Daniel A Combs

Interests

Research

Pediatric sleep medicineCongenital heart diseaseSleep-disordered breathing

Courses

Scholarly Contributions

Chapters

• Combs, D. A., & Cranmer, L. D. (2012). Melanoma and Skin Cancer. In Neuropsychological Impact of Cancer and Oncology. New York: Springer Publishing Company.

Journals/Publications

• Combs, D., Edgin, J., Hsu, C. H., Bottrill, K., Van Vorce, H., Gerken, B., Matloff, D., La Rue, S., & Parthasarathy, S. (2023). The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 19(12), 2065-2073.
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  Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA). Current OSA treatments have limited effectiveness in this population. We evaluated the effectiveness of atomoxetine and oxybutynin (ato-oxy) to treat OSA in children with Down syndrome.
• Mashaqi, S., Rihawi, A., Rangan, P., Ho, K., Khokhar, M., Helmick, S., Combs, D. A., Ghaderi, I., Parthasarathy, S., & Ashouri, Y. (2023). The impact of bariatric surgery on breathing-related polysomnography parameters—Updated systematic review and meta-analysis. Frontiers in Sleep, 2.
• Mashaqi, S., William, M., Quan, S. F., Combs, D. A., Estep, L., Patel, S. I., Sahni, j., & Parthasarathy, S. (2023). Case report: A case of complete resolution of obstructive and central sleep apnea with Cheyne Stokes breathing in a patient with heart failure 60 days post-left ventricular assist device implantation. Frontiers in Sleep, 2.
• Mashaqi, S., Kallamadi, R., Matta, A., Quan, S. F., Patel, S. I., Combs, D., Estep, L., Lee-Iannotti, J., Smith, C., Parthasarathy, S., & Gozal, D. (2022). Obstructive Sleep Apnea as a Risk Factor for COVID-19 Severity-The Gut Microbiome as a Common Player Mediating Systemic Inflammation via Gut Barrier Dysfunction. Cells, 11(9).
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  The novel corona virus that is now known as (SARS-CoV-2) has killed more than six million people worldwide. The disease presentation varies from mild respiratory symptoms to acute respiratory distress syndrome and ultimately death. Several risk factors have been shown to worsen the severity of COVID-19 outcomes (such as age, hypertension, diabetes mellitus, and obesity). Since many of these risk factors are known to be influenced by obstructive sleep apnea, this raises the possibility that OSA might be an independent risk factor for COVID-19 severity. A shift in the gut microbiota has been proposed to contribute to outcomes in both COVID-19 and OSA. To further evaluate the potential triangular interrelationships between these three elements, we conducted a thorough literature review attempting to elucidate these interactions. From this review, it is concluded that OSA may be a risk factor for worse COVID-19 clinical outcomes, and the shifts in gut microbiota associated with both COVID-19 and OSA may mediate processes leading to bacterial translocation via a defective gut barrier which can then foster systemic inflammation. Thus, targeting biomarkers of intestinal tight junction dysfunction in conjunction with restoring gut dysbiosis may provide novel avenues for both risk detection and adjuvant therapy.
• Patel, S. I., Zareba, W., LaFleur, B., Couderc, J. P., Xia, X., Woosley, R., Patel, I. Y., Combs, D., Mashaqi, S., Quan, S. F., & Parthasarathy, S. (2022). Markers of ventricular repolarization and overall mortality in sleep disordered breathing. Sleep medicine, 95, 9-15.
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  Variability and prolongation of ventricular repolarization - measured by changes in QT interval and QT variability are independently associated with ventricular arrhythmias, sudden death, and mortality but such studies did not examine the role of sleep-disordered breathing. We aimed to determine whether sleep-disordered breathing moderated the association between measures of ventricular repolarization and overall mortality.
• Combs, D., Hsu, C. H., Bailey, O., Patel, S. I., Mashaqi, S., Estep, L., Provencio-Dean, N., Lopez, S., & Parthasarathy, S. (2021). Differences in sleep timing and related effects between African Americans and non-Hispanic Whites. Journal of clinical sleep medicine, 17(5), 897-908.
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  Prior studies have shown a morning chronotype for African Americans compared to non-Hispanic Whites, yet self-reported sleep timing is delayed in African Americans compared to Whites.
• Knobbe, K., Partha, M., Seckeler, M. D., Klewer, S., Hsu, C. H., Edgin, J., Morgan, W. J., Provencio-Dean, N., Lopez, S., Parthasarathy, S., & Combs, D. (2021). Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. Journal of the American Heart Association, 10(21), e021749.
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  Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (
• Mashaqi, S., Mansour, H. M., Alameddin, H., Combs, D., Patel, S., Estep, L., & Parthasarathy, S. (2021). Matrix metalloproteinase-9 as a messenger in the crosstalk between obstructive sleep apnea and comorbid systemic hypertension, cardiac remodeling, and ischemic stroke: a literature review. Journal of clinical sleep medicine, 17(3), 567-591.
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  Obstructive sleep apnea is a common sleep disorder. There is a strong link between sleep related breathing disorders and cardiovascular and cerebrovascular diseases. Matrix metalloproteinase-9 (MMP-9) is a biological marker for extracellular matrix degradation which plays a significant role systemic hypertension, myocardial infarction and post-MI heart failure, and ischemic stroke. This manuscript reviews MMP-9 as an inflammatory mediator and a potential messenger between OSA and OSA-induced comorbidities.
• Mashaqi, S., Patel, S. I., Combs, D. A., Estep, L., Helmick, S., Machamer, J., & Parthasarathy, S. (2020). The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea – A literature Review. Int J Environ Res Public Health.
• Mashaqi, S., Patel, S. I., Combs, D., Estep, L., Helmick, S., Machamer, J., & Parthasarathy, S. (2021). The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea-A Literature Review. International journal of environmental research and public health, 18(4).
