Salma Imran Patel

Interests

Research

Sleep Medicine; Breathing Disorders; Cardiovascular Disease; Mentoring; Health Disparities.

Teaching

Sleep Medicine; Internal Medicine; Clinical Research; Public Health; Mentoring; Diversity and Inclusion.

Courses

Scholarly Contributions

Journals/Publications

• Hildebrand, L., Huskey, A., Dailey, N., Jankowski, S., Henderson-Arredondo, K., Trapani, C., Patel, S., Chen, A., Chou, Y., & Killgore, W. (2024). Transcranial Magnetic Stimulation of the Default Mode Network to Improve Sleep in Individuals With Insomnia Symptoms: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Research Protocols, 13(1). doi:10.2196/51212
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  Background: Cortical hyperarousal and ruminative thinking are common aspects of insomnia that have been linked with greater connectivity in the default mode network (DMN). Therefore, disrupting network activity within the DMN may reduce cortical and cognitive hyperarousal and facilitate better sleep. Objective: This trial aims to establish a novel, noninvasive method for treating insomnia through disruption of the DMN with repetitive transcranial magnetic stimulation, specifically with continuous theta burst stimulation (cTBS). This double-blind, pilot randomized controlled trial will assess the efficacy of repetitive transcranial magnetic stimulation as a novel, nonpharmacological approach to improve sleep through disruption of the DMN prior to sleep onset for individuals with insomnia. Primary outcome measures will include assessing changes in DMN functional connectivity before and after stimulation. Methods: A total of 20 participants between the ages of 18 to 50 years with reported sleep disturbances will be recruited as a part of the study. Participants will then conduct an in-person screening and follow-on enrollment visit. Eligible participants then conduct at-home actigraphic collection until their first in-residence overnight study visit. In a double-blind, counterbalanced, crossover study design, participants will receive a 40-second stimulation to the left inferior parietal lobule of the DMN during 2 separate overnight in-residence visits. Participants are randomized to the order in which they receive the active stimulation and sham stimulation. Study participants will undergo a prestimulation functional magnetic resonance imaging scan and a poststimulation functional magnetic resonance imaging scan prior to sleep for each overnight study visit. Sleep outcomes will be measured using clinical polysomnography. After their first in-residence study visit, participants conduct another at-home actigraphic collection before returning for their second in-residence overnight study visit. Results: Our study was funded in September 2020 by the Department of Defense (W81XWH2010173). We completed the enrollment of our target study population in the October 2022 and are currently working on neuroimaging processing and analysis. We aim to publish the results of our study by 2024. Primary neuroimaging outcome measures will be tested using independent components analysis, seed-to-voxel analyses, and region of interest to region of interest analyses. A repeated measures analysis of covariance (ANCOVA) will be used to assess the effects of active and sham stimulation on sleep variables. Additionally, we will correlate changes in functional connectivity to polysomnography-graded sleep. Conclusions: The presently proposed cTBS protocol is aimed at establishing the initial research outcomes of the effects of a single burst of cTBS on disrupting the network connectivity of the DMN to improve sleep. If effective, future work could determine the most effective stimulation sites and administration schedules to optimize this potential intervention for sleep problems.
• Huskey, A., Fisher, J., Hildebrand, L., Negelspach, D., Henderson-Arredondo, K., Jankowski, S., Patel, S., Chou, Y., Dailey, N., & Killgore, W. (2024). Polysomnographically mediated cognitive improvements in individuals with insomnia symptoms following continuous theta-burst stimulation of the default mode network. Frontiers in Sleep, 3. doi:10.3389/frsle.2024.1424083
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  Introduction: Insomnia is associated with mild cognitive impairment, although the mechanisms of this impairment are not well-understood. Timing of slow-wave and rapid eye movement sleep may help explain cognitive impairments common in insomnia. This investigation aimed to determine whether cognitive changes following continuous theta-burst stimulation (cTBS) are attributable to active stimulation, polysomnographic parameters of sleep, or both. Method: Data presented here are part of a pilot clinical trial aiming to treat insomnia by targeting a node in the default mode network using an inhibitory 40-s (cTBS). A double-blind counterbalanced sham-controlled crossover design was conducted. Participants (N = 20) served as their own controls on two separate in-laboratory visits—one with active cTBS and the other with sham cTBS. Each visit included cognitive assessments before and after stimulation and following a night of sleep in the lab monitored with polysomnography. Results: Slow wave sleep duration influenced working memory in the active cTBS condition, with shorter duration predicting improvements in working memory post sleep (B = −0.003, p = 0.095). Onset latency to rapid eye movement sleep predicted subsequent working memory, regardless of treatment condition (B = −0.001, p = 0.040). Results suggest that changes in attention and processing speed were primarily due to slow wave sleep onset (B = −0.001, p = 0.017) and marginally predicted by slow wave sleep duration (B = 0.002, p = 0.081) and sleep efficiency (B = 0.006, p = 0.090). Conclusions: Findings emphasize the important role that timing of slow-wave and rapid eye movement sleep have on information processing. Future work using larger sample sizes and more stimulation sessions is needed to determine optimal interactions between timing and duration of slow wave and rapid eye movement throughout the sleep period. Clinical trial registration: This study is registered on ClinicalTrials.gov (NCT04953559). https://clinicaltrials.gov/study/NCT04953559?locStr=Arizona&country=United%20States&state=Arizona&cond=insomnia&intr=tms%20&rank=1
• Yakpogoro, N., Desai, S., Huskey, A., Henderson-Arredondo, K., Jankowski, S., Patel, S., Hildebrand, L., Trapani, C., Franca, G., Reich-Fuehrer, M. M., Grandner, M. A., Chen, Y. (., Chou, Y., Dailey, N., & Killgore, W. (2024). 0432 Neuromodulation of REM Sleep: Age-Associated Effects of Transcranial Magnetic Stimulation. SLEEP, 47(Supplement_1), A185-A186. doi:10.1093/sleep/zsae067.0432
• Arora, A., Zareba, W., Woosley, R. L., Klimentidis, Y. C., Patel, I. Y., Quan, S. F., Wendel, C., Shamoun, F., Guerra, S., Parthasarathy, S., & Patel, S. I. (2023). Genetic QT Score and Sleep Apnea as Predictors of Sudden Cardiac Death in the UK Biobank. medRxiv : the preprint server for health sciences.
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  The goal of this study was to evaluate the association between a polygenic risk score (PRS) for QT prolongation (QTc-PRS), QTc intervals and mortality in patients enrolled in the UK Biobank with and without sleep apnea.
• Hildebrand, L., Jankowski, S., Henderson-Arredondo, K., Patel, S., Chen, Y., Chou, Y., Dailey, N., & Killgore, W. (2023).

