Anu (Thomas) Nicholas
Post-Doctoral Fellow

Overview
My work is revolving around helping develop a grant proposal about the influence of sleep disturbances and preoperative cognitive impairments in developing post-operative complications in older adults undergoing elective surgery.
The Big Picture of My Work
An understanding of this relationship can aid in highlighting the importance of screening for sleep disturbances and cognitive decline including mild early stages. Incidence of mild cognitive impairment (MCI) in patients over 65 years of age is believed to be about 3 to 22%, based on the study population. The annual rate of progression to dementia and Alzheimer's disease (AD) in people with MCI is 5% to 10% and 15%, respectively. Hence early identification can aid is early interventions to slow down the development to neurodegenerative diseases in this elderly patient cohort.
Why is This So Important?
Studies conducted among surgical patients have reported all-time highest rates of surgery among patients above 80 years; more than one in five patients. Age tends to be an independent risk factor for 30-day mortality after emergency general surgeries. Age-related changes include but are not limited to physical, emotional and cognitive alterations. Earlier prediction of underlying reasons for post-operative health decline in this patient group would help in pre-surgery interventions that can help in better post-surgery recovery and improved quality of life.
What Will This Mean for Patients?
The identification of risk factors in this patient group would help in incorporating strategies to prevent post-operative complications.
A Snap Shot of My Lab Work - Important Finding Within the Last Year
Literature searches and review of literature for the present project, grant preparation and submission.
What's Next?
Currently I am in the process of preparing a research proposal for a grant submission early this year. Success in acquiring funding will be followed by submission to the ethics board and other formalities required to start the study.

Colin Suen
Post-Doctoral Fellow

Overview
My work is focused on understanding the in-hospital outcomes associated with obstructive sleep apnea (OSA). OSA is associated with the development of several cardiovascular diseases, arrhythmias and even sudden cardiac death. As well, up to 50% of patients undergoing cardiac surgery have unrecognized OSA and may be at risk for poor cardiovascular outcomes during hospitalization. Currently, we are developing a clinical trial to study the effectiveness of non-invasive ventilation methods to prevent OSA-related postoperative complications.
The Big Picture of My Work
Determining the prevalence of OSA in the cardiac surgery population and studying therapies to prevent hypoxemia and reduce the risk of postoperative complications.
Why is This So Important?
Many patients with cardiovascular disease also have unrecognized OSA. Furthermore, between 40 to 60% of patients with OSA do not adhere to the standard therapy, CPAP, and could be at higher risk of complications when untreated.
What Will This Mean for Patients?
We may be able to use alternative methods of ventilation such as high flow nasal cannula to restore airflow and prevent complications.
A Snap Shot of My Lab Work - Important Finding Within the Last Year
Last year we looked at sleep study parameters among patients with OSA, and found that in general, lower oxygen saturation levels were associated with postoperative complications, which was published in the journal CHEST. We also examined the literature studied in-hospital outcomes of patients hospitalized for cardiac disease such as myocardial infarction and heart failure, and found that OSA was associated with increased length of stay, mortality, and markers of myocardial injury.
What's Next?
The next phase of our study will be to perform a small pilot study to determine whether alternatives such as. high flow nasal cannula is better than CPAP. This work may lead to the design of a larger clinical trial to examine whether high flow nasal cannula can be used to prevent postoperative hypoxemia, and in turn, other complications.

