Melissa Xanthopoulos - Academia.edu (original) (raw)

Papers by Melissa Xanthopoulos

Research paper thumbnail of Feasibility and performance of home sleep apnea testing in youth with Down syndrome

Journal of Clinical Sleep Medicine, Apr 27, 2023

Research paper thumbnail of Caregiver experiences helping children with Down syndrome use positive airway pressure to treat obstructive sleep apnea

Research paper thumbnail of Commentary on “Maintenance of Functional Gains Following a Goal-Directed and FES-Assisted Cycling Program for Children With Cerebral Palsy”

Pediatric Physical Therapy

Research paper thumbnail of 0357 Interdisciplinary Training in Pediatric Sleep

Sleep

Introduction Sleep is a critical domain of child functioning. However, clinical psychology progra... more Introduction Sleep is a critical domain of child functioning. However, clinical psychology programs lack formal sleep education while behavioral sleep instruction is deficient in sleep and pulmonary fellowships. Cross-disciplinary training in pediatric sleep is ideal. This study examined medical and psychology trainee satisfaction with two interdisciplinary experiences: a 1-2 semester clinical rotation for medical fellows and psychology doctoral students and a concentrated annual elective for medical students. The rotation includes 1-2 half-day clinics per week wherein medical sleep fellows and behavioral sleep medicine trainees conduct a sleep interview together and ask specific questions within their discipline. With an attending psychologist and physician, they discuss case conceptualization, differential diagnoses, and possible interventions. The team reviews pertinent findings and collaboratively provides recommendations to the patient. Trainees also participate in weekly didac...

Research paper thumbnail of 0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome

Sleep

Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA)... more Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families. Methods Prospective comparative effectiveness study. Youth <18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater...

Research paper thumbnail of Positive Airway Pressure Therapy Initiation in Hospitalized Children with Obstructive Sleep Apnea

B49. SLEEP, CHEST WALL, AND NEUROMUSCULAR - OH MY!

Research paper thumbnail of Pediatric sleep

Research paper thumbnail of The Association Between Gastroesophageal Reflux Disease and Obesity

American Journal of Gastroenterology, 2008

Nearly all epidemiologic studies have found an association between increasing body mass index (BM... more Nearly all epidemiologic studies have found an association between increasing body mass index (BMI) and symptoms of gastroesophageal reflux disease (GERD). Changes in gastroesophageal anatomy and physiology caused by obesity may explain the association. These include an increased prevalence of esophageal motor disorders, diminished lower esophageal sphincter (LES) pressure, the development of a hiatal hernia, and increased intragastric pressure. Central adiposity may be the most important risk for the development of reflux and related complications such as Barrett's esophagus and esophageal adenocarcinoma. Weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD. The mechanism of action through which this surgery is successful at improving GERD may be independent of weight loss and needs further examination. Current evidence suggests that laparoscopic adjusted gastric banding should be avoided in these patients as the impact on gastroesophageal reflux disease appears unfavorable.

Research paper thumbnail of Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Pediatric Pulmonology, 2021

To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in child... more To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in children hospitalized for asthma exacerbation.

Research paper thumbnail of The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

Sleep Medicine, 2021

OBJECTIVES Acute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is p... more OBJECTIVES Acute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is particularly severe in those with Down syndrome (DS). Obstructive sleep apnea (OSA), common in DS, is also associated with respiratory complications. However, it is unknown whether OSA is associated with worse outcomes in children with and without DS, hospitalized with bronchiolitis. We hypothesized that in children with bronchiolitis, OSA is associated with worse outcomes in those with DS, independent of DS-related comorbidities. METHODS Hospital discharge records of children with bronchiolitis aged ≤2 years were obtained for 1997-2012 from the Kid's Inpatient Database. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay, and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for DS-associated comorbidities. RESULTS There were 928,961 hospitalizations for bronchiolitis. The DS group with bronchiolitis (n = 8697) was more likely to have OSA [241 (2.77%) vs 1293 (0.14%), p < 0.001] compared to the non-DS group (n = 920,264). Multivariable logistic regression showed that OSA was associated with IMV (adjusted odds ratio [OR], 3.32 [95% CI 2.54-4.35], p < 0.0001) in all children with bronchiolitis; and in those with DS, it was associated with IMV (adjusted OR, 2.34 [95% CI 1.38-3.97], p = 0.002), NIMV (adjusted OR, 8.21 [95% CI 4.48-15.04], p < 0.0001) and IACH (adjusted β, 0.18 [95% CI 0.02-0.34], p = 0.031). CONCLUSIONS OSA is independently associated with assisted ventilation in all children hospitalized with bronchiolitis, regardless of DS-associated comorbidities in those with DS. The severity of bronchiolitis in children with DS may be driven by the high prevalence of OSA.

