngology-Head & Neck Surgery, Toronto, ON, Canada
| | - Manoj M Lalu
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada
| | - Daniel I McIsaac
- University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada.
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Spilg EG, Rushton CH, Phillips JL, Kendzerska T, Saad M, Gifford W, Gautam M, Bhatla R, Edwards JD, Quilty L, Leveille C, Robillard R. The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry 2022; 22:19. [PMID: 34991514 PMCID: PMC8734541 DOI: 10.1186/s12888-021-03637-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. METHODS A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. FINDINGS Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. INTERPRETATION Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.
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Affiliation(s)
- Edward G Spilg
- Department of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
| | - Cynda Hylton Rushton
- Berman Institute of Bioethics & School of Nursing, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Jennifer L Phillips
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Tetyana Kendzerska
- Department of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Mysa Saad
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Mamta Gautam
- Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Rajiv Bhatla
- Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Jodi D Edwards
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario, K1G 5Z3, Canada
| | - Lena Quilty
- Centre for Addiction and Mental Health, 1025 Queen Street, Toronto, Ontario, M6J 1H1, Canada
| | - Chloe Leveille
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
| | - Rebecca Robillard
- The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, Ontario, K1Z 7K4, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, Ontario, K1N 6N5, Canada
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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36
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Solomonova E, Picard-Deland C, Rapoport IL, Pennestri MH, Saad M, Kendzerska T, Veissiere SPL, Godbout R, Edwards JD, Quilty L, Robillard R. Stuck in a lockdown: Dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic. PLoS One 2021; 16:e0259040. [PMID: 34818346 PMCID: PMC8612516 DOI: 10.1371/journal.pone.0259040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedent factors (new pandemic, threat of disease, global uncertainty, the experience of social isolation and exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes; and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey. METHODS 968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen's Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology. RESULTS 34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams, nightmares, and dreams about the pandemic, inefficacy, and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety. CONCLUSIONS Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.
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Affiliation(s)
- Elizaveta Solomonova
- Neurophilosophy Lab, McGill University, Montreal, Canada
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Culture, Mind and Brain research group, McGill University, Montreal, Canada
| | - Claudia Picard-Deland
- Dream and Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, Montreal, Canada
- Department of Neuroscience, University of Montreal, Montreal, Canada
| | | | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
- Sleep Laboratory and Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
| | - Mysa Saad
- The Royal’s Institute of Mental Health Research, Ottawa, Canada
| | - Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Samuel Paul Louis Veissiere
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, Culture, Mind and Brain research group, McGill University, Montreal, Canada
| | - Roger Godbout
- Sleep Laboratory and Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Jodi D. Edwards
- University of Ottawa Heart Institute, Ottawa, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Lena Quilty
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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Kendzerska T, Leung RS, Boulos MI, McIsaac DI, Murray BJ, Bryson GL, Talarico R, Malhotra A, Gershon AS, MacKenzie C, Povitz M. An Association Between Positive Airway Pressure (PAP) Device Manufacturer and Incident Cancer?: A Secondary Data Analysis. Am J Respir Crit Care Med 2021; 204:1484-1488. [PMID: 34587472 DOI: 10.1164/rccm.202107-1734le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tetyana Kendzerska
- University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, 50010, Toronto, Ontario, Canada;
| | | | - Mark I Boulos
- University of Toronto, 7938, Toronto, Ontario, Canada
| | | | | | - Gregory L Bryson
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada
| | | | - Atul Malhotra
- University of California San Diego, 8784, Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California, United States
| | - Andrea S Gershon
- Sunnybrook Research Institute, 282299, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Marcus Povitz
- University of Calgary, 2129, Calgary, Alberta, Canada
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38
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Robillard R, Daros AR, Phillips JL, Porteous M, Saad M, Pennestri MH, Kendzerska T, Edwards JD, Solomonova E, Bhatla R, Godbout R, Kaminsky Z, Boafo A, Quilty LC. Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants durant la pandémie de la COVID-19: une étude canadienne multisite. Can J Psychiatry 2021; 66:815-826. [PMID: 33464115 PMCID: PMC8504288 DOI: 10.1177/0706743720986786] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. METHODS An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. RESULTS The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically important worsening in anxiety, depression, and suicidal ideation symptoms relative to pre-outbreak estimates were significantly higher in those with psychiatric diagnoses. Furthermore, 15% to 19% of respondents reported increased alcohol or cannabis use. Worse psychological changes relative to pre-outbreak estimate were associated with female sex, younger age, lower income, poorer coping skills, multiple psychiatric comorbidities, previous trauma exposure, deteriorating physical health, poorer family relationships, and lower exercising. Reductions in mental health care were associated with increased suicidal ideation. CONCLUSION The worsening in mental health symptoms and the decline in access to care call for the urgent development of adapted interventions targeting both new mental disorders and pre-existing psychiatric conditions affected by the COVID-19 pandemic.
