For more than 30 years, Dr. John Fleetham has been investigating sleep – or lack thereof due to snoring and sleep apnea. Dr. Fleetham is a respirologist and medical director of the Vancouver Coastal Health (VCH) Sleep Disorder Program. His specific research area of interest is obstructive sleep apnea (OSA) and over the past three decades he has led a research program investigating its causes, prevalence, consequences, diagnosis, and treatments.
Obstructive sleep apnea (OSA) is a disorder in which a person repeatedly stops breathing during sleep for an average of 10 to 30 seconds, sometimes hundreds of times per night.
“Left untreated, OSA can give rise to diabetes, high blood pressure, and heart disease,” says Dr. Fleetham. “It also increases the risk of motor vehicle accidents and work-related injuries.”
The main treatment for OSA is continuous positive airway pressure (CPAP), which involves patients wearing a mask that blows air into the mouth or nose to help them breathe more easily while sleeping. Clinical trials have shown CPAP to be a cost-effective treatment.
A CPAP device can cost between $2,000 and $2,500 but only Ontario, Manitoba, and Saskatchewan cover CPAP through their provincial medical plans.
“It’s frustrating that British Columbia does not cover such an effective treatment,” says Dr. Fleetham. “Helping people get the sleep they need is integral to preventing multiple potential health issues.”
About three per cent of Canadian adults have OSA and the figure jumps to five per cent for Canadians 45 years old and up. Twice as many men as women have OSA and 26 per cent of Canadian adults report the presence of at least three symptoms or risk factors for OSA such loud snoring, daytime sleepiness, high blood pressure, and being overweight1.
Support expands in the field of sleep research
Three years ago, the Canadian Institutes of Health Research (CIHR) established the Sleep Team Awards. The multidisciplinary team of researchers Dr. Fleetham brought together at the VCH Sleep Disorder Program received one of four awards in the amount of $300,000 per year for five years.
In Fall 2014, the CIHR awarded the program a grant for a major clinical trial comparing two standard treatments for sleep apnea: CPAP and oral appliances. The latter treatment was the result of a long standing collaboration between the team at the VCH Sleep Disorder Program and the UBC Faculty of Dentistry.
“The innovation with this clinical trial is that we have the ability to monitor CPAP use and oral appliance use,” adds Dr. Fleetham.
Oral appliances attach to the top and bottom teeth and bring the jaw forward, expanding the upper airway. Many patients prefer oral appliances to CPAP. And although appliances are not always as effective as CPAP, they are less obtrusive.
“Recognition of the adverse consequences of sleep apnea is growing, and clinical research allows us to help patients and know that we have access to the most recent research to help better direct their care.” says Dr. Fleetham.
The Vancouver Coastal Health Research Institute wishes to thank Dr. Fleetham for his leadership as director of the Centre for Respiratory, Cardiac and Critical Care Medicine over the past 12 years. He retired from the role in January 2015.