Breaking the link between obstructive sleep apnea and cardiovascular disease using a translational experimental approach

Previous research by Dr. Foster has illustrated that angiotensin receptor blockade can abolish the blood pressure response to intermittent hypoxia (IH), reduce oxidative stress and increase nitric oxide bioavailability. In addition, recent work suggests heightened peripheral neurovascular transduction in response to baroreflex activation.

Building on this work, over the next 5 years Dr. Foster will focus on the cardiovascular consequences of IH associated with obstructive sleep apnea (OSA). Since OSA and IH directly contribute to the morbidity and mortality of hypertension, myocardial infarction and stroke, there is an urgent need to establish a treatment capable of protecting OSA patients from IH-induced cardiovascular disease (CVD).

Dr. Foster's research will elucidate the mechanisms by which AT1R antagonists or statins could protect OSA patients from IH-induced CVD. By breaking the link between CVD and OSA, and capitalizing on the pleiotropic properties of angiotensin receptor blockers and statins, this research is ultimately intended to generate a novel treatment. This knowledge will provide the necessary proof of concept for large-scale clinical trials, and will help reduce stress on health care infrastructure and improve the health, quality of life and longevity of Canadians.

The anti-inflammatory effects of exercise in patients with chronic obstructive pulmonary disease

The number of individuals suffering from chronic obstructive pulmonary disease, or COPD is on the rise in Canada and around the world. COPD, is an inflammatory disease primarily associated with lung inflammation. Inflammation also extends beyond the lungs, and the presence of inflammatory factors in the blood causes blood vessel and heart disease, increasing a COPD patient’s risk of heart attack and stroke. Exercise training is known to have anti-inflammatory effects that are beneficial in the treatment and prevention of a number of chronic conditions. However, the effects of exercise on inflammation in the airways and blood of COPD patients is not well understood. It is also unknown whether exercise training can reverse some of the detrimental effects of inflammation in the blood vessels and brains of patients with COPD and reduce their risk of having a heart attack or stroke. To answer these important questions, Dr. Neil Eves will be conducting two studies. His first study will investigate how exercise training affects the airway and blood inflammation of patients with COPD. His second study will investigate how exercise training improves blood vessel function in patients with COPD and whether these improvements are related to changes in inflammation. Reducing inflammation with exercise in patients with COPD could greatly improve the health of these patients and reduce secondary morbidities associated with the disease.

Role of cerebral blood flow in the pathophysiology of central and obstructive sleep apnea

Sleep apnea occurs when a person repeatedly stops breathing for a short period of time while they sleep. This common disorder affects about 20 per cent of Canadians. During sleep apnea episodes, blood oxygen levels fall, resulting in persistent low levels of oxygen, called hypoxia. Consequently, people with sleep apnea commonly experience adverse health outcomes, including high blood pressure, heart attacks and strokes. Preliminary findings from Dr. Philip Ainslie’s research lab have shown that reductions in brain blood flow can worsen sleep apnea, while increases in brain blood flow may reduce it. Dr. Shawnda Morrison’s research will expand on these exciting initial findings by exploring the possibility of treating sleep apnea by manipulating brain blood flow. Dr. Morrison will use sophisticated imaging techniques to examine the effect of an oral medication, which alters brain blood flow, in patients at rest and while they sleep. Her first study will examine patients with and without sleep apnea in a controlled laboratory setting. In her second study, Dr. Morrison will induce sleep apnea in otherwise healthy humans at high altitude (5,000 metres, near the base camp of Mt. Everest, Nepal). In this study, she will also conduct the same experiments on a group of high-altitude residents who do not develop sleep apnea, and compare any differences observed between the two groups. The results of these studies will have major implications for understanding what influences brain blood flow and how these different factors can then affect sleep apnea. Those people who do not develop sleep apnea will provide insight into future sleep apnea treatments. Indeed, these studies will provide a “proof of concept” that an oral medication, which alters brain blood flow, can be an effective treatment for sleep apnea. This will, in turn, dramatically reduce the incidence of heart disease and stroke in patients who have sleep apnea.