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  Obstructive sleep apnea (OSA) is a common sleep disorder that affects all age groups and is associated with many co-morbid diseases (especially cardiovascular diseases). Continuous positive airway pressure (CPAP) is the gold standard for treating OSA. However, adherence to PAP therapy has been a major challenge with an estimated adherence between 20% and 80%. Mandibular advancement devices (MAD) are a good alternative option if used in the appropriate patient. MAD are most effective in mild and moderate OSA but not severe OSA. Surgical options are invasive, not appropriate for severe OSA, and associated with pain and long healing time. Hypoglossal nerve stimulation (HGNS), or upper airway stimulation (UAS), is a novel therapy in treating moderate and severe degrees of OSA in patients who cannot tolerate CPAP therapy. We reviewed the MEDLINE (PubMed) database. The search process yielded 303 articles; 31 met the inclusion and exclusion criteria and were included. We concluded that hypoglossal nerve stimulation is a very effective and novel alternative therapy for moderate and severe OSA in patients who cannot tolerate CPAP therapy. Adherence to HGNS is superior to CPAP. However, more developments are needed to ensure the highest safety profile.
• Berryhill, S., Morton, C. J., Dean, A., Berryhill, A., Provencio-Dean, N., Patel, S. I., Estep, L., Combs, D., Mashaqi, S., Gerald, L. B., Krishnan, J. A., & Parthasarathy, S. (2020). Effect of wearables on sleep in healthy individuals: a randomized crossover trial and validation study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(5), 775-783.
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  The purpose of this study was to determine whether a wearable sleep-tracker improves perceived sleep quality in healthy participants and to test whether wearables reliably measure sleep quantity and quality compared with polysomnography.
• Combs, D., & Parthasarathy, S. (2020). Nocturnal Oxygen for High Altitude Travel in Patients With Chronic Obstructive Pulmonary Disease. JAMA network open, 3(6), e208022.
• Combs, D., Edgin, J. O., Klewer, S., Barber, B. J., Morgan, W. J., Hsu, C. H., Abraham, I., & Parthasarathy, S. (2020). OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest, 158(3), 1208-1217.
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  Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD.
• Pandey, A., Mereddy, S., Combs, D., Shetty, S., Patel, S. I., Mashaq, S., Seixas, A., Littlewood, K., Jean-Luis, G., & Parthasarathy, S. (2020). Socioeconomic Inequities in Adherence to Positive Airway Pressure Therapy in Population-Level Analysis. Journal of clinical medicine, 9(2).
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  (a) Background: In patients with sleep apnea, poor adherence to positive airway pressure (PAP) therapy has been associated with mortality. Regional studies have suggested that lower socioeconomic status is associated with worse PAP adherence but population-level data is lacking. (b) Methods: De-identified data from a nationally representative database of PAP devices was geo-linked to sociodemographic information. (c) Results: In 170,641 patients, those in the lowest quartile of median household income had lower PAP adherence (4.1 + 2.6 hrs/night; 39.6% adherent by Medicare criteria) than those in neighborhoods with highest quartile median household income (4.5 + 2.5 hrs/night; 47% adherent by Medicare criteria; < 0.0001). In multivariate regression, individuals in neighborhoods with the highest income quartile were more adherent to PAP therapy than those in the lowest income quartile after adjusting for various confounders (adjusted Odds Ratio (adjOR) 1.18; 95% confidence interval (CI) 1.14, 1.21; < 0.0001). Over the past decade, PAP adherence improved over time (adjOR 1.96; 95%CI 1.94, 2.01), but health inequities in PAP adherence remained even after the Affordable Care Act was passed. (d) Conclusion: In a nationally representative population, disparities in PAP adherence persist despite Medicaid expansion. Interventions aimed at promoting health equity in sleep apnea need to be undertaken.
• Patel, S. I., Combs, D., & Parthasarathy, S. (2020). Sleep apnea 20/20: a 20-year cohort that continues to inform the next 20 years. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
• Bailey, O. F., Combs, D., Sans-Fuentes, M., Havens, C., Patel, S., Poongkunran, C., Berryhill, S., Provencio, N., Quan, S. F., & Parthasarathy, S. (2019). Delayed sleep time in African Americans and depression in a community-based population. Journal of Clinical Sleep Medicine.
• Bailey, O., Combs, D., Sans-Fuentes, M., Havens, C. M., Grandner, M. A., Poongkunran, C., Patel, S., Berryhill, S., Provencio, N., Quan, S. F., & Parthasarathy, S. (2019). Delayed Sleep Time in African Americans and Depression in a Community-Based Population. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(6), 857-864.
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  Studies have shown racial differences in circadian rhythm in African Americans when compared to non-Hispanic whites, and an association between circadian dyssynchrony and depression. We hypothesized that the prevalence of delayed sleep time is greater in African Americans when compared to whites and that delayed sleep time is associated with depression.
• Combs, D., Goodwin III, J. L., Quan, S. F., Morgan, W. J., Hsu, C., Edgin, J. O., & Parthasarathy, S. (2019). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. Journal of Clinical Sleep Medicine.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., Hsu, C. H., Edgin, J. O., & Parthasarathy, S. (2019). Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(1), 111-117.
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  Parent report or child report is commonly used to obtain information on sleep in children. Data are lacking comparing the validity of parent-reported versus child-reported sleep parameters.