Research paper thumbnail of Correction to: Mental Health in the Young Athlete

Current Psychiatry Reports, 2020

In the recently published article "Mental Health in the Young Athlete" the following author name ... more In the recently published article "Mental Health in the Young Athlete" the following author name was inadvertently misspelled as Christine L. Master. The correct spelling of the author's name is: Christina L. Master as shown above. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Positive Airway Pressure for the Treatment of OSA in Infants

Chest, 2021

BACKGROUND Positive airway pressure (PAP) is a standard therapy for the treatment of obstructive ... more BACKGROUND Positive airway pressure (PAP) is a standard therapy for the treatment of obstructive sleep apnea syndrome (OSAS) in children, but objective data on effectiveness of PAP in infants are sparse. The aim of this study was to compare the effectiveness of PAP in infants <6 months old with school-age children. RESEARCH QUESTION Compared to school-age children, can PAP be titrated as successfully in infants and is adherence to PAP similar in both age groups? STUDY DESIGN and Methods: Single-center retrospective study. For consecutive infants <6 months old and school-age children 5-10 years old with OSAS treated with PAP, baseline and titration polysomnography data, PAP adherence data, and parent-reported barriers to adherence were compared between groups. RESULTS 41 infants and 109 school-age children were included. Median (interquartile range) obstructive apnea hypopnea index (OAHI) in infants was 25.7/hr (17.8,35.9) and was greater than school-age children (12.1/hr (7.6,21.5) (p<0.0001). After PAP titration, OAHI was reduced by (median) 92.1% in infants, similar to 93.4% in school-age children (p=0.67). PAP was used in infants on 94.7% of nights, which was greater than 83% in school-age children (p=0.003). There were no differences in barriers to adherence between infants and school-age children, with behavioral barriers being most common in both groups. INTERPRETATION Objective data demonstrates that PAP is both highly effective at treating OSAS and well-tolerated in infants. Like older patients, PAP should be considered along with other therapies for the treatment of OSAS in even the youngest children.

Research paper thumbnail of Mental Health in the Young Athlete

Current Psychiatry Reports, 2020

Purpose of Review The goal of the present paper is to provide a comprehensive overview of mental ... more Purpose of Review The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors. Recent Findings Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Summary Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.

Research paper thumbnail of Trajectory of Positive Airway Pressure Initiated for Children with OSA While Inpatient

A26. PEDIATRIC SLEEP I, 2020

Research paper thumbnail of 0754 Depressive Symptomatology in School-Aged Children with Obstructive Sleep Apnea Syndrome: Incidence, Demographic Factors, and Changes Following a Randomized Controlled Trial of Adenotonsillectomy