Best Practices: Integration of New Graduate Nurses in the Workplace

The overall objective of this 18-month project is to explore the use of best practices to facilitate the successful integration and retention of new graduate Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs). This project will evaluate the current application of health human resources best practice knowledge/strategies in BC to support the beginning practice of new nursing graduates, and to identify best practice knowledge/strategies likely to succeed in various health care settings.

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A Preliminary Study to Assess and Develop a Métis Community Readiness Model and Indicators of Success

Métis in BC and Canada have significantly lower health status than the general population. Arthritis, high blood pressure, diabetes and stomach problems are common chronic conditions among the Métis population. Currently, the BC health care system addresses Métis health issues within the mainstream system of care — a system that lacks the resources and guidelines to address culturally and regionally specific health issues. Consequently, there have been calls for Métis-specific health services. The provincial organization, Métis Nation BC (MNBC), has recently begun working with Métis communities to plan and deliver Métis-specific health programs and services. The Community Readiness Model (CRM) is a method for assessing and planning culturally valid strategies in communities that takes community resources, attitudes, and experiences into consideration. Dr. Peter Hutchinson is collaborating with MNBC and Okanagan Métis Child and Family Services to assess the CRM and identify indicators of success for social services. Dr. Hutchinson will present the model to community members and Métis social service providers to gather suggestions for adapting it for Métis communities. In addition, Dr. Hutchinson will work with his Métis partners to identify indicators for gauging the success of Métis-specific health services, determining the Okanagan Métis community’s priorities for specific health issues, and developing a proposal to pilot test the CRM. Ultimately, this research will improve health in Métis communities by enhancing health delivery and increasing access to services.

Rationing in health care

Limited health care resources require organizations to have mechanisms for making funding decisions. Decision makers, however, may not be familiar with tools to assist in maximizing resources. Decision makers also face organizational constraints and other challenges that counter the use of priority setting tools. This award supports the development of a team that will bring together two leading-edge, BC-based research programs on priority setting and resource allocation in health care, while also tapping into other related research areas. The team’s overall aim is to develop a plan that will establish BC as the international lead on research in health care priority setting. The team will structure activities around a series of interactive decision maker-researcher forums addressing key areas for development in health care priority setting.

BC Southern Interior Health Services Research Team (BCSIHSR)

The BCSIHSR plans to focus on research to improve the range and quality of services provided to the frail elderly in the Central Okanagan sub-region of Interior Health, where more than 20 per cent of the population is 65 or older. The Team’s research program includes evaluating the costs and quality of services currently provided within Interior Health; developing and implementing an evidence-based decision-making process to reallocate resources among program options; and evaluating outcomes, including quality of care measures. This award funds a program of four workshops to help BCSIHSR develop research capacity, identify research priorities, refine approaches and methods, and prepare funding applications.

Priority setting and resource allocation in the Vancouver Island Health Authority

With limited resources in our health care system, difficult choices must be made in how health authorities prioritize services and allocate resources. Recent research has shown that decision-makers in health authorities face two sets of impediments in this task: a lack of skills in these processes, and an organizational culture in health administration that implicitly supports allocation based on historical patterns. Program budgeting and marginal analysis (PBMA) is a framework designed to assist decision-makers in weighing evidence from numerous sources to determine how resources might be allocated to improve health gain or to better meet other relevant criteria. To facilitate organizational adoption of PBMA as an alternative decision-making process, further research is required to develop strategies for implementation, as well as to drive key methodological aspects of the process. Craig Mitton is addressing these issues by applying PBMA across service areas in the Vancouver Island Health Authority (VIHA). While advancing key aspects of priority setting through the introduction of PBMA within VIHA, he is also facilitating skill-building among stakeholders in the application of the new decision-making process. He is also evaluating its implementation, which will not only refine the process for VIHA, but also contribute to the literature on priority setting in health organizations.