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Affiliation(s)
- Rebecca Robillard
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ontario, Canada
| | | | - Jennifer L. Phillips
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Meggan Porteous
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ontario, Canada
| | - Mysa Saad
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Marie-Helene Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Hopital en santé mentale Rivières-des-Prairies, CIUSSS du Nord-de-l’Ile-de-Montreal, Quebec, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Elizaveta Solomonova
- Mind and Brain research group, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rajiv Bhatla
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Roger Godbout
- Hopital en santé mentale Rivières-des-Prairies, CIUSSS du Nord-de-l’Ile-de-Montreal, Quebec, Canada
- Department of PSychiatry, Université de Montréal, Québec, Canada
| | - Zachary Kaminsky
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Addo Boafo
- The Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lena C. Quilty
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
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Gershon AS, McGihon RE, Luo J, Blazer AJ, Kendzerska T, To T, Aaron SD. Trends in Chronic Obstructive Pulmonary Disease Prevalence, Incidence, and Health Services Use in Younger Adults in Ontario, Canada, 2006-2016. Am J Respir Crit Care Med 2021; 203:1196-1199. [PMID: 33347389 DOI: 10.1164/rccm.202006-2495le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea S Gershon
- Sunnybrook Health Sciences Centre Toronto, Ontario, Canada.,ICES Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
| | | | - Jin Luo
- ICES Toronto, Ontario, Canada
| | | | - Tetyana Kendzerska
- ICES Toronto, Ontario, Canada.,University of Ottawa Ottawa, Ontario, Canada
| | - Teresa To
- ICES Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada.,The Hospital for Sick Children Toronto, Ontario, Canada and
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40
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Kendzerska T, Aaron SD, Meteb M, Gershon AS, To T, Lougheed MD, Tavakoli H, Chen W, Kunkel E, Sadatsafavi M. Specialist Care in Individuals With Asthma Who Required Hospitalization: A Retrospective Population-Based Study. J Allergy Clin Immunol Pract 2021; 9:3686-3696. [PMID: 34182160 DOI: 10.1016/j.jaip.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients who are at risk for severe asthma exacerbations should receive specialist care. However, the care pattern for such patients in the real world is unclear. OBJECTIVE To describe the pattern of care among individuals with asthma who required hospitalization, and to identify factors associated with receiving asthma specialist care. METHODS This was a retrospective population-based study using health administrative data from two Canadian provinces. Individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma at or within 5 years after the initial asthma diagnosis were included. First, we calculated frequencies of primary and specialist care around the asthma diagnosis: 1 year before and 2 years after in a 6-month period. Next, among individuals diagnosed with asthma by a primary care physician, we used multivariable Cox regressions to identify factors associated with receiving specialist care. RESULTS For 1862 individuals included, we found that most (≥71% per time period) were cared for by primary care physicians 1 year before and 2 years after the asthma diagnosis; the percentage of individuals seen at least once by a specialist for asthma and/or asthma-related respiratory conditions during the first 6 months since the diagnosis did not exceed 40%. Among 1411 of 1862 individuals who were under primary care before the asthma diagnosis (76%), controlling for covariates, living in a rural area or a low-income neighborhood was associated with less likelihood of receiving specialist care. CONCLUSIONS Despite recommendations, more than half of individuals with asthma who required hospitalization did not receive specialist care during the first 2 years since the diagnosis. Identified factors associated with receiving asthma specialist care suggested that access is an important barrier to receiving recommended care.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada; ICES, Ontario, Canada.