Sleep, Apr 1, 2018

Introduction: Our previous study has shown that low flow oxygen is an effective treatment for inf... more Introduction: Our previous study has shown that low flow oxygen is an effective treatment for infant with OSA. High loop gain is postulated to play a role in responses to oxygen. Because significant maturation changes in loop gain occurs during infancy, we evaluate developmental changes in respiratory and sleep parameters in infants treated with oxygen. Methods: This is a retrospective study performed at CCHMC. We obtained data on infants with OSA from 2005 to 2017. All infants had a room air diagnostic PSG, followed by a PSG with oxygen. They were classified as oxygen responders when the improvement of apnea hypopnea index (AHI) on oxygen were more than 50%, otherwise classified as non-responders. Primary outcomes were changes in AHI. Secondary outcomes were changes in sleep parameters. Generalized linear mixed model was used for comparing the two groups by time with adjustment for multiplicity. A p-value of less than 0.05 was considered statistically significant. Results: 96 subjects were included for analysis with 64% were oxygen responders. Mean age at the initial sleep study was 0.25 ± 0.25 years. After adjustment for multiplicity, there were significant decreases in AHI in oxygen responders over time from age 0-6 months to 6-9 months and to 12-18 months (p<0.0001). This change was not observed in oxygen non-responders. For obstructive index (OI), OI reduced from age 0-6 months to 6-9 months (p=0.0415) and to 12-18 months (p=0.0071) in oxygen non-responders. However, the rate of improvement was larger for oxygen responders. For sleep architecture, there were significant decreases in arousal index and increases in sleep efficiency in both oxygen responders and oxygen non-responders over time. Conclusion: Developmental changes in respiratory and sleep parameters occur over time in infants with OSA treated with oxygen. Rate of improvement in respiratory parameters is larger in oxygen responders. We speculate that oxygen responders group have higher loop gain and are more likely to have more stable respiratory pattern with maturation. Support (If Any): nil.

Research paper thumbnail of 0896 Nutritional Status Improves Following The Implementation Of Positive Airway Pressure For The Treatment Of Obstructive Sleep Apnea In Youth With Down Syndrome

Sleep, 2020

Introduction In typically developing youth, increases in body mass index (BMI) and rates of obesi... more Introduction In typically developing youth, increases in body mass index (BMI) and rates of obesity accompany treatment of obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy regardless of baseline BMI and OSAS severity. Residual OSAS following adenotonsillectomy and overweight/obesity are common in Down syndrome (DS). We sought to examine the impact of positive airway pressure (PAP) on BMIZ in youth with DS and OSAS. Methods Baseline, 6, and 12 month height/length and weight as well as pre-PAP PSG data were abstracted from the Children’s Hospital of Philadelphia Sleep Center for patients with DS and OSAS initiated on PAP between 01/01/2014-07/11/01/2017 (N=73; Median age=6.6y IQR: 3.6-12.1; 52% White, 29% Black; 42% Male). BMIZ was calculated. Longitudinal mixed effects models adjusted for adherence from 0-6 months, baseline BMIZ, and baseline SpO2 nadir were used to evaluate change in BMIZ at months 6 and 12 and the impact of baseline BMIZ on trajectories. Results OAHI...

Research paper thumbnail of 0888 A Peer-Based Social Media Intervention to Promote Continuous Positive Airway Pressure Adherence in Adolescents With Obstructive Sleep Apnea

Sleep, 2020

Introduction Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive... more Introduction Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive sleep apnea (OSA) is suboptimal. This study evaluated an innovative CPAP adherence intervention for adolescents and their caregivers delivered via private Facebook groups. Study aims: (1) determine feasibility and acceptability of the intervention and (2) assess CPAP use pre- and post-intervention. Methods A pilot cohort study design was employed (N=6 dyads). Intervention included psychoeducation, CPAP use downloads/feedback, promoting peer-engagement through posts, videos, and polls. Adolescent and caregiver groups ran separately and simultaneously over 4-weeks. Measures: demographics, engagement/participation data, CPAP use, semi-structured interviews. Analysis: descriptive statistics and thematic content analysis. Results Adolescents were Black/African American (100%), males (100%) with a median age of 16 years (range 13-17). Caregivers (n=6) were mothers (67%) and fathers (33%) with...