  0066 Continuous Theta Burst Transcranial Magnetic Stimulation for Insomnia and its Effects on Verbal Recall Performance

  . SLEEP, 46(Supplement_1), A30-A31. doi:10.1093/sleep/zsad077.0066
• Killgore, W. D., Jankowski, S., Henderson-Arredondo, K., Lucas, D. A., Patel, S. I., Hildebrand, L. L., Huskey, A., & Dailey, N. S. (2023). Functional connectivity of the default mode network predicts subsequent polysomnographically measured sleep in people with symptoms of insomnia. Neuroreport, 34(14), 734-740.
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  Insomnia is often accompanied by excessive pre-sleep rumination. Such ruminative thinking is also associated with increased connectivity of the default mode network (DMN). It is likely that DMN connectivity and associated rumination contribute to the pathogenesis of insomnia. We hypothesized that resting state functional connectivity (rsFC) between the DMN and other brain regions prior to bedtime would predict objectively measured sleep among individuals with insomnia. Twenty participants (12 female; M age = 26.9, SD = 6.6 years) with symptoms of insomnia underwent an rsFC scan in the early evening followed by a night of polysomographically (PSG) measured sleep. Connectivity of the DMN with other brain regions was regressed against several PSG sleep metrics, including time in wake, N1, N2, N3, REM, total sleep time (TST), and sleep efficiency (SE) at a cluster corrected false discovery rate (FDR) correction P < 0.05. The connectivity between DMN and cortical regions was negatively correlated with PSG indices of poorer sleep including time in wake (right angular gyrus) and N1 (precuneus) but positively correlated with time in REM (orbitofrontal cortex), TST (insula, orbitofrontal cortex, superior frontal gyrus, paracingulate gyrus), SE (orbitofrontal cortex). Connectivity between DMN and the pons was negatively correlated with SE. Among individuals with symptoms of insomnia, better sleep was predicted by rsFC between the DMN and cortical regions involved in executive functioning, consciousness, and complex cognition. Findings raise the possibility that future interventions aimed at suppressing pre-sleep DMN activation may weaken synergy between pre-sleep ruminative worry and complex cognitions, potentially ameliorating problems falling asleep.
• 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., William, M., Quan, S., Combs, D., Estep, L., Patel, S., 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. doi:10.3389/frsle.2023.1228038
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  Sleep-disordered breathing (obstructive and central sleep apnea) are common in patients with heart failure with reduced ejection fraction. Herein, we report a 69-year-old patient with a history of severe heart failure and refractory ventricular arrhythmia who was diagnosed with a moderate degree of obstructive and central sleep apnea with Cheyne Stokes breathing. He underwent a successful implantation of left ventricular assist device. Our patient had a complete resolution of both obstructive and central sleep apnea 60 days post-LVAD implantation as confirmed by home sleep apnea test.
• Patel, S. I., Zareba, W., Wendel, C., Perez, K., Patel, I., Quan, S. F., Youngstedt, S. D., Parthasarathy, S., & Woosley, R. L. (2023). A QTc risk score in patients with obstructive sleep apnea. Sleep medicine, 103, 159-164.
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  Patients with obstructive sleep apnea (OSA) are at risk for QTc prolongation, a known risk factor for increased mortality. The pro-QTc score can help identify individuals at increased risk for mortality associated with increased QTc however, it has not been evaluated in patients with OSA. The goal of this study was to evaluate the pro-QTc score in patients with OSA.
• Patel, S., Erwin, M., Olmstead, R., Jean-Louis, G., Parthasarathy, S., & Youngstedt, S. (2023). Comparisons of Sleep, Demographics, and Health-Related Variables in Older Long and Average Duration Sleepers. Sleep Science, 16(2). doi:10.1055/s-0043-1770804