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Moussa Meteb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Teresa To
- ICES, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Research Institute, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - M Diane Lougheed
- ICES, Ontario, Canada; Kingston General Hospital Research Institute, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Elizabeth Kunkel
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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Kendzerska T, van Walraven C, McIsaac DI, Povitz M, Mulpuru S, Lima I, Talarico R, Aaron SD, Reisman W, Gershon AS. Case-Ascertainment Models to Identify Adults with Obstructive Sleep Apnea Using Health Administrative Data: Internal and External Validation. Clin Epidemiol 2021; 13:453-467. [PMID: 34168503 PMCID: PMC8216743 DOI: 10.2147/clep.s308852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background There is limited evidence on whether obstructive sleep apnea (OSA) can be accurately identified using health administrative data. Study Design and Methods We derived and validated a case-ascertainment model to identify OSA using linked provincial health administrative and clinical data from all consecutive adults who underwent a diagnostic sleep study (index date) at two large academic centers (Ontario, Canada) from 2007 to 2017. The presence of moderate/severe OSA (an apnea–hypopnea index≥15) was defined using clinical data. Of 39 candidate health administrative variables considered, 32 were tested. We used classification and regression tree (CART) methods to identify the most parsimonious models via cost-complexity pruning. Identified variables were also used to create parsimonious logistic regression models. All individuals with an estimated probability of 0.5 or greater using the predictive models were classified as having OSA. Results The case-ascertainment models were derived and validated internally through bootstrapping on 5099 individuals from one center (33% moderate/severe OSA) and validated externally on 13,486 adults from the other (45% moderate/severe OSA). On the external cohort, parsimonious models demonstrated c-statistics of 0.75–0.81, sensitivities of 59–60%, specificities of 87–88%, positive predictive values of 79%, negative predictive values of 73%, positive likelihood ratios (+LRs) of 4.5–5.0 and –LRs of 0.5. Logistic models performed better than CART models (mean integrated calibration indices of 0.02–0.03 and 0.06–0.12, respectively). The best model included: sex, age, and hypertension at the index date, as well as an outpatient specialty physician visit for OSA, a repeated sleep study, and a positive airway pressure treatment claim within 1 year since the index date. Interpretation Among adults who underwent a sleep study, case-ascertainment models for identifying moderate/severe OSA using health administrative data had relatively low sensitivity but high specificity and good discriminative ability. These findings could help study trends and outcomes of OSA individuals using routinely collected health care data.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Carl van Walraven
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada.,Departments of Anesthesiology & Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine at Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.,Cumming School of Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Isac Lima
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Robert Talarico
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William Reisman
- Department of Medicine at Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.,Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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42
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Gershon AS, Pequeno P, Machado AA, Aaron SD, Kendzerska T, Luo J, Stanbrook MB, Tan WC, Porter J, To T. FACTORS ASSOCIATED WITH NON-RECEIPT OF RECOMMENDED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MEDICATIONS: A POPULATION STUDY. Chest 2021; 160:1670-1680. [PMID: 34144022 DOI: 10.1016/j.chest.2021.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practise guidelines. RESEARCH QUESTION How common is non-receipt of recommended medications among people with COPD and what are factors associated with non-receipt? STUDY DESIGN AND METHODS We conducted a population cohort study in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged 65 and older. Health administrative data were used to identify people 66 years of age or older with physician-diagnosed COPD as of 2018 and group them into lower or higher risk for future COPD exacerbation groups. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modelling was used to determine associations between patient and physician factors and non-receipt of recommended medications. RESULTS About 54% and 88% of people with COPD receoved sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with non-receipt of recommended medications in both groups. People who had a co-diagnosis of asthma and who received care by a pulmonologist and spirometry were more likely to receive recommended medication . INTERPRETATION COPD medications appear underused by the COPD population and various factors are associated with sub-optimal receipt. Targeting these factors would help improve the care and health of people with COPD.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Shawn D Aaron
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Tetyana Kendzerska
- ICES, Toronto and Ottawa, ON, Canada; The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Jin Luo
- ICES, Toronto and Ottawa, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, ON, Canada