Research paper thumbnail of Carole L. Marcus, M.B.B.Ch. (1960 – 2017)

Behavioral Sleep Medicine, 2018

Research paper thumbnail of Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities

Journal of Clinical Sleep Medicine, 2019

STUDY OBJECTIVES To determine whether adherence to positive airway pressure (PAP) differs in chil... more STUDY OBJECTIVES To determine whether adherence to positive airway pressure (PAP) differs in children with developmental disabilities (DD) compared to typically developing (TD) children. METHODS PAP adherence of 240 children initiated on PAP for obstructive sleep apnea (OSA) was retrospectively analyzed. Adherence between groups, expressed as percentage of nights used and hours of usage on nights used at 3 and 6 months, was compared. Predictive factors of adherence were studied using a median regression model. RESULTS A total of 103 children with DD (median [interquartile range] age = 7.9 [3.2-13.1] years) and 137 TD (11.0 [5.5-16.1], P = .005) children were included. Percentage of nights used was significantly higher in children with DD at 3 (DD = 86.7 [33.9-97.9], TD = 62.9 [30.8-87.8] P = .01) and 6 months (DD = 90.0 [53.3-100], TD = 70.7 [29.2-90.8], P = .003). Hours of usage on nights used at 3 and 6 months were similar between groups (DD = 5.0 [1.4-7.9], TD = 4.6 [1.9-7.2], P = .715; DD = 6.4 [1.8-8.3], TD = 5.7 [2.5-7.3], P = .345, respectively). This adherence measure improved over time in both groups (DD, P = .007; TD, P = .005). At 6 months, higher median neighborhood income and titration at or before 6 months were significantly predictive for percentage of nights used; higher PAP pressure was significantly predictive for hours of usage in both groups. CONCLUSIONS Children with DD had better PAP adherence expressed as percentage of nights used than TD children. Hours of usage on nights used at 3 and 6 months were similar between groups and improved over time. Higher income and titration at or before 6 months were predictive of adherence in all children. These findings indicate that children with DD can successfully wear PAP.

Research paper thumbnail of Clinical Utility of Repeated Positive Airway Pressure Titrations in Children with Obstructive Sleep Apnea Syndrome

B66. SRN: CURRENT AND EMERGING TREATMENT THERAPIES TO IMPROVE SLEEP, 2019

Research paper thumbnail of Feasibility and performance of home sleep apnea testing in youth with Down syndrome

Journal of Clinical Sleep Medicine, Apr 27, 2023

Research paper thumbnail of Caregiver experiences helping children with Down syndrome use positive airway pressure to treat obstructive sleep apnea

Research paper thumbnail of Commentary on “Maintenance of Functional Gains Following a Goal-Directed and FES-Assisted Cycling Program for Children With Cerebral Palsy”

Pediatric Physical Therapy

Research paper thumbnail of 0357 Interdisciplinary Training in Pediatric Sleep

Sleep

Introduction Sleep is a critical domain of child functioning. However, clinical psychology progra... more Introduction Sleep is a critical domain of child functioning. However, clinical psychology programs lack formal sleep education while behavioral sleep instruction is deficient in sleep and pulmonary fellowships. Cross-disciplinary training in pediatric sleep is ideal. This study examined medical and psychology trainee satisfaction with two interdisciplinary experiences: a 1-2 semester clinical rotation for medical fellows and psychology doctoral students and a concentrated annual elective for medical students. The rotation includes 1-2 half-day clinics per week wherein medical sleep fellows and behavioral sleep medicine trainees conduct a sleep interview together and ask specific questions within their discipline. With an attending psychologist and physician, they discuss case conceptualization, differential diagnoses, and possible interventions. The team reviews pertinent findings and collaboratively provides recommendations to the patient. Trainees also participate in weekly didac...

Research paper thumbnail of 0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome

Sleep

Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA)... more Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families. Methods Prospective comparative effectiveness study. Youth <18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater...

Research paper thumbnail of Positive Airway Pressure Therapy Initiation in Hospitalized Children with Obstructive Sleep Apnea

B49. SLEEP, CHEST WALL, AND NEUROMUSCULAR - OH MY!