• Knitter, J., Bailey, O. F., Poongkunran, C., Martinez, A. F., Martinez, L., Kobayashi, U., Combs, D., Lane, R., Zareba, W., & Parthasarathy, S. (2019). Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea. American journal of respiratory and critical care medicine, 199(7), 925-928.
• Knitter, J., Bailey, O., Poongkunran, C., Flores-Martinez, A., Martinez, L., Kobayashi, U., Combs, D., Lane, R. D., Zareba, W., & Parthasarathy, S. (2019). Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices In Patients With Complex Sleep Apnea. American Journal of Respiratory and Critical Care Medicine.
• Tubbs, A. S., Combs, D., Grandner, M., & Parthasarathy, S. (2019). Obstructive Sleep Apnea in Jacobsen Syndrome. Sleep and Vigilance.
• Tubbs, A. S., Grandner, M. A., & Combs, D. (2019). Refractory Insomnia in an Adolescent with Total Blindness. The Yale journal of biology and medicine, 92(2), 201-204.
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  We present a totally blind adolescent with refractory insomnia due to a combination of Non-24 hour sleep-wake disorder and restless leg syndrome that was successfully treated with tasimelteon, iron replacement, and gabapentin. To our knowledge, this is the first published report of treatment of N24 with tasimelteon in an adolescent. In addition, this case highlights the importance of recognizing and treating multifactorial causes of insomnia.
• Tubbs, A., Grandner, M., & Combs, D. (2019). Refractory insomnia in a visually impaired adolescent. Yale Journal of Biology and Medicine.
• Bailey, O., Parthasarathy, S., & Combs, D. (2018). Too Little, but Still Great?. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 907-908.
• Combs, D., Skrepnek, G., Seckeler, M. D., Barber, B. J., Morgan, W. J., & Parthasarathy, S. (2018). Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(9), 1551-1558.
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  Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997-2012.
• Parthasarathy, S., Combs, D., Patel, S. N., Poongkunran, C., & Quan, S. F. (2018). Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment. Annals of internal medicine, 169(3), 201-202.
• Quan, S. F., Combs, D., & Parthasarathy, S. (2018). Impact of Sleep Duration and Weekend Oversleep on Body Weight and Blood Pressure in Adolescents. Southwest journal of pulmonary & critical care, 16(1), 31-41.
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  Weekend oversleep or catchup sleep is a frequent occurrence in children, but there are relatively little data concerning its impact on weight and blood pressure. The aim of this study was to assess the association between sleep duration and oversleep, and weight and blood pressure in adolescents.
• Combs, D., & Parthasarathy, S. (2017). Machines Learning to Detect Obstructive Sleep Apnea in Children. Are We There Yet?. American journal of respiratory and critical care medicine, 196(12), 1506-1507.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., Shetty, S., & Parthasarathy, S. (2016). Insomnia, Health-Related Quality of Life and Health Outcomes in Children: A Seven Year Longitudinal Cohort. Scientific reports, 6, 27921.
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  Insomnia is common in children, and is associated with decreased school performance and increased psychopathology. Although adult insomnia is linked to worsened health-related quality of life (HRQOL), there is insufficient data evaluating insomnia and HRQOL in children. We examined the HRQOL and health associations of insomnia in a longitudinal cohort of 194 children (96 girls, age at study start 8.7 ± 1.6 years, age at data analysis 15.0 ± 1.8 years) over 7 years. International Classification of Sleep Disorders, second edition (ICSD2) derived insomnia was seen intermittently in 27% of children, and was persistent in 4%. Children reporting ICSD2-derived insomnia had lower HRQOL. Additionally, the presence of insomnia was associated with an increased risk of reporting a new medical condition (intermittent insomnia odds ratio 5.9 [95% CI 1.3-26.7, p = 0.04], persistent insomnia odds ratio 8 [95% CI 2.3-27.7, p = 0.001]). Persistent ICSD2-derived insomnia was associated with an increased risk of reporting a new medication (odds ratio 4.9 (95% CI 1.0-23.6), p = 0.049), and reporting a new psychiatric medication (odds ratio 13.7, 95% CI: 2.6-73.5, p = 0.002). These associations were present even after adjusting for socioeconomic factors and the presence of obstructive sleep apnea. Insomnia in children is associated with worsened HRQOL and health outcomes.
• Combs, D., Shetty, S., & Parthasarathy, S. (2016). Big-Data or Slim-Data: Predictive Analytics Will Rule with World. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 12(2), 159-60.
• Grandner, M. A., Alfonso-Miller, P., Fernandez-Mendoza, J., Shetty, S., Shenoy, S., & Combs, D. (2016). Sleep: important considerations for the prevention of cardiovascular disease. Current opinion in cardiology.
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  Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors.
• Parthasarathy, S., Carskadon, M. A., Jean-Louis, G., Owens, J., Bramoweth, A., Combs, D., Hale, L., Harrison, E., Hart, C. N., Hasler, B. P., Honaker, S. M., Hertenstein, E., Kuna, S., Kushida, C., Levenson, J. C., Murray, C., Pack, A. I., Pillai, V., Pruiksma, K., , Seixas, A., et al. (2016). Implementation of Sleep and Circadian Science: Recommendations from the Sleep Research Society and National Institutes of Health Workshop. Sleep.