| | - Wan C Tan
- University of British Columbia, UBC James Hogg Research Laboratories, Providence Heart and Lung Institute, Vancouver, BC, Canada
| | | | - Teresa To
- ICES, Toronto and Ottawa, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Vozoris NT, Wilton AS, Austin PC, Kendzerska T, Ryan CM, Gershon AS. Morbidity and mortality reduction associated with polysomnography testing in idiopathic pulmonary fibrosis: a population-based cohort study. BMC Pulm Med 2021; 21:185. [PMID: 34078346 PMCID: PMC8170825 DOI: 10.1186/s12890-021-01555-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background It is not well-known if diagnosing and treating sleep breathing disorders among individuals with idiopathic pulmonary fibrosis (IPF) improves health outcomes. We evaluated the association between receipt of laboratory-based polysomnography (which is the first step in the diagnosis and treatment of sleep breathing disorders in Ontario, Canada) and respiratory-related hospitalization and all-cause mortality among individuals with IPF. Methods We used a retrospective, population-based, cohort study design, analyzing health administrative data from Ontario, Canada, from 2007 to 2019. Individuals with IPF were identified using an algorithm based on health administrative codes previously developed by IPF experts. Propensity score matching was used to account for potential differences in 41 relevant covariates between individuals that underwent polysomnography (exposed) and individuals that did not undergo polysomnography (controls), in order minimize potential confounding. Respiratory-related hospitalization and all-cause mortality were evaluated up to 12 months after the index date. Results Out of 5044 individuals with IPF identified, 201 (4.0%) received polysomnography, and 189 (94.0%) were matched to an equal number of controls. Compared to controls, exposed individuals had significantly reduced rates of respiratory-related hospitalization (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.24–0.75), p = 0.003) and all-cause mortality (HR 0.49, 95% CI 0.30–0.80), p = 0.004). Significantly reduced rate of respiratory-related hospitalization (but not all-cause mortality) was also observed among those with > = 1 respiratory-related hospitalization (HR 0.38, 95% CI 0.15–0.99) and systemic corticosteroid receipt (HR 0.37, 95% CI 0.19–0.94) in the year prior to the index date, which reflect sicker subgroups of persons. Conclusions Undergoing polysomnography was associated with significantly improved clinically-important health outcomes among individuals with IPF, highlighting the potential importance of incorporating this testing in IPF disease management. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01555-x.
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Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,ICES (Formerly Known As Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.
| | - Andrew S Wilton
- ICES (Formerly Known As Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Peter C Austin
- ICES (Formerly Known As Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tetyana Kendzerska
- ICES (Formerly Known As Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respirology, University Health Network, Toronto, ON, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,ICES (Formerly Known As Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Robillard R, Saad M, Ray LB, BuJáki B, Douglass A, Lee EK, Soucy L, Spitale N, De Koninck J, Kendzerska T. Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study. J Clin Sleep Med 2021; 17:505-513. [PMID: 33118928 DOI: 10.5664/jcsm.8942] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The effects of serotonergic agents on respiration neuromodulation may vary according to differences in the serotonin system, such as those linked to depression. This study investigated how sleep-related respiratory disturbances relate to depression and the use of medications commonly prescribed for depression. METHODS Retrospective polysomnography was collated for all 363 individuals who met selection criteria out of 2,528 consecutive individuals referred to a specialized sleep clinic (Ottawa, Canada) between 2006 and 2016. The apnea-hypopnea index (AHI), oxygen saturation nadir, and oxygen desaturation index during REM and NREM sleep were analyzed using mixed analyses of covariance comparing 3 main groups: (1) medicated individuals with depressive disorders (antidepressant group; subdivided into the selective serotonin reuptake inhibitor and norepinephrine-dopamine reuptake inhibitor subgroups), (2) non-medicated individuals with depressive disorders (non-medicated group), and (3) mentally healthy control patients (control group). RESULTS Individuals with depressive disorders (on antidepressants or not) had significantly higher AHIs compared to control patients (both P ≤ .007). The antidepressant group had a lower NREM sleep oxygen saturation nadir and a higher NREM sleep oxygen desaturation index than the control and non-medicated groups (all P ≤ .009). Within individuals with depressive disorders, independent of depression severity, the selective serotonin reuptake inhibitor group had a lower oxygen saturation nadir and a higher oxygen desaturation index during NREM sleep than the norepinephrine-dopamine reuptake inhibitor (both P ≤ .045) and non-medicated groups (both P < .001) and a higher NREM sleep AHI than the non-medicated group (P = .014). CONCLUSIONS These findings suggest that the use of selective serotonin reuptake inhibitors may be associated with impaired breathing and worse nocturnal oxygen saturation in individuals with depressive disorders and sleep complaints, but this needs to be confirmed by prospective studies.