Research paper thumbnail of Pediatric sleep

Research paper thumbnail of The Association Between Gastroesophageal Reflux Disease and Obesity

American Journal of Gastroenterology, 2008

Nearly all epidemiologic studies have found an association between increasing body mass index (BM... more Nearly all epidemiologic studies have found an association between increasing body mass index (BMI) and symptoms of gastroesophageal reflux disease (GERD). Changes in gastroesophageal anatomy and physiology caused by obesity may explain the association. These include an increased prevalence of esophageal motor disorders, diminished lower esophageal sphincter (LES) pressure, the development of a hiatal hernia, and increased intragastric pressure. Central adiposity may be the most important risk for the development of reflux and related complications such as Barrett's esophagus and esophageal adenocarcinoma. Weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD. The mechanism of action through which this surgery is successful at improving GERD may be independent of weight loss and needs further examination. Current evidence suggests that laparoscopic adjusted gastric banding should be avoided in these patients as the impact on gastroesophageal reflux disease appears unfavorable.

Research paper thumbnail of Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Pediatric Pulmonology, 2021

To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in child... more To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in children hospitalized for asthma exacerbation.

Research paper thumbnail of The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

Sleep Medicine, 2021

OBJECTIVES Acute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is p... more OBJECTIVES Acute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is particularly severe in those with Down syndrome (DS). Obstructive sleep apnea (OSA), common in DS, is also associated with respiratory complications. However, it is unknown whether OSA is associated with worse outcomes in children with and without DS, hospitalized with bronchiolitis. We hypothesized that in children with bronchiolitis, OSA is associated with worse outcomes in those with DS, independent of DS-related comorbidities. METHODS Hospital discharge records of children with bronchiolitis aged ≤2 years were obtained for 1997-2012 from the Kid's Inpatient Database. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay, and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for DS-associated comorbidities. RESULTS There were 928,961 hospitalizations for bronchiolitis. The DS group with bronchiolitis (n = 8697) was more likely to have OSA [241 (2.77%) vs 1293 (0.14%), p < 0.001] compared to the non-DS group (n = 920,264). Multivariable logistic regression showed that OSA was associated with IMV (adjusted odds ratio [OR], 3.32 [95% CI 2.54-4.35], p < 0.0001) in all children with bronchiolitis; and in those with DS, it was associated with IMV (adjusted OR, 2.34 [95% CI 1.38-3.97], p = 0.002), NIMV (adjusted OR, 8.21 [95% CI 4.48-15.04], p < 0.0001) and IACH (adjusted β, 0.18 [95% CI 0.02-0.34], p = 0.031). CONCLUSIONS OSA is independently associated with assisted ventilation in all children hospitalized with bronchiolitis, regardless of DS-associated comorbidities in those with DS. The severity of bronchiolitis in children with DS may be driven by the high prevalence of OSA.

Research paper thumbnail of Correction to: Mental Health in the Young Athlete

Current Psychiatry Reports, 2020

In the recently published article "Mental Health in the Young Athlete" the following author name ... more In the recently published article "Mental Health in the Young Athlete" the following author name was inadvertently misspelled as Christine L. Master. The correct spelling of the author's name is: Christina L. Master as shown above. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Positive Airway Pressure for the Treatment of OSA in Infants

Chest, 2021

BACKGROUND Positive airway pressure (PAP) is a standard therapy for the treatment of obstructive ... more BACKGROUND Positive airway pressure (PAP) is a standard therapy for the treatment of obstructive sleep apnea syndrome (OSAS) in children, but objective data on effectiveness of PAP in infants are sparse. The aim of this study was to compare the effectiveness of PAP in infants <6 months old with school-age children. RESEARCH QUESTION Compared to school-age children, can PAP be titrated as successfully in infants and is adherence to PAP similar in both age groups? STUDY DESIGN and Methods: Single-center retrospective study. For consecutive infants <6 months old and school-age children 5-10 years old with OSAS treated with PAP, baseline and titration polysomnography data, PAP adherence data, and parent-reported barriers to adherence were compared between groups. RESULTS 41 infants and 109 school-age children were included. Median (interquartile range) obstructive apnea hypopnea index (OAHI) in infants was 25.7/hr (17.8,35.9) and was greater than school-age children (12.1/hr (7.6,21.5) (p<0.0001). After PAP titration, OAHI was reduced by (median) 92.1% in infants, similar to 93.4% in school-age children (p=0.67). PAP was used in infants on 94.7% of nights, which was greater than 83% in school-age children (p=0.003). There were no differences in barriers to adherence between infants and school-age children, with behavioral barriers being most common in both groups. INTERPRETATION Objective data demonstrates that PAP is both highly effective at treating OSAS and well-tolerated in infants. Like older patients, PAP should be considered along with other therapies for the treatment of OSAS in even the youngest children.