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  A wealth of scientific knowledge is being generated in sleep and circadian science. In order for us to realize the return on investment for such scientific knowledge and to improve the health of the nation, we need to disseminate and implement research findings into practice. An implementation gap - termed a "quality chasm" by the Institutes of Medicine - separates the scientific knowledge we possess and the implementation of such knowledge into preventative interventions or healthcare treatments. It is frequently reported that a time lag of 17 years transpires before medical research reaches clinical practice. The rapid development of new therapies and devices for sleep and circadian disorders, the emergence of wearable devices and mobile health, combined with the mounting interest in sleep from the public and technology industries, present a transformative opportunity for sleep and circadian science researchers. In order to capitalize on this opportunity, the Sleep Research Society and the National Institutes of Health partnered to organize a workshop focused on the translation of evidence-based interventions for sleep and circadian disorders into practice strategies that benefit population health and patient outcomes. The workshop drew on the collective expertise of implementation scientists and sleep scientists in the areas of insomnia, sleep-disordered breathing, and adolescent sleep health. Together, they identified implementation gaps, effective interventions, implementation strategies and relevant outcomes and created a set of recommendations that could accelerate late-stage translation of sleep and circadian rhythms research findings to benefit public health. This white paper represents the proceedings and consensus developed at the workshop. The recommendations for high-priority implementation research are targeted at sleep and implementation researchers, educators, patients, professional societies, industry partners, funding-decision and policy makers. The major recommendations for implementation science in sleep and circadian sciences were to address the following high priority future research needs: (1) Costs and economic benefits associated with screening, diagnosing, treating insomnia across different systems (health care system, employers, etc.). (2) Promoting health literacy and education of patients, providers and community stakeholders regarding obstructive sleep apnea. (3) Increase the proportion of students in grades 9 through 12 who get sufficient sleep and (4) Perform trials aimed at improving adherence to treatments for sleep-disordered breathing (particularly evaluating cognitive therapy approaches). The fourth priority area was identified as an important barrier to implementation science efforts in sleep.
• Shetty, S., Fernandes, A., Patel, S., Combs, D., Grandner, M. A., & Parthasarathy, S. (2016). Unanticipated Nocturnal Oxygen Requirement During Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Home-based management of sleep-disordered breathing (SDB) generally excludes patients with significant medical comorbidities, but such an approach lacks scientific evidence. The current study examined whether significant medical comorbidities are associated with persistent hypoxia that requires unanticipated nocturnal O2 supplementation to positive airway pressure (PAP) therapy. Conceivably, in such patients, home-based management of SDB may not detect or therefore adequately treat persistent hypoxia.
• Yamauchi, M., Combs, D., & Parthasarathy, S. (2016). Adaptive Servo-Ventilation for Central Sleep Apnea in Heart Failure. The New England journal of medicine, 374(7), 689.
• Buterbaugh, J., Wynstra, C., Provencio, N., Combs, D., Gilbert, M., & Parthasarathy, S. (2015). Cerebrovascular reactivity in young subjects with sleep apnea. Sleep, 38(2), 241-50.
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  Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., & Parthasarathy, S. (2015). Longitudinal differences in sleep duration in Hispanic and Caucasian children. Sleep medicine.
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  Short sleep duration is associated with significant negative consequences, including poor school performance, behavioral problems, obesity, and hypertension. There is prior evidence that there are disparities in sleep duration related to ethnicity; however, there are no specific data on Hispanic children. We aimed to test the hypothesis that there are ethnic differences in parent-reported sleep duration in a community-based cohort of Hispanic and Caucasian children.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., & Parthasarathy, S. (2015). Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children. PloS one, 10(11), e0142242.
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  Obstructive sleep apnea (OSA) is prevalent in children and diagnostic polysomnography is costly and not readily available in all areas. We developed a pediatric modification of a commonly used adult clinical prediction tool for stratifying the risk of OSA and the need for polysomnography.
• Parthasarathy, S., Shetty, S., & Combs, D. (2015). Mend the Mind and Mind the "MCC". Sleep, 38(7), 1001-3.
• Combs, D., Rice, S. A., & Kopp, L. M. (2014). Incidence of delirium in children with cancer. Pediatric blood & cancer, 61(11), 2094-5.
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  There are limited data on the incidence of delirium in children with cancer. We performed a retrospective chart review of all pediatric oncology admissions over a 1 year period to determine the incidence of delirium in this population. We identified seven patients with delirium (10% incidence). Delirium is associated with significant morbidity and mortality, and is likely under-recognized in this population. Improved diagnosis and treatment of delirium may improve outcomes in children with cancer.
• Combs, D., Shetty, S., & Parthasarathy, S. (2014). Advances in Positive Airway Pressure Treatment Modalities for Hypoventilation Syndromes. Sleep medicine clinics, 9(3), 315-325.
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  Positive airway pressure therapy for hypoventilation syndromes can significantly improve health-related quality of life (HR-QOL), healthcare costs, and even mortality. The sleep-disordered breathing in such individuals are quite complex and require sophisticated devices with algorithms that are designed to accurately detect and effectively treat respiratory events that includes hypoventilation, upper airway obstruction, lower airway obstruction, central apneas and central hypopneas and reduce the work of breathing while maintaining breathing comfort.

