McGill researchers identify a set of measures to diagnose and treat obstructive sleep apnea in the context of the ongoing pandemic.

By Ashley Rabinovitch

“Sleep apnea is everywhere,” says Dorrie Rizzo, PhD, a postdoctoral researcher in the Department of Medicine at McGill University’s Faculty of Medicine and Health Sciences. Over the years, researchers in her field have come to recognize that a significant percentage of the population, particularly people with issues like insomnia, depression, and anxiety, are suffering from undiagnosed and untreated obstructive sleep apnea (OSA).

According to a recent study published in the Journal of Clinical and Sleep Medicine, by Rizzo and other members of Professor Eva Libman’s lab, the COVID-19 pandemic has made it more challenging—but more critical than ever—to diagnose OSA. As patients confront longer wait times for specialized sleep care, behavioural measures are leading the way to diagnosis and treatment.

Connecting the dots

Years ago, a short survey of simple questions dubbed the Sleep Symptom Checklist was developed to screen patients in family practice waiting rooms. The survey identifies the presence of symptoms related to untreated sleep disorders, such as anxiety, depression, fatigue and sleepiness. In many cases, these questions will lead to a referral for an overnight sleep study to diagnosis OSA, potentially reducing the risk of developing other conditions that frequently accompany sleep disorders, including diabetes, obesity and cardiovascular problems.

Unfortunately, the same conditions that tend to accompany OSA put patients at a higher risk of complications if they contract COVID-19. “We were surprised to find a clear linkage between COVID-19 and OSA,” shares Rizzo. “As sleep labs stopped screening patients for OSA during the early days of the pandemic, we asked ourselves what we could do for patients who weren’t being screened.” Rizzo and her colleagues reasoned that if they could help family doctors identify more patients suffering from OSA, they could improve sleep health and decrease the risk and severity of COVID-19 at the same time.

Asking the right questions

For their recent study, Rizzo and her co-investigators used the Sleep Symptom Checklist as a proxy for home or in-laboratory testing for OSA. Several hundred participants, all of whom were already enrolled in a large longitudinal study with the Department of Medicine, completed the checklist, a sleep test, and a range of other self-reporting measures.

Individuals with OSA reported more symptoms on the checklist related to insomnia, daytime symptoms, sleep disorders and psychological issues than the control patients in the study, while additional sleep studies confirmed the correlation. “Essentially, our study demonstrates that family practitioners can effectively pre-screen patients for OSA using the Sleep Symptom Checklist,” says Rizzo.

If a diagnosis of obstructive sleep apnea is suspected, the study recommends a range of behavioural techniques for family physicians to suggest in routine appointments during and after the pandemic. “These behavioural techniques have actually existed in sleep medicine research for many years,” Rizzo acknowledges. Slight changes like sleeping in an elevated position or sleeping in a different position can effectively mitigate symptoms. “Patients will eventually need to be tested at a lab, but techniques as basic as strapping a tennis ball to your back so you sleep on your side can make all the difference,” she says.

As the pandemic continues to delay or prevent specialized sleep services from taking place, the Sleep Symptom Checklist offers a research-backed way to pre-screen and begin to treat patients as they wait in growing lines for continued care. According to Rizzo, the use of no-risk behavioural techniques is particularly cost-effective given the expense of specialized services. “Most clinics don’t cover the cost of treatment, which often includes a $2,000 CPAP machine,” she shares.

In future research, Rizzo and her colleagues will attempt to link at-home behavioural techniques with treatment outcomes for patients with OSA. In the meantime, they are preparing to present their current research at this year’s international SLEEP convention in June and the Canadian Sleep Society convention in October. “It’s exciting to create some awareness around an effort that improves public health, while playing a role in reducing the negative consequences of the pandemic at the same time.”

March 22 2021