Current Research Projects

The effect of nocturnal hypoxemia on fatigue, depression & cognitive functioning in COPD patients

Rationale: Despite the negative effect of nocturnal hypoxemia on neuropsychological and brain functionning has long been described in sleep-disordered breathing, it remains unclear whether nocturnal desaturation in mild to moderate hypoxemic COPD patients contributes to explain the plausible cognitive impairments associated with this progressive disease. Furthermore, it remains unclear whether fatigue in COPD patients is related to sleep-related disordered breathing and hypoxemia.

Objective: To evaluate the degree of fatigue, psychological and cognitive functioning in patients with COPD with and without nocturnal hypoxemia.

Status: Study active, recruitment on-going (n=60 enrolled patients, out of 253 candidates).

Publication: David Préfontaine, Adrienne S. Scott, Esther Dajczman, Marcel A. Baltzan, and Norman Wolkove. Nocturnal oxygen desaturation in patients with COPD: the impact on cognitive function, quality of life, fatigue and depression? Abstract will be published in the American Journal of Respiratory and Critical Care Medicine and presented at the upcoming 2012 American Thoracic Society (ATS) International Conference, San Francisco, May 2012.

INOX Trial – International multi-centered randomized controlled trial on nocturnal oxygen therapy in patients with COPD

Rationale: Chronic obstructive pulmonary disease (COPD) represents a major health issue in Canada. Several studies demonstrated oxygen desaturation during sleep in patients with COPD. Continuous oxygen therapy (CONT-O2) is one of the few components of the management of COPD that improves survival. However, sleep-related oxygen desaturation often occurs in patients who do not benefit from CONT-O2.

Objective: To determine whether nocturnal oxygen therapy (N-O2) decrease mortality and/or the requirement for CONT-O2 in patients with COPD who exhibit significant nocturnal oxygen desaturation and not initially qualifying for CONT-O2, in a 3-year randomized, multi-centered, placebo-controlled clinical trial conducted internationally.

Status: Study active, recruitment on-going (n=12 randomizations out of 33 patients enrolled, 133 approached). In collaboration with Dr Yves Lacasse, principal investigator from the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) – Université Laval, Quebec City.

Further information is available at: http://clinicaltrials.gov/ct2/show/NCT01044628?term=inox&rank=1

The effect of Zopiclone on the level of compliance with continuous positive airway pressure (CPAP) in patients treated for Obstructive Sleep Apnea (OSA)

Rationale: OSA is associated with poor sleep quality, daytime sleepiness, fatigue and depression. Furthermore, OSA is increasingly associated with cardiovascular diseases including hypertension, congestive heart failure and coronary artery disease. Poor compliance and low satisfaction with continuous positive airway pressure (CPAP) are significant obstacles in the treatment of OSA. Zopiclone is a hypnotic agent commonly used to treat insomnia.

Objective: To determine whether initial prescription of Zopiclone has an effect on the level of compliance to CPAP in adults treated for OSA in a double-blind, randomized, parallel group study of 26 weeks.

Status: Research Ethics Board approval of the proposal is pending. The proposal received approval from the Research Ethics Board at the Cité de la Santé de Laval in March 2011.

Potential gain in treating Sleep Apnea Compared to Hyperlipidemia in the prevention of Cardiac diseases – A systematic review

Rationale: Obstructive Sleep Apnea (OSA) is a common and important comorbiditiy in patients with coronary artery disease (CAD). It remains unclear whether having OSA increases the risk of having CAD as much as the documented risk of developing CAD in patients with documented hyperlipidemia/hypercholesterolemia. It is also unclear whether treating OSA is beneficial in reducing CAD in the long-term as much as controlling hyperlipidemia.

Objective: To conduct a systemic review of the literature on these topics in order to compare effect size estimates of the impact of hyperlipidemia on primary and secondary CAD events with the impact of OSA.

Status: Study active, systemic review in progress. In collaboration with Ms. Lorie Kloda, Associate Librarian, McGill Life Sciences Library. An abstract was accepted and presented (poster) at the Annual Meeting of the Associated Professional Sleep Societies (APSS) – Sleep 2011 (June, Minneapolis, MN).

Publication: Marcel A. Baltzan, David Préfontaine, Adrienne S. Scott and Norman Wolkove. Potential gain in treating sleep apnea compared to hyperlipidemia in the prevention of cardiac disease. Abstract published in the Journal of Sleep and Sleep Disorders Research, 2010, 34:A233.

Changing demographics of patients with COPD admitted to a sub-acute pulmonary rehabilitation unit – A 2000 vs. 2010 retrospective chart review

Rationale: Demographic and severity trends in the in-patients with chronic obstructive pulmonary disease (COPD) are important indicators of possible changes to our patient population and may be helpful in understanding healthcare needs and services.

Objective: The objective of this study is to identify whether there were changes in the demographics, disease severity, length of stay and co-morbid conditions of patients admitted with a primary diagnosis of COPD for short-term respiratory care at Mount Sinai Hospital Centre during the last decade i.e. comparing the year 2000 vs. 2010.

Status: Study completed, report in progress. In collaboration with Laurent Cohen from Medical Records.

Publication: David Préfontaine, Esther Dajczman, Ryan Fiter, Laurent Cohen, Marcel A. Baltzan, and Norman Wolkove. Changing demographics of patients with COPD admitted to a sub-acute pulmonary rehabilitation unit. Abstract will be published in the American Journal of Respiratory and Critical Care Medicine and presented at the upcoming 2012 American Thoracic Society (ATS) International Conference, San Francisco, May 2012.

The effect of nocturnal hypoxemia on systemic inflammation in patients with COPD

Rationale: Nocturnal oxygen desaturation is more common in patients with COPD compared with age-matched healthy subjects. COPD is considered as an inflammatory disease of the lung but systemic inflammation, also present in COPD patients, is often associated with extra-pulmonary co-morbidities e.g. cardiovascular diseases. Whether patients with COPD presenting significant nocturnal oxygen desaturation display a more prominent blood inflammatory profile compared with patients who do not desaturate at night is not known.

Objective: This study aims at characterizing the impact of nocturnal desaturation on systemic inflammation in COPD patients.

Status: Research Ethics Board approval was obtained. Study is being implemented.

Improving informed consent: Do research participants give informed consent?

Rationale: One of the most basic requirements for the ethical conduct of research involving human subjects is informed consent. There are calls in the literature for more academic work to be done in improving informed consent. A recent systematic review highlighted that increased one-on-one interaction between researchers and research participants is most effective, with improved consent forms and multimedia resources less effective.

Objective: The primary objective of this pilot project is to determine whether research participants give informed consent. Additionally, we will determine just what research participants understand and take away from the informed consent process.

Status: Research Ethics Board approval was obtained. Study active with on-going recruitment (n=2). In collaboration with Drs. Kruszewski, Parry and Sewitch from St. Mary’s Hospital, Montreal.

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