Proceedings Publications

• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. In Sleep, 41, A277.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. In Circulation, 138(Suppl 1), 14956.
• Parthasarathy, S., Bailey, O., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2018, Spring). Parent treatment preferences for mild obstructive sleep apnea in children. In American Journal of Respiratory and Critical Care Medicine, 197, A2005.

Presentations

• Combs, D. A. (2022).

  Case-based review of Pediatric Sleep Medicine

  . 13th Annual Education Conference of the Arizona Sleep Society.
• Combs, D. A. (2023).

  Current and emerging pharmacological approaches in pediatric OSA

  . 2023 Pediatric Sleep Medicine Meeting. Hilton Head Island, SC.
• Combs, D. A. (2023).

  Sleep Medicine for the Primary Care Pediatrician

  . Pediatrics in the Desert. Tucson, AZ.
• Combs, D. A. (2023).

  Understanding Sleep Health for People with Down Syndrome

  . Down Syndrome Network Arizona webinar.
• Combs, D. A., Swanson, J. E., Hsu, C., Bottrell, K., Van Vorce, H., Gerken, B., Matloff, D., La Rue, S., Esparza, L., & Parthasarathy, S. (2023). Safety and efficacy of the combination of atomoxetine and oxybutynin for OSA treatment in children with Down Syndrome. Associated Professional Sleep Societies. Indianapolis, IN.
• Combs, D. A. (2022).

  Assent for research in people with Down syndrome

  . NIH INCLUDE Project Clinical Trials Webinar Series.
• Combs, D. A. (2022).

  Medications for Obstructive Sleep Apnea in Children with Down Syndrome

  . NIH Include Investigators workshop.
• Combs, D. A. (2022).

  Sleep after Traumatic Brain Injury

  . SPARCC Concussion Symposium. Tucson, AZ.
• Combs, D. A. (2022).

  Sleep difficulties in children with congenital heart disease.

  . Annual Scientific Sessions of the Cardiac Neurodevelopmental Outcome Collaborative. Montreal, ON, Canada.
• Combs, D. A. (2022).