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  Introduction Long sleep duration is associated with many health risks, particularly in older adults, but little is known about other characteristics associated with long sleep duration. Methods Across 5 sites, adults aged 60-80 years who reported sleeping 8-9 h (“long sleepers”, n ¼ 95) or 6-7.25 h (“average sleepers”, n ¼ 103) were assessed for two weeks using actigraphy and sleep diary. Demographic and clinical characteristics, objective sleep apnea screening, self-reported sleep outcomes, and markers of inflammation and glucose regulation were measured. Results Compared to average sleepers, long sleepers had a greater likelihood of being White and unemployed and/or retired. Long sleepers also reported longer time in bed, total sleep time and wake after sleep onset by sleep diary and by actigraphy. Other measures including medical co-morbidity, apnea/hypopnea index, sleep related outcomes such as sleepiness, fatigue, depressed mood, or markers of inflammation and glucose metabolism did not differ between long and average sleepers. Conclusion Older adults with long sleep duration were more likely to be White, report unemployment and retirement suggesting the social factors or related sleep opportunity contributed to long sleep duration in the sample. Despite known health risks of long sleep duration, neither co-morbidity nor markers of inflammation or metabolism differed in older adults with long sleep duration compared with those with average sleep duration.
• 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.
• Patel, S., Youngstedt, S., Angadi, S., & Petrov, M. (2022). 0098 A Model for a Chronic Napping in Older Adults at Risk for Alzheimer’s Disease. Sleep, 45(Supplement_1), A44-A44. doi:10.1093/sleep/zsac079.096
• Youngstedt, S. D., Elliott, J., Patel, S., Zi-Ching Mak, N., Raiewski, E., Malek, E., Strong, M., Mun, C. J., Peters, T., Madlol, R., Tasevska, N., Rasoul, M., Nguyen, C., Vargas Negrete, K. M., Adaralegbe, A. O., Sudalaimuthu, S., Granholm, D., Finch, A., Eksambe, A., , Malready, A., et al. (2022). Circadian acclimatization of performance, sleep, and 6-sulfatoxymelatonin using multiple phase shifting stimuli. Frontiers in endocrinology, 13, 964681.
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  Misalignment between the environment and one's circadian system is a common phenomenon (e.g., jet lag) which can have myriad negative effects on physical and mental health, mental and physiological performance, and sleep. Absent any intervention, the circadian system adjusts only 0.5-1.0 h per day to a shifted light-dark and sleep-wake schedule. Bright light facilitates circadian adjustment, but in field studies, bright light is only modestly better than no stimulus. Evidence indicates that exercise and melatonin can be combined with bright light to elicit larger shifts but no study has combined all of these stimuli or administered them at the times that are known to elicit the largest effects on the circadian system. The aims of this study are to compare the effects of different treatments on circadian adjustment to simulated jet lag in a laboratory. Following 2 weeks of home recording, 36 adults will spend 6.5 consecutive days in the laboratory. Following an 8 h period of baseline sleep recording on the participant's usual sleep schedule on Night 1 (e.g., 0000-0800 h), participants will undergo a 26 h circadian assessment protocol involving 2 h wake intervals in dim light and 1 h of sleep in darkness, repeated throughout the 26 h. During this protocol, all urine voidings will be collected; mood, sleepiness, psychomotor vigilance, and pain sensitivity will be assessed every 3 h, forehead temperature will be assessed every 90 min, and anaerobic performance (Wingate test) will be tested every 6 h. Following, the circadian assessment protocol, the participant's sleep-wake and light dark schedule will be delayed by 8 h compared with baseline (e.g., 0800-1400 h), analogous to travelling 8 times zones westward. This shifted schedule will be maintained for 3 days. During the 3 days on the delayed schedule, participants will be randomized to one of 3 treatments: (1) Dim Red Light + Placebo Capsules, (2) Bright Light Alone, (3) Bright Light + Exercise + Melatonin. During the final 26 h, all conditions and measures