Research paper thumbnail of Mental Health in the Young Athlete

Current Psychiatry Reports, 2020

Purpose of Review The goal of the present paper is to provide a comprehensive overview of mental ... more Purpose of Review The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors. Recent Findings Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Summary Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.

Research paper thumbnail of Trajectory of Positive Airway Pressure Initiated for Children with OSA While Inpatient

A26. PEDIATRIC SLEEP I, 2020

Research paper thumbnail of 0754 Depressive Symptomatology in School-Aged Children with Obstructive Sleep Apnea Syndrome: Incidence, Demographic Factors, and Changes Following a Randomized Controlled Trial of Adenotonsillectomy

Sleep, Apr 1, 2018

Introduction: Our previous study has shown that low flow oxygen is an effective treatment for inf... more Introduction: Our previous study has shown that low flow oxygen is an effective treatment for infant with OSA. High loop gain is postulated to play a role in responses to oxygen. Because significant maturation changes in loop gain occurs during infancy, we evaluate developmental changes in respiratory and sleep parameters in infants treated with oxygen. Methods: This is a retrospective study performed at CCHMC. We obtained data on infants with OSA from 2005 to 2017. All infants had a room air diagnostic PSG, followed by a PSG with oxygen. They were classified as oxygen responders when the improvement of apnea hypopnea index (AHI) on oxygen were more than 50%, otherwise classified as non-responders. Primary outcomes were changes in AHI. Secondary outcomes were changes in sleep parameters. Generalized linear mixed model was used for comparing the two groups by time with adjustment for multiplicity. A p-value of less than 0.05 was considered statistically significant. Results: 96 subjects were included for analysis with 64% were oxygen responders. Mean age at the initial sleep study was 0.25 ± 0.25 years. After adjustment for multiplicity, there were significant decreases in AHI in oxygen responders over time from age 0-6 months to 6-9 months and to 12-18 months (p<0.0001). This change was not observed in oxygen non-responders. For obstructive index (OI), OI reduced from age 0-6 months to 6-9 months (p=0.0415) and to 12-18 months (p=0.0071) in oxygen non-responders. However, the rate of improvement was larger for oxygen responders. For sleep architecture, there were significant decreases in arousal index and increases in sleep efficiency in both oxygen responders and oxygen non-responders over time. Conclusion: Developmental changes in respiratory and sleep parameters occur over time in infants with OSA treated with oxygen. Rate of improvement in respiratory parameters is larger in oxygen responders. We speculate that oxygen responders group have higher loop gain and are more likely to have more stable respiratory pattern with maturation. Support (If Any): nil.

Research paper thumbnail of 0896 Nutritional Status Improves Following The Implementation Of Positive Airway Pressure For The Treatment Of Obstructive Sleep Apnea In Youth With Down Syndrome

Sleep, 2020

Introduction In typically developing youth, increases in body mass index (BMI) and rates of obesi... more Introduction In typically developing youth, increases in body mass index (BMI) and rates of obesity accompany treatment of obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy regardless of baseline BMI and OSAS severity. Residual OSAS following adenotonsillectomy and overweight/obesity are common in Down syndrome (DS). We sought to examine the impact of positive airway pressure (PAP) on BMIZ in youth with DS and OSAS. Methods Baseline, 6, and 12 month height/length and weight as well as pre-PAP PSG data were abstracted from the Children’s Hospital of Philadelphia Sleep Center for patients with DS and OSAS initiated on PAP between 01/01/2014-07/11/01/2017 (N=73; Median age=6.6y IQR: 3.6-12.1; 52% White, 29% Black; 42% Male). BMIZ was calculated. Longitudinal mixed effects models adjusted for adherence from 0-6 months, baseline BMIZ, and baseline SpO2 nadir were used to evaluate change in BMIZ at months 6 and 12 and the impact of baseline BMIZ on trajectories. Results OAHI...