  Sleep in Children with Congenital Heart Disease

  . Children's Hospital of Philadelphia Sleep Grand Rounds.
• Combs, D. A., Partha, M., Hsu, C., Edgin, J. O., Seckeler, M., Klewer, S. E., Parthasarathy, S., & Cooper, D. S. (2022). Trouble sleeping predicts future decreased quality of life in young children with Fontan circulation. 2022 meeting of the Associated Professional Sleep Societies. Charlotte, NC.
• Berryhill, S., Morton, C. J., Dean, A., Berryhill, A., Provencio-Dean, N., Patel, S. I., Estep, L., Combs, D., Gerald, L. B., Krishnan, J. A., & Parthasarathy, S. (2020, June). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Combs, D. A. (2020, May). Medications for Obstructive Sleep Apnea in Children with Down Syndrome. NIH INCLUDE Project workshop on Clinical Trials in Down syndrome for Co-occurring Conditions across the Lifespan. Bethesda, MD: National Institutes of Health.
• Combs, D. A. (2020, May). Sleep Apnea in Children with Down Syndrome. NIH INCLUDE Project workshop on Clinical Trials in Down syndrome for Co-occurring Conditions across the Lifespan. Bethesda, MD: National Institutes of Health.
• Combs, D. A. (2020, November). Medications for Obstructive Sleep Apnea in Children with Down Syndrome. New England Down Syndrome Symposium. Cambridge, MA: Massachusetts Institute of Technology.
• Huang, F., Patel, S. I., Combs, D., & Parthasarathy, S. (2020, June). Mortality and hospitalization in patients with heart failure and sleep apnea: A retrospective study of positive airway pressure therapy in medicare beneficiaries. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Parthasarathy, S., Kukafka, D. S., Antonescu, C., Patel, S. I., Combs, D., Quan, S. F., & Lee-Iannotti, J. K. (2020, June). Test Characteristics of a machine learned Electronic Medical Record Extractable tool for OSA Case Identification in a Community-based Population. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Patel, S. I., Vasquez, M., Huang, F., Guerra, S., Combs, D., & Parthasarathy, S. (2020, June). Positive Airway Pressure Therapy to Treat Sleep Disordered Breathing Impacts Number of Hospitalizations in Patients with Heart Failure. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Patel, S. I., Wendel, C., Sarah, B., Provencio, N., DeArmond, R. L., Quan, S. F., Combs, D., Skrepnek, G. H., & Parthasarathy, S. (2019, June). Effects of peer support participation on peer mentors. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Combs, D. (2018, June). Patient and Caregiver Perspectives of Treatment in Pediatric OSA. Strategically Leverage, Engage and Empower PCOR in Sleep (SLEEP2) PCOR Engagement Conference. Baltimore, MD.
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  Presentation on ongoing research
• Parthasarathy, S., Combs, D., Abraham, I. L., Edgin, J. O., Hsu, C., Barber, B. J., Morgan, W. J., Morgan, W. J., Barber, B. J., Hsu, C., Edgin, J. O., Abraham, I. L., Combs, D., & Parthasarathy, S. (2018, June). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. 2018 meeting of the Associated Professional Sleep Societies. Baltimore, MD.
• Parthasarathy, S., Combs, D., Bailey, O., Abraham, I. L., Morgan, W. J., Hsu, C., Hsu, C., Morgan, W. J., Bailey, O., Abraham, I. L., Combs, D., & Parthasarathy, S. (2018, May). Parent treatment preferences for mild obstructive sleep apnea in children. 2018 International Meeting of the American Thoracic Society. San Diego, CA.
• Combs, D. A., Collop, N., Katzan, I., Walia, H., Dedhia, R., & Luyster, F. (2016, June). Patient Reported Outcomes: Benchmarks for High Quality Patient Care in Sleep Disorders. 2016 meeting of the Associated Professional Sleep Societies. Denver, CO.
• Combs, D. A., Skrepnek, G., Seckeler, M., Barber, B. J., & Parthasarathy, S. (2016, June). Sleep-disordered breathing is associated with increased mortality among hospitalized infants with congenital heart disease. 2016 meeting of the Associated Professional Sleep Societies. Denver, CO.
• Combs, D. A. (2015, October). Sleep-Disordered Breathing is Associated with Impaired IQ in Children with Congenital Heart Disease. 14th International Symposium on Sleep and Breathing. Pernambuco, Brazil.