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Affiliation(s)
- Rébecca Robillard
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Mysa Saad
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Laura B Ray
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada
| | - Brad BuJáki
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - Alan Douglass
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Elliott K Lee
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Louis Soucy
- Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Naomi Spitale
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - Joseph De Koninck
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Tetyana Kendzerska
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
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Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall CE. The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review. Risk Manag Healthc Policy 2021; 14:575-584. [PMID: 33623448 PMCID: PMC7894869 DOI: 10.2147/rmhp.s293471] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. METHODS A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. FINDINGS During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. INTERPRETATION Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.
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Affiliation(s)
- Tetyana Kendzerska
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David T Zhu
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Science, Western University, London, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cayden Peixoto
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research/University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Robillard R, Dion K, Pennestri M, Solomonova E, Lee E, Saad M, Murkar A, Godbout R, Edwards JD, Quilty L, Daros AR, Bhatla R, Kendzerska T. Profiles of sleep changes during the COVID-19 pandemic: Demographic, behavioural and psychological factors. J Sleep Res 2021; 30:e13231. [PMID: 33200477 PMCID: PMC7744844 DOI: 10.1111/jsr.13231] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 01/07/2023]
Abstract
This study aimed to evaluate changes in sleep during the COVID-19 outbreak, and used data-driven approaches to identify distinct profiles of changes in sleep-related behaviours. Demographic, behavioural and psychological factors associated with sleep changes were also investigated. An online population survey assessing sleep and mental health was distributed between 3 April and 24 June 2020. Retrospective questions were used to estimate temporal changes from before to during the outbreak. In 5,525 Canadian respondents (67.1% females, 16-95 years old: Mean ± SD = 55.6 ± 16.3 years), wake-up times were significantly delayed relative to pre-outbreak estimates (p < .001, ηp2 = 0.04). Occurrences of clinically meaningful sleep difficulties significantly increased from 36.0% before the outbreak to 50.5% during the outbreak (all p < .001, g ≥ 0.27). Three subgroups with distinct profiles of changes in sleep behaviours were identified: "Reduced Time in Bed", "Delayed Sleep" and "Extended Time in Bed". The "Reduced Time in Bed" and "Delayed Sleep" subgroups had more adverse sleep outcomes and psychological changes during the outbreak. The emergence of new sleep difficulties was independently associated with female sex, chronic illnesses, being employed, family responsibilities, earlier wake-up times, higher stress levels, as well as heavier alcohol use and television exposure. The heterogeneity of sleep changes in response to the pandemic highlights the need for tailored interventions to address sleep problems.
