Background:
Disadvantaged individuals, including people experiencing homelessness, are at higher risk
of getting infected, transmitting disease, and having poor health outcomes. Access to
medical care, even within a system of universal health insurance like that of Canada, is
decreased among people experiencing homelessness, but available evidence has demonstrated
the efficacy of using telemedicine to reach vulnerable people in remote areas or people
experiencing homelessness. However, at present, telemedicine-facilitated care in Canada
is predominantly devoid of any technology to evaluate patient vital signals. The
application of such technology to this population, if feasible, could have
transformational implications for monitoring and management of such disadvantaged
populations. Currently, it is known that there is a greater prevalence of chronic health
diseases such as asthma, cardiology, and respiratory diseases in people experiencing
homelessness. But there is no literature on the prevalence of obstructive sleep apnea
(OSA) in the people experiencing homelessness. OSA is a condition characterized by
repeated episodes of breathing cessation during sleep. Patients with OSA can suffer from
daytime sleepiness, fatigue, and lack of energy. OSA is also associated with the
conditions that account for the leading causes of mortality in adults: hypertension,
cardiovascular, and cerebrovascular diseases. Seeing as the people experiencing
homelessness already face many societal barriers to healthcare access, it is likely that
there may exist a higher prevalence of undiagnosed OSA among the people experiencing
homelessness.
Rationale:
From past studies, chronic diseases have been shown to be of higher prevalence in the
people experiencing homelessness versus the general population, with an emphasis on a
high prevalence of asthma and hypertension in the people experiencing homelessness. There
is already a well-established connection between the prevalence of OSA in patients who
have asthma and/or hypertension and OSA is already a highly undiagnosed condition in the
general population. OSA also contributes to many other chronic health conditions. Given
the strong association of hypertension and asthma with OSA, and the above average
prevalence of both asthma and hypertension, among other chronic diseases, in this
population, it is reasonable to infer that there might also be a high prevalence of
undiagnosed OSA among the people experiencing homelessness. The use of technology and
telemedicine will decrease the barriers in receiving care for people experiencing
homelessness and allow for ease of access to diagnose OSA.
Inclusion/Exclusion Criteria:
The eligibility criteria for participants will include residing in a shelter at the time
of recruitment, and being >18 years old. Participants with allergies to medical tape will
be excluded from the study. For treatment protocol, exclusion criteria for mandibular
advancement treatment will be dental and oral health requiring extensive dental treatment
or periodontal disease with tooth mobility.
Hypotheses:
The investigators hypothesize that the prevalence of obstructive sleep apnea in the
people experiencing homelessness will exceed that observed in the general population, as
do the associated conditions of hypertension and asthma. Furthermore, the investigators
hypothesize that the use of technology will help to decrease barriers in diagnosing and
providing treatment for OSA.
Primary Objectives:
Assess the prevalence of sleep apnea in shelter residents
Evaluate the effects of preferred sleep apnea treatment on quality of life of the
people experiencing homelessness
Significance:
The investigators anticipate the results of this study to help lower barriers to
healthcare and provide better health outcomes for people experiencing homelessness. This
study will provide insight into the prevalence of OSA in people experiencing homelessness
and the feasibility of using technology in telemedicine.