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Toronto Rehab inventors explain how they came together to solve the problem of diagnosing sleep apnea, which affects about two million Canadians. (Video: UHN)
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When Dr. Hisham Alshaer landed a job running a sleep lab to earn extra money while studying for his Master's Degree, he had no idea it would lay the groundwork for an award-winning device he would later co-invent at Toronto Rehab.

As a young doctor, Dr. Alshaer pursued a Master's in biomedical engineering in Turkey.

"I had a passion to combine medicine and technology at the same time," says Dr. Alshaer, now a scientist at Toronto Rehab. "I wanted to combine my skills to create something tangible."

It was in that sleep lab in Turkey that he began to think about snoring and the sounds people make while they sleep – he thought about leveraging the information in those sounds to diagnose sleep disorders using a device he could design.

While Dr. Alshaer's career led him to Canada after his degree, Toronto Rehab was facing an interesting challenge when it came to a common sleep disorder in the country.

A problem to solve: sleep apnea diagnosis

"The Ministry of Health asked us to solve the problem of the costs associated with sleep apnea testing," explains Dr. Douglas Bradley, Director of the Sleep Research Laboratories at Toronto Rehab and Toronto General.

Sleep apnea – which affects about two million Canadians – is a sleep disorder that can lead to health conditions such as heart attacks, strokes and high blood pressure. Those with sleep apnea stop breathing repeatedly while they sleep. Standard tests are costly and often require an overnight stay in a Sleep Lab. Eighty-five per cent of people with sleep apnea are not diagnosed.

"So, the government challenged us to create a diagnostic device at a lower cost and with greater accessibility for the population," says Dr. Bradley.

The stars align: three researchers come together

Working in Ottawa on a separate project, Dr. Alshaer had a conversation with Dr. Geoff Fernie, Research Director at Toronto Rehab, about the sleep apnea diagnosis challenge. That interaction set him on a path to revisit the ideas he had back in Turkey about sleep disorders.

Dr. Hisham in Turkey
Dr. Hisham Alshaer started to think about new ways to diagnose sleep disorders while working in a sleep lab in Turkey. (Photo: Hisham Alshaer)

"Hisham seemed to be exactly the right person for the job," says Dr.  Fernie. "As a trained physician, engineer, sleep lab technician and electronics whiz kid, he was too good a chance to miss."

Dr. Alshaer joined the team at Toronto Rehab and the three researchers started to work on the device.

"Hisham realized, as a sleep lab technician, that we could diagnose sleep apnea simply by listening to breath sounds," Dr. Bradley explains.

A small, sleek and affordable diagnostic device is born

The first step was the physical model of the device – which came to be known as BresoDx.

"At the beginning it was a proof of concept," explains Dr. Alshaer. "Our purpose was initially to collect breath sounds and develop the algorithm that can identify the disease from the sounds. That was the toughest segment of the work."

Then, the team at Toronto Rehab developed the software to analyze the sounds that the device was recording. Since then, the whole system has been condensed into one piece: the microphone, battery, data-capturing module, and memory card are all part of a small gadget.

BresoDx went through several phases before it became the device it is today. (Video: UHN)
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The device has also become manufacturer-friendly, for ease in producing it in mass quantities. Now in its fourth phase, it contains more power for diagnosis. BresoDx can tell when breathing interruptions take place and whether the patient is awake or asleep and whether the patient is lying on their back or their side.

"Over the years we've tested over 300 patients with the BresoDx and found it to be highly accurate compared to a full in-laboratory sleep study in terms of diagnosing sleep apnea," says Dr. Bradley.

It is the first product designed by BresoTec, a company founded by Drs. Fernie, Bradley and Alshaer, which aims to develop, produce and sell devices to diagnose and treat sleep disorders.

A homegrown innovation

The Research Institute's mandate is to promote a spirit of innovation that fosters homegrown commercialization from Toronto Rehab.

 "Toronto Rehab is here to solve problems for people," says Dr. Fernie. "When we develop a solution that is a device, we want people to be able to buy it."

Three inventors – IOTY 2016
The culture at Toronto Rehab helped the team of researchers, (L to R) Drs. Hisham Alshaer, Douglas Bradley and Geoff Fernie, to succeed in their work on BresoDx. (Photo: BresoTec Inc.)

"If we build a company here, then people can see it. They can see we're employing people and the company can give contracts back to Toronto Rehab to develop more products.

"All of a sudden we've got a channel so that ideas can be readily and quickly taken to market."

For researchers, Dr. Fernie explains, this means that within one building, they have the ability to conceive an idea, do the background research, design a product, prototype it, test it clinically, create a business plan and start a company.

"Toronto Rehab is a very resourceful environment, where you have everything in one place," says Dr. Alshaer.

"It's very intriguing and exciting for scientists."

A local success with broad impact

Health Canada has approved BresoDx and the device has been on the market for about a year. Those who would like to purchase it can do so by getting in touch with BresoTec through their website.

In 2016, the trio behind BresoDx was named 'Inventor of the Year' by UHN.

Drs. Fernie, Bradley and Alshaer
Drs. Fernie, Bradley and Alshaer were awarded for their work on BresoDx with a UHN Inventor of the Year award in 2016. (Photo: UHN’s StRIDe team​)

For the team, the device and its company have represented a great internal success that has impact beyond UHN.

"I find it very satisfying that we've developed a technology that works, and we've done it in Ontario," says Dr. Bradley.

"With BresoDx, we can improve healthcare for much larger portions of the population than is the case now." 

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