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Affiliation(s)
- Rebecca Robillard
- Sleep Research UnitThe Royal’s Institute of Mental Health ResearchOttawaONCanada,School of PsychologyUniversity of OttawaOttawaONCanada
| | - Karianne Dion
- Sleep Research UnitThe Royal’s Institute of Mental Health ResearchOttawaONCanada,School of PsychologyUniversity of OttawaOttawaONCanada
| | - Marie‐Helene Pennestri
- Department of Educational & Counselling PsychologyMcGill UniversityMontréalQCCanada,Hôpital en santé mentale Rivières‐des‐PrairiesCIUSSS du Nord‐de‐l'Île‐de‐MontréalMontréalQCCanada
| | - Elizaveta Solomonova
- Culture, Mind and Brain Research GroupDivision of Social and Transcultural PsychiatryMcGill UniversityMontréalQCCanada
| | - Elliott Lee
- Sleep Research UnitThe Royal’s Institute of Mental Health ResearchOttawaONCanada,The Royal Ottawa Mental Health CentreOttawaONCanada
| | - Mysa Saad
- Sleep Research UnitThe Royal’s Institute of Mental Health ResearchOttawaONCanada
| | - Anthony Murkar
- Sleep Research UnitThe Royal’s Institute of Mental Health ResearchOttawaONCanada
| | - Roger Godbout
- Hôpital en santé mentale Rivières‐des‐PrairiesCIUSSS du Nord‐de‐l'Île‐de‐MontréalMontréalQCCanada
| | | | - Lena Quilty
- Centre for Addiction and Mental HealthTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Raj Bhatla
- The Royal Ottawa Mental Health CentreOttawaONCanada,Department of PsychiatryUniversity of OttawaOttawaONCanada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute/University of OttawaOttawaONCanada
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Ahmad A, Ahmad R, Meteb M, Ryan CM, Leung RS, Montandon G, Luks V, Kendzerska T. The relationship between opioid use and obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101441. [PMID: 33567395 DOI: 10.1016/j.smrv.2021.101441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/11/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
We conducted a systematic review to address limited evidence suggesting that opioids may induce or aggravate obstructive sleep apnea (OSA). All clinical trials or observational studies on adults from 1946 to 2018 found through MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases were eligible. We assessed the quality of the studies using published guidelines. Fifteen studies (six clinical trials and nine observational) with only two of good quality were included. Fourteen studies investigated the impact of opioids on the presence or severity of OSA, four addressed the effects of treatment for OSA in opioid users, and none explored the consequences of opioid use in individuals with OSA. Eight of 14 studies found no significant relationship between opioid use or dose and apnea-hypopnea index (AHI) or degree of nocturnal desaturation. A random-effects meta-analysis (n = 10) determined the pooled mean change in AHI associated with opioid use of 1.47/h (-2.63-5.57; I2 = 65%). Three of the four studies found that continuous positive airway pressure (CPAP) therapy reduced AHI by 17-30/h in opioid users with OSA. Bilevel therapy with a back-up rate and adaptive servo-ventilation (ASV) without mandatory pressure support successfully normalized AHI (≤5) in opioid users. Limited by a paucity of good-quality studies, our review did not show a significant relationship between opioid use and the severity of OSA. There was some evidence that CPAP, Bilevel therapy, and ASV alleviate OSA for opioid users, with higher failure rates observed in patients on CPAP in opioid users.
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Affiliation(s)
- Aseel Ahmad
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ontario, Canada
| | - Randa Ahmad
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ontario, Canada
| | - Moussa Meteb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clodagh M Ryan
- University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Richard S Leung
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gaspard Montandon
- University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Vanessa Luks
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ontario, Canada.
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48
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Pakhale S, Tariq S, Huynh N, Jama S, Kaur T, Charron C, Florence K, Nur F, Bustamante-Bawagan ME, Bignell T, Boyd R, Haddad J, Kendzerska T, Alvarez G. Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: a community-based mixed-method, observational study. BMC Public Health 2021; 21:183. [PMID: 33478466 PMCID: PMC7819217 DOI: 10.1186/s12889-021-10209-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally the burden of Obstructive Lung Diseases (OLD) is growing, however its effect on urban poor populations with the high prevalence of tobacco dependence is virtually unknown. The purpose of this project is to estimate the prevalence and burden of OLD in the urban, low-income populations of Ottawa, Canada. METHODS The study presented in this paper was part of the PROMPT (Management and Point-of-Care for Tobacco Dependence) project; a prospective cohort study in a community-based setting (n = 80) with meaningful Patient Engagement from design to dissemination. Spirometry data, standardized questionnaires and semi-structured interviews from PROMPT were interpreted to understand the lung function, disease burden and social determinants (respectively) in this population. RESULTS The prevalence of OLD among those who completed spirometry (N = 64) was 45-59%. Generic and disease-specific quality of life was generally poor in all PROMPT participants, even those without OLD, highlighting the higher disease burden this vulnerable population faces. Quality of life was impacted by two major themes, including i) socioeconomic status and stress and ii) social networks and related experiences of trauma. CONCLUSION The prevalence and disease burden of OLD is significantly higher in Ottawa's urban poor population than what is observed in the general Canadian population who smoke, suggesting an etiological role of the social determinants of health. This urges the need for comprehensive care programs addressing up-stream factors leading to OLDs, including poor access and utilization of preventive healthcare addressing the social determinants of health. TRIAL REGISTRATION ClinicalTrails.gov - NCT03626064 , Retrospective registered: August 2018.