Poster Presentations

• Robertson, K., Seckeler, M., Klewer, S. E., Hsu, C., Edgin, J. O., Provencio-Dean, N., Lopez, S., Parthasarathy, S., & Combs, D. A. (2021, June). Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation. 2021 Meeting of the Associated Professional Sleep Societies.
• Xia, X., Couderc, J., Zareba, W., Parthasarathy, S., Patel, S. I., Patel, I., LaFleur, B. J., Combs, D. A., & Mashaqi, S. (2021, June 10-13). The association of QTc and QT Variability with Severity of Sleep Disordered Breathing. SLEEP. Virtual: American Academy of Sleep Medicine.
• Xia, X., Woosley, R., Couderc, J., Zareba, W., Parthasarathy, S., Patel, S. I., Patel, I., LaFleur, B. J., Combs, D. A., Woosley, R., & Mashaqi, S. (2021, June 10-13). The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality. SLEEP. Virtual: American Academy of Sleep Medicine.
• Combs, D. A., Fernandez, V., Barber, B. J., Morgan, W. J., Hsu, C., Andrews, J. G., Parthasarathy, S., Klewer, S. E., & Seckeler, M. (2020, November). Obstructive Sleep Apnea Is Associated with Cardiac Dysfunction In Children With Congenital Heart Disease. 2020 American Heart Association Scientific SessionsAmerican Heart Association.
• Combs, D., Patel, S. I., Mashaqi, S., Estep, L., Provencio-Dean, N., Lopez, S., & Parthasarathy, S. (2020, June). Objective differences in sleep timing between African Americans and Non-Hispanic Whites. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Jain, S., Combs, D. A., Parthasarathy, S., Kondapalli, K., & Moskowitz, A. (2020, August). Sleep Education Improves Screening for Sleep Disorders among Physicians and Residents in Primary Care and Neurology Specialties. 2020 meeting of the Associated Professional Sleep Societies.
• Patel, S. I., Vasquez, M., Huang, F., Guerra, S., Combs, D., & Parthasarathy, S. (2020, June). Positive Airway Pressure Therapy to Treat Sleep Disordered Breathing Impacts Number of Hospitalizations in Patients with Heart Failure. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Berryhill, S., Patel, S. I., Provencio, N., Combs, D., Havens, C. M., Morton, C. J., & Parthasarathy, S. (2019, June). Cloud-Based Evaluation Of Wearable-Derived Sleep Data In Insomnia Trials. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Combs, D., Abraham, I. L., Hsu, C., Morgan, W. J., Patel, S. I., & Parthasarathy, S. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• DeArmond, R., Morton, C. J., Parthasarathy, S., Combs, D., & Patel, S. I. (2019, June). Sex as a Biological Variable on the Inflammatory Effects of Intermittent Hypoxia. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Parthasarathy, S., Combs, D., Guerra, S., Vasquez, M., & Patel, S. I. (2019, November). Treatment of Sleep Disordered Breathing With Positive Airway Pressure Therapy Reduces The Number of Hospitalizations In A Large Cohort Of Patients With Heart Failure. 2019 American Heart Association Scientific Sessions. Philadelphia, PA.
• Parthasarathy, S., Morton, C. J., Havens, C. M., Combs, D., Provencio, N., Patel, S. I., & Berryhill, S. (2019, June). Cloud-Based Evaluation Of Wearable-Derived Sleep Data In Insomnia Trials. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Patel, S. I., Vasquez, M., Guerra, S., Combs, D., & Parthasarathy, S. (2019, November). Treatment of Sleep Disordered Breathing With Positive Airway Pressure Therapy Reduces The Number of Hospitalizations In A Large Cohort Of Patients With Heart Failur. 2019 American Heart Association Scientific Sessions. Philadelphia, PA.
• Bailey, O., Sans-Fuente, M., Havens, C., Combs, D., Poongkunran, C., Patel, S., Berryhill, S., Provencio, N., Quan, S. F., & Parthasarathy, S. (2018, June). Delayed sleep time in African Americans and depression in a community-based population. 2018 meeting of the Associated Professional Sleep Societies. Baltimore, MD.
• Knitter, J., Patel, S., Bailey, O., Poongkunran, C., Flores Martinez, A., Martinez, L., Kobayashi, U., Combs, D., & Parthasarathy, S. (2018, June). Comparison of Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea. 2018 meeting of the Associated Professional Sleep. Baltimore, MD.
• Parthasarathy, S., Combs, D., Abraham, I. L., Edgin, J. O., Hsu, C., Barber, B. J., Morgan, W. J., Klewer, S. E., Klewer, S. E., Morgan, W. J., Barber, B. J., Hsu, C., Edgin, J. O., Abraham, I. L., Combs, D., & Parthasarathy, S. (2018, November). Obstructive Sleep Apnea is a Novel Risk Factor for Neurocognitive Impairment in Children with Congenital Heart Disease. 2018 American Heart Association Scientific Sessions. Chicago, IL.
• Troxler, R. B., Chen, M. L., Combs, D., Lenker, C. V., Matthews, C., & Wagner, M. (. (2018, February). Pediatric Sleep Health is Public Health: An Interdisciplinary Approach to Development of Web-Based Education Modules for Primary Care Providers. 2018 Association of Maternal & Child Health Programs Annual Conference. Arlington, VA.