Research paper thumbnail of 0888 A Peer-Based Social Media Intervention to Promote Continuous Positive Airway Pressure Adherence in Adolescents With Obstructive Sleep Apnea

Sleep, 2020

Introduction Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive... more Introduction Continuous positive airway pressure (CPAP) adherence in adolescents with obstructive sleep apnea (OSA) is suboptimal. This study evaluated an innovative CPAP adherence intervention for adolescents and their caregivers delivered via private Facebook groups. Study aims: (1) determine feasibility and acceptability of the intervention and (2) assess CPAP use pre- and post-intervention. Methods A pilot cohort study design was employed (N=6 dyads). Intervention included psychoeducation, CPAP use downloads/feedback, promoting peer-engagement through posts, videos, and polls. Adolescent and caregiver groups ran separately and simultaneously over 4-weeks. Measures: demographics, engagement/participation data, CPAP use, semi-structured interviews. Analysis: descriptive statistics and thematic content analysis. Results Adolescents were Black/African American (100%), males (100%) with a median age of 16 years (range 13-17). Caregivers (n=6) were mothers (67%) and fathers (33%) with...

Research paper thumbnail of Carole L. Marcus, M.B.B.Ch. (1960 – 2017)

Behavioral Sleep Medicine, 2018

Research paper thumbnail of Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities

Journal of Clinical Sleep Medicine, 2019

STUDY OBJECTIVES To determine whether adherence to positive airway pressure (PAP) differs in chil... more STUDY OBJECTIVES To determine whether adherence to positive airway pressure (PAP) differs in children with developmental disabilities (DD) compared to typically developing (TD) children. METHODS PAP adherence of 240 children initiated on PAP for obstructive sleep apnea (OSA) was retrospectively analyzed. Adherence between groups, expressed as percentage of nights used and hours of usage on nights used at 3 and 6 months, was compared. Predictive factors of adherence were studied using a median regression model. RESULTS A total of 103 children with DD (median [interquartile range] age = 7.9 [3.2-13.1] years) and 137 TD (11.0 [5.5-16.1], P = .005) children were included. Percentage of nights used was significantly higher in children with DD at 3 (DD = 86.7 [33.9-97.9], TD = 62.9 [30.8-87.8] P = .01) and 6 months (DD = 90.0 [53.3-100], TD = 70.7 [29.2-90.8], P = .003). Hours of usage on nights used at 3 and 6 months were similar between groups (DD = 5.0 [1.4-7.9], TD = 4.6 [1.9-7.2], P = .715; DD = 6.4 [1.8-8.3], TD = 5.7 [2.5-7.3], P = .345, respectively). This adherence measure improved over time in both groups (DD, P = .007; TD, P = .005). At 6 months, higher median neighborhood income and titration at or before 6 months were significantly predictive for percentage of nights used; higher PAP pressure was significantly predictive for hours of usage in both groups. CONCLUSIONS Children with DD had better PAP adherence expressed as percentage of nights used than TD children. Hours of usage on nights used at 3 and 6 months were similar between groups and improved over time. Higher income and titration at or before 6 months were predictive of adherence in all children. These findings indicate that children with DD can successfully wear PAP.

Research paper thumbnail of Clinical Utility of Repeated Positive Airway Pressure Titrations in Children with Obstructive Sleep Apnea Syndrome

B66. SRN: CURRENT AND EMERGING TREATMENT THERAPIES TO IMPROVE SLEEP, 2019