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The research program at the Sleep Center of Children’s Hospital of Philadelphia is focused on pediatric sleep disorders, with an emphasis on childhood obstructive sleep apnea syndrome (OSAS), a condition where there are pauses in breathing during sleep. An important research focus is the pathophysiology of childhood OSAS, as well as developing optimal treatments for OSAS. In addition, the Center has strong focus on behavioral sleep research.
Research Project Highlights
Researchers at the Sleep Center are engaged in the following efforts:
- Cerebral blood flow and neurocognition in children with OSAS. PI: Ignacio Tapia, MD. This project aims to understand the mechanisms of cognitive and behavioral dysfunction in children with OSAS. The project will use a novel non-invasive optical device to measure cerebral blood flow and other determinants of brain metabolism during wakefulness and sleep in children with OSAS and controls. These measurements will be correlated with neurobehavioral testing results.
- Utility of nasal steroids for the treatment of childhood OSAS. PI: Ignacio Tapia. OSAS is common in children, but current treatment options are limited. This randomized controlled trial will evaluate the effect of intranasal corticosteroids for treatment of mild to moderate OSAS. The study will also evaluate whether certain children (e.g., those with asthma) respond better than others to the treatment, the required duration of treatment, and side-effects associated with the treatment.
- Mechanisms of OSAS in infants with micrognathia. PI: Christopher Cielo. Babies born with a defect causing their jaw to be small (called micrognathia) puts them at high risk for OSAS. It’s likely there are multiple factors that put these babies at risk for OSAS and cause them to have difficulty with growth, but these aren’t well understood. This study will use a variety of procedures including sleep studies, MRIs, and measurement of the calories consumed to determine which infants are at increased risk and which will benefit most from surgical correction of micrognathia, improving the care of these highly vulnerable patients.
- Implementing evidence-based behavioral sleep intervention in urban primary care. PI: Ariel Williamson. Behavioral sleep problems such as insomnia and insufficient sleep are associated with deleterious childhood physical and mental health outcomes, yet are modifiable, particularly in early development. The purpose of this K23 proposal is to prepare the applicant for a career in primary care-based behavioral intervention research, and to adapt and pilot an evidence-based behavioral sleep intervention so that its contents and service delivery methods are appropriate for lower-socio-economic status (SES) preschoolers within an urban primary care context. The knowledge gained from this proposal will help to address a critical need for accessible sleep interventions for lower-SES children, who experience high rates of behavioral sleep problems and often lack access to specialty care treatment.
- Impact of treatment of sleep-disordered breathing in children’s health. Site PI: Ignacio Tapia, MD. Multicenter study. Adenotonsillectomy is one of the most common surgical procedures performed in children, usually for symptoms of obstructed breathing during sleep and snoring, but often without actual OSAS, for example those with mild sleep-disordered breathing (MSDB). However, the effects of surgery on MSDB is not known. This study will evaluate the effects of adenotonsillectomy on behavior, attention and healthcare utilization in children with MSDB, as well as identify subgroups who are most likely to benefit, thus informing future management approaches of this common pediatric condition and helping to direct resources to those children most likely to benefit.
- HEalthy SLeeP for Children with Down Syndrome (HELP-DS). Site PI: Ignacio Tapia, MD. Multicenter study. Individuals with Down sundrome are predisposed to OSAS due to craniofacial features such as midface hypoplasia, glossoptosis, hypotonia, obesity, and hypothyroidism. Studies have shown a prevalence of OSAS in children with Down syndrome between 45 and 55 percent. These rates are markedly higher than that of typically developing children. However, there’s a lack of data regarding the degree of sleep-disordered breathing that warrants treatment as well as the ability of these children to undergo neurocognitive assessments. The aim of this observational study is to gather data on children with Down syndrome and sleep-disordered breathing referred for treatment with adenotonsillectomy. These data will be analyzed to address key questions needed to design a future randomized controlled trial, including approaches related to the selection of: participating sites, the patient population to receive the intervention, and outcome measurements.