• Combs, D., Goodwin, J., Quan, S. F., Morgan, W. J., Edgin, J. O., & Parthasarathy, S. (2017, June). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. 2017 meeting of the Associated Professional Sleep Societies.
• Combs, D., Goodwin, J., Quan, S. F., Morgan, W. J., Edgin, J. O., & Parthasarathy, S. (2017, June). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. 2017 meeting of the Associated Professional Sleep Societies. Boston, MA.
• Mereddy, S., Pandey, A., Combs, D., Parthasarathy, S., & Jean-Louis, G. (2017, May). Altitudinal Central Apneas and Adherence to Positive Airway Pressure Therapy. 2017 International Meeting of the American Thoracic Society..
• Pandey, A., Mereddy, S., Combs, D., & Parthasarathy, S. (2017, June). Adherence to Positive Airway Pressure Therapy and US Regional Mortality in Obstructive Sleep Apnea. 2017 meeting of the Associated Professional Sleep Societies.
• Pandey, A., Mereddy, S., Combs, D., Parthasarathy, S., & Jean-Louis, G. (2017, May). Health Disparities in Adherence to Positive Airway Pressure Therapy in Population Level Analysis. 2017 International Meeting of the American Thoracic Society..
• Pandey, A., Mereddy, S., Combs, D., Shetty, S., Girardin, J., & Parthasarathy, S. (2017, May). Health Disparities in Adherence to Positive Airway Pressure Therapy in Population Level Analysis. 2017 International Meeting of the American Thoracic Society. Washington, D.C.: American Thoracic Society.
• Parthasarathy, S., Combs, D., Abraham, I. L., Edgin, J. O., Hsu, C., Barber, B. J., Morgan, W. J., Morgan, W. J., Barber, B. J., Hsu, C., Edgin, J. O., Abraham, I. L., Combs, D., & Parthasarathy, S. (2017, July). Sleep-disordered breathing is associated with memory impairment in children with congenital heart disease. 15th International Symposium on Sleep and Breathing. Madison, WI.
• Troxler, R. B., Maddox, M. H., Sonney, J., Caffey, F., Konop, G., Lord, L., Phan, H., Combs, D., Lenker, C., Chen, M., Matthews, C., Wagner, A., Troxler, R. B., Maddox, M. H., Sonney, J., Caffey, F., Konop, G., Lord, L., Phan, H., , Combs, D., et al. (2017, November). Developing Web-based Education Modules on Pediatric Sleep Disorders for Primary Care Providers: An Interdisciplinary Approach. 9th Pediatric Sleep Medicine Conference. Amelia Island, FL.
• Wagner, A., Matthews, C., Chen, M., Lenker, C., Combs, D., Phan, H., Lord, L., Konop, G., Caffey, F., Sonney, J., Maddox, M. H., & Troxler, R. B. (2017, November). Developing Web-based Education Modules on Pediatric Sleep Disorders for Primary Care Providers: An Interdisciplinary Approach. 9th Pediatric Sleep Medicine Conference. Amelia Island, FL.
• Daulat, R., Daulat, R., DeArmond, R., DeArmond, R., Combs, D. A., Combs, D. A., Shetty, S., Shetty, S., Parthasarathy, S., & Parthasarathy, S. (2016, May). Circadian Rhythms in Survivors of Critical Illness is Related to Acuity of Illness. 2016 International Meeting of the American Thoracic Society. San Francisco, CA.
• Oren, E., Oren, E., Combs, D. A., Combs, D. A., Fisher, J., Fisher, J., Goodwin, J., Goodwin, J., Billheimer, D. D., Billheimer, D. D., Gerald, J. K., Gerald, J. K., Clemens, C. J., Clemens, C. J., Brown, M. A., Brown, M. A., Gerald, L. B., Gerald, L. B., Oren, E., , Combs, D. A., et al. (2016, May). Impact of supervised asthma medication use on sleep outcomes of elementary school children. 2016 International Meeting of the American Thoracic Society. San Francisco, CA.
• Combs, D. A., Goodwin, J. L., Quan, S. F., Morgan, W. J., & Parthasarathy, S. (2015, June). Development of a Modified STOP-Bang Tool for Adolescent Children. Associated Professional Sleep Societies 2015 annual meeting. Seattle, WA.
• Combs, D., Combs, D., Abraham, I. L., Abraham, I. L., Hsu, C., Hsu, C., Morgan, W. J., Morgan, W. J., Patel, S. I., Patel, S. I., Parthasarathy, S., & Parthasarathy, S. (2018, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Parthasarathy, S., Combs, D. A., Morgan, W. J., Edgin, J. O., Archbold, K., Rice, S. A., Barber, B. J., Barber, B. J., Archbold, K., Rice, S. A., Edgin, J. O., Morgan, W. J., Combs, D. A., & Parthasarathy, S. (2015, May). Prevalence of Sleep-Disordered Breathing in Children with Congenital Heart Disease. 2015 International meeting of the American Thoracic Society. Denver, CO.
• Provencio, N., Parthasarathy, S., Morton, C. J., Quan, S. F., Desai, B., Wendel, C. W., Berryhill, S., Patel, S. I., Partha, M., Combs, D., Kulkarni, H., Kulkarni, H., Partha, M., Combs, D., Berryhill, S., Patel, S. I., Wendel, C. W., Desai, B., Morton, C. J., , Quan, S. F., et al. (2018, December). EMR- And Clinic-Based Approaches For Recruiting Peer Support For Sleep Apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.