R John Kimoff

Position
Associate Professor, Department of Medicine, McGill University
Associate Physician, Director, Sleep Laboratory, Royal Victoria Hospital

Research Interests

Our research program currently involves pathophysiologic and clinical investigations on sleep-disordered respiration in human subjects. The focus of the pathophysiologic studies has been on the mechanisms of respiratory-related arousal from sleep and apnea termination, as well as on the control of breathing in obstructive sleep apnea (OSA).

Our current studies relate to the role of upper airway sensory afferents in determining OSA severity. We have recently provided evidence that an attenuation of upper airway mechanoreceptor function plays an important role in mediating impaired end-apneic arousal in OSA patients (Cala et al., J Appl Physiol 81(6):2618-26.). We are presently engaged in a detailed assessment of upper airway tactile sensory function in OSA patients, snorers and controls. Our findings to date indicate a selective impairment in upper airway sensation in OSA subjects. We are proceeding to investigate the relationship of sensory abnormalities to measures of end-apneic arousal responsiveness and to the control of upper airway patency as assessed by upper airway muscle dilator and swallowing reflexes.

We also have active clinical research programs in several areas. Epidemiologic studies are being performed in collaboration with Clinical Epidemiology on the prevalence of automobile accidents in OSA prior to and following institution of treatment for OSA, and also on the knowledge base of medical practitioners concerning sleep-disordered breathing.

We are engaged in the development and assessment of novel devices for the diagnosis and treatment of OSA. A current study is evaluating the efficacy of two commercial self-adjusting nasal continuous positive airway pressure (CPAP) devices for OSA. In collaboration with colleagues in Barcelona, we are evaluating the utility of a forced oscillation technique for diagnosis of upper airway obstruction during sleep and automated adjustment of CPAP treatement. Various clinical trials are also being conducted in sleep-disordered breathing patients. We are collaborating with the Department of Nursing in a study on the effects of a nursing intervention on patient compliance with CPAP in OSA. Upcoming studies will include participation in a multi-centre trial of CPAP in patients with congestive heart failure and periodic breathing during sleep, and our laboratory will also evaluate the effects of nocturnal nasal CPAP on asthma control in asthmatics with heavy snoring and OSA in a cross-over design.

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