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Affiliation(s)
- Smita Pakhale
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. .,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada.
| | - Saania Tariq
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Nina Huynh
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Sadia Jama
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Tina Kaur
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Catherine Charron
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,University of Ottawa, Ottawa, Canada
| | - Kelly Florence
- Community (peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Fozia Nur
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | | | - Ted Bignell
- Community (peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Robert Boyd
- Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Joanne Haddad
- Canadian Mental Health Association, The Ottawa Branch, Ottawa, Canada
| | - Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Gonzalo Alvarez
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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Kendzerska T, Aaron SD, To T, Licskai C, Stanbrook MB, Hogan ME, Tan WC, Bourbeau J, Gershon AS. Effect of type and dosage of newly prescribed inhaled corticosteroids on obstructive lung disease and pneumonia hospitalisations in older individuals with asthma, COPD or both: a retrospective study of health administrative data. Eur Respir J 2021; 57:13993003.02585-2020. [PMID: 32703774 DOI: 10.1183/13993003.02585-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/05/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Tetyana Kendzerska
- Dept of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada .,ICES, Ottawa, ON, Canada
| | - Shawn D Aaron
- Dept of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Chris Licskai
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Wan C Tan
- University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- McGill University, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Andrea S Gershon
- The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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50
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Cragg JJ, Azoulay L, Collins G, De Vera MA, Etminan M, Lalji F, Gershon AS, Guyatt G, Harrison M, Jutzeler C, Kassam R, Kendzerska T, Lynd L, Mansournia MA, Sadatsafavi M, Tong B, Warner FM, Tremlett H. The reporting of observational studies of drug effectiveness and safety: recommendations to extend existing guidelines. Expert Opin Drug Saf 2021; 20:1-8. [PMID: 33170749 DOI: 10.1080/14740338.2021.1849134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The use of observational data to assess drug effectiveness and safety can provide relevant information, much of which may not be feasible to obtain through randomized clinical trials. Because observational studies provide critical drug safety and effectiveness information that influences drug policy and prescribing practices, transparent, consistent, and accurate reporting of these studies is critical. AREAS COVERED We provide recommendations to extend existing reporting guidelines, covering the main components of primary research studies (methods, results, discussion). EXPERT OPINION Our recommendations include extending drug safety and effectiveness guidelines to include explicit checklist items on: study registration, causal diagrams, rationale for measures of effect, comprehensive assessment of bias, comprehensive data cleaning steps, drug equivalents, subject-level drug data visualization, sex and gender-based analyses and results, patient-oriented outcomes, and patient involvement in research.
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Affiliation(s)
- Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, BC, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University , Montreal, QC, Canada
| | - Gary Collins
- Centre for Statistics in Medicine, University of Oxford , Oxford, United Kingdom & EQUATOR
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Mahyar Etminan
- Departments of Ophthalmology and Medicine, Faculty of Medicine, University of British Columbia , Vancouver, BC, Canada
| | - Fawziah Lalji
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto , Toronto, Ontario
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University , Hamilton, Ontario, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital , Vancouver, BC, Canada
| | - Catherine Jutzeler
- Department of Biosystems Science & Engineering, ETH Zurich , Zurich, Switzerland
| | - Rosemin Kassam
- School of Population and Public Health, University of British Columbia , Vancouver, BC, Canada
| | | | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, BC, Canada
| | - Freda M Warner
- Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, University of British Columbia , Vancouver, BC, Canada
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