of the baseline circadian protocol will be repeated. Acclimatization will be defined by shifts in circadian rhythms of aMT6s, psychomotor vigilance, Wingate Anaerobic performance, mood, and sleepiness, and less impairments in these measures during the shifted schedule compared with baseline. We posit that Bright Light Alone and Bright Light + Exercise + Melatonin will elicit greater shifts in circadian rhythms and less impairments in sleep, mood, performance, and sleepiness compared with Dim Red Light + Placebo Capsules. We also posit that Bright Light + Exercise + Melatonin will elicit greater shifts and less impairments than Bright Light Alone.
• 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. (2019). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. Journal of Clinical Sleep Medicine.
• 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 : JCSM : official publication of the American Academy of Sleep Medicine, 17(5), 897-908.
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  Prior studies have shown a morning chronotype for African Americans compared with non-Hispanic Whites, yet self-reported sleep timing is delayed in African Americans compared with Whites.
• 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.
• Parthasarathy, S., Machamer, J., Helmick, S., Estep, L., Combs, D. A., Patel, S. I., & Mashaqi, S. (2020). The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea – A literature Review. Int J Environ Res Public Health.
• Parthasarathy, S., Patel, I., Woosley, R., LaFleur, B., Patel, S., Zareba, W., Couderc, J., Xia, X., Combs, D., Mashaqi, S., & Perez, K. (2021). 478 The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality. Sleep, 44(Supplement_2), A188-A189. doi:10.1093/sleep/zsab072.477
• Parthasarathy, S., Patel, S., Combs, D., Mansour, H. M., Mashaqi, S., Alameddin, H., & Estep, L. (2021). Matrix metalloproteinase-9 as a messenger in the cross talk 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. doi:10.5664/jcsm.8928
• Parthasarathy, S., Woosley, R., Patel, S., Zareba, W., Couderc, J., Xia, X., Patel, I., Combs, D., & Mashaqi, S. (2021). 479 The association of QTc and QT Variability with Severity of Sleep Disordered Breathing. Sleep, 44(Supplement_2), A189-A189. doi:10.1093/sleep/zsab072.478
• Tubbs, A. S., Fernandez, F. X., Ghani, S. B., Karp, J. F., Patel, S. I., Parthasarathy, S., & Grandner, M. A. (2021). Prescription medications for insomnia are associated with suicidal thoughts and behaviors in two nationally representative samples. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(5), 1025-1030.
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  Z-drugs (eszopiclone, zolpidem, and zaleplon) are commonly used for insomnia but are also associated with suicide risk. However, it is unclear if this association is unique to Z-drugs. Therefore, the present study estimated the associations between multiple prescription insomnia medications and suicidal thoughts and behaviors.
• 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.
• Mashaqi, S., Mansour, H. M., Alameddin, H., Combs, D., Patel, S., Estep, L., & Parthasarathy, S. (2020). 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 : JCSM : official publication of the American Academy of Sleep Medicine.
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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.
• 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.
• Parthasarathy, S., Mashaqi, S., Estep, L., Patel, S. I., Berryhill, S., Morton, C. J., Dean, A., Berryhill, A., Provencio-Dean, N., Combs, D., Gerald, L. B., & Krishnan, J. A. (2020). Effect of wearables on sleep in healthy individuals: a randomized crossover trial and validation study. Journal of Clinical Sleep Medicine, 16(5), 775-783. doi:10.5664/jcsm.8356
• Patel, S. I. (2020). Reopening an Academic Dental Sleep Medicine and Orofacial Pain Clinic Amid COVID-19. Journal of Dental Sleep Medicine, Volume 7(Special Article 2, Issue 7.3). doi:http://dx.doi.org/10.15331/jdsm.7140
• 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, 16(S1), 27-28.
• Patel, S. I., Zareba, W., Couderc, J., Xia, X., LaFleur, B., Torabzadeh, E., Woosley, R., & Parthasarathy, S. (2020). 0