Impact of wait times for treatment on clinical outcomes in patients with obstructive sleep apnoea: protocol for a randomised controlled trial

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

Tracing carbon flow and trophic structure of a coastal Arctic marine food web using highly branched isoprenoids and carbon, nitrogen and sulfur stable isotopes

Climate-driven alterations of the marine environment are most rapid in Arctic and subarctic regions, including Hudson Bay in northern Canada, where declining sea ice, warming surface waters and ocean acidification are occurring at alarming rates. These changes are altering primary production patterns that will ultimately cascade up through the food web. Here, we investigated (i) the vertical trophic structure of the Southampton Island marine ecosystem in northern Hudson Bay, (ii) the contribution of benthic and pelagic-derived prey to the higher trophic level species, and (iii) the relative contribution of ice algae and phytoplankton derived carbon in sustaining this ecosystem. For this purpose, we measured bulk stable carbon, nitrogen and sulfur isotope ratios as well as highly branched isoprenoids in samples belonging to 149 taxa, including invertebrates, fishes, seabirds and marine mammals. We found that the benthic invertebrates occupied 4 trophic levels and that the overall trophic system went up to an average trophic position of 4.8. The average δ34S signature of pelagic organisms indicated that they exploit both benthic and pelagic food sources, suggesting there are many interconnections between these compartments in this coastal area. The relatively high sympagic carbon dependence of Arctic marine mammals (53.3 ± 22.2 %) through their consumption of benthic invertebrate prey, confirms the important role of the benthic subweb for sustaining higher trophic level consumers in the coastal pelagic environment. Therefore, a potential decrease in the productivity of ice algae could lead to a profound alteration of the benthic food web and a cascading effect on this Arctic ecosystem