Soodaba Mir, MSc
University of Toronto
2018-2019

Overview
My work was focused on understanding the interaction between centrally acting drugs and opioids in chronic pain patients with obstructive sleep apnea (OSA) and or central sleep apnea (CSA). Chronic opioid use is now recognized to be associated with the development of sleep disordered breathing including both OSA and CSA. Centrally acting drugs with sedating properties are commonly co-prescribed with opioids in chronic pain patients, and together the two may result in respiratory events and increased risk of sleep disordered breathing. Currently, we are publishing our work on the combined use of the centrally acting drug benzodiazepine with opioids in chronic pain patients.
The Big Picture of My Work
Determining the effect of concomitant centrally acting drug use with opioids in chronic pain patients with sleep disordered breathing.
Why is This So Important?
Many chronic pain patients who are prescribed opioids have unrecognized sleep disordered breathing. Furthermore, a large percentage of these patients are co-prescribed sedating centrally acting drugs with their opioid medication despite them being contraindicated. These chronic pain patients on concomitant opioidcentrally acting drugs higher risk of respiratory depression if they have underlying sleep disordered breathing that is left untreated.
What Will This Mean for Patients?
Chronic pain patients on opioid medication should be screened for sleep disordered breathing, and at-risk patients should not be prescribed potentially detrimental centrally acting drugs with their opioid medication.
A Snap Shot of My Lab Work - Important Finding Within the Last Year
Last year we looked at chronic pain patients on opioid medication with sleep disordered breathing and found that, there may be potential to reduce the risk and severity of sleep apnea in specific chronic pain patients on opioids using certain benzodiazepine sedatives by selecting those with a low respiratory arousal threshold in whom sleep promotion may stabilize breathing. We presented our work at the World Sleep Congress 2019 in Vancouver.
What's Next?
The next phase of our research will be to potentially perform a prospective cohort study to determine whether concomitant opioid and benzodiazepine use in chronic pain patients with a low respiratory arousal threshold could be beneficial in reducing the risk of sleep apnea.

Sally Hu, MD
PGY-1 Resident Physician
Dept. of Anesthesia, University of Toronto
June 2018

I worked with Dr. Chung on a project over the course of 2 years. Dr. Chung is a fantastic research supervisor to work with. She always gave very insightful and timely feedback on the project. Under her supervision, we successfully published the project in a highly reputable journal and presented it at an international conference. Furthermore, Dr. Chung also became a mentor for me and continues to provide me with insightful guidance in my training in anesthesia. It is a pleasure working with Dr. Chung and I look forward to further collaborations with her in the future.

Thach Lam, MD
PGY-5 Resident Physician
Dept. of Anesthesia, University of Toronto
March 2018

I had the opportunity of working closely with Dr. Frances Chung throughout my Anesthesiology residency from PGY2-5. As a research supervisor, I found Dr. Chung to be very encouraging, always available, and very supportive (even when you don't have a research background like me). Most importantly, she is resident friendly - she recognizes that we have a busy residency schedule and is very accommodating with research deadlines, while being very prompt with her review and comments. She goes above and beyond to make sure your hard research work gets recognized, published and presented. I published 2 first author papers in Anesthesia & Analgesia and 2 letters to the editor with Dr. Chung. She also provided me with a stipend to present my research at an international conference. I am very grateful to have had the opportunity to work with such a dedicated mentor. I will be working in Barrie's Royal Victoria Hospital as staff anesthesiologist after I graduate.

George Ho
Medical Student | Class of 2021
University of Toronto
March 2018

I had the pleasure of working under the direct supervision of Dr. Chung as her research assistant for a period of 18 months. From the start, Dr. Chung worked closely to provide me with opportunities and resources to succeed in research. As I progressed under her guidance, I was entrusted with greater responsibility and independence to work on projects. She understood when and how to provide the right motivation and constructive feedback to build my character and skills. Under her supervision, I wrote 3 abstracts, presented at local and international conferences, and co-authored a total of 4 manuscripts, 2 of which are published

Most importantly, Dr. Chung is passionate about supporting and teaching students such as pre-meds like myself. Under her mentorship, she helped me appreciate the importance of persistence, strong work ethic and responsibility. She also connected me with medical students, residents and physicians, who provided me with invaluable guidance and advice. If it were not for Dr. Chung's continued support, I do not believe I would have gotten into medical school. I learned skills and developed competencies in her team that I continue to apply and advance as a medical student. Dr. Chung has my utmost respect, admiration and appreciation.

Russel Brown MD FRCPC
Assistant professor, McMaster University
Staff anesthesiologist, Hamilton Health Sciences, Hamilton, Ontario, Canada
March 2018

As a 2nd year resident in 2012, I was fortunate enough to work on a successful project with Dr. Chung that resulted in an abstract, and we developed it further into a well cited publication. This success reflects her supportive and highly approachable nature and keen role as a mentor. Additionally it also helped me achieve my own career goals, and have since obtained an academic post as an Assistant Professor in the Department of Anesthesia at McMaster University.

Limei Zhou
PhD, molecular biology, Beijing Institute of Basic Medical Sciences
MS statistics, University of Toronto
March 2018

I am originally from China. When I was doing my Masters in Statistics from University of Toronto, I worked part-time for Dr. Chung for about half a year from September 2011 to March 2012 as a research analyst. My project was to predict postoperative adverse events based on parameters from preoperative nocturnal oximetry. As a highly accomplished clinical scientist, not only Dr. Chung is very passionate about research herself, she also encourages and challenges her team members to think independently and critically, and to achieve the highest they can do. Inspired, I was able to finish the project within a short period of time, and won the Best Abstract Award in Patient Safety in 2012 Canadian Anaesthesiologists' Society Annual Meeting, and the paper "Parameters from preoperative overnight oximetry predict postoperative adverse events" was subsequently published in Minerva Anestesiologica. Currently I work as a senior research analyst at Institute of Clinical Evaluative Sciences, Toronto.

David Lam BMSc
Medical Student - Year 3 (University College Cork)
March 2018

I was a summer research assistant for Dr. Chung in 2010 and 2011. After completing my undergraduate degree from the Medical Science Program at Western University in 2013, I worked as Dr. Chung's full-time research assistant from May 2014 to August 2015. As Dr. Chung's research assistant, I worked with a high caliber team in the Department of Anesthesia at the Toronto Western Hospital, University Health Network. I was able to develop my knowledge of writing systematic reviews and conduct clinical studies in the area of sleep apnea. While working closely with Dr. Chung, I had many opportunities to collaborate with other staff physicians and residents on various projects. Dr. Chung was very supportive and demonstrated a willingness to provide guidance throughout the different stages of project development. Dr. Chung actively encouraged and provided opportunities for her team to publish their work. In my time working with Dr. Chung, I was able to publish five papers. This experience taught me invaluable and transferable research skills that I find useful even now as a medical student. I highly recommend anyone interested in clinical research to contact Dr. Chung.

Edmond Hung Leong Chau, MD. FRCPC
Site Lead, Department of Anesthesia,
Welland Hospital Site, Niagara Health
March 2018

I am currently a staff anesthesiologist and intensivist at Niagara Health. I worked with Dr. Chung during my anesthesia residency from 2011 to 2014. I was involved in writing two manuscripts and a book chapter. Dr. Chung is very resourceful as a supervisor and she has an excellent research team. She provided me with a highly supportive environment that fosters my skills in critical thinking and writing. I also had abundant opportunities to present my work at international conferences and develop valuable connections with a wide group of experts in the field.

Matin Rashid, MD
Medical Resident
Dept. of Anesthesia, University of Toronto

I worked with Dr. Chung and want to thank her so much for giving me the opportunity to work under her leadership and allowing me to be apart of the team and it's success. Since the day she took me in, she was so kind, got me involved, teached me essential skills in research, and constantly pushed me to be a better version of myself. These lessons will stay with me forever. Once again, thank you for everything and congratulations on a well deserved achievement!

Mark Hwang, MD
Medical Resident (Class of 2023)
Dept. of Anesthesia, University of Toronto

I had the pleasure of working under the supervision of Dr. Chung over the course of 2 years. Dr. Chung is an excellent supervisor and mentor. She is exceptionally organized, supportive, and available. She was always prompt with her insightful review and feedback. It was an invaluable experience to work with and learn from a research leader in the fields of obstructive sleep apnea and perioperative medicine. She also provided generous support in publishing our work in a recognized journal and presenting at an international conference. I am grateful to have had the opportunity to work under her guidance.

Maged Andrawes MD, FRCPC
March 2018

I am an IMG, graduated from Faculty of Medicine, Cairo university. After I finished my MCC exam, I was lacking enough research experience. I was lucky and joined the STOP-Bang research team in 2011 and worked with Dr. Chung for one year. The entire team members were helpful and understanding which created good atmosphere for new research members. During that year, I got great exposure to different research methodology and coauthored 3 papers that has been published in prestigious journals. I believe, that experience was one of the reasons I got accepted into the Anesthesia residency at University of Toronto through the Advanced Specialty Training (residency) Program in 2012. Now I am FRCPC anesthetist and currently doing Pain Medicine residency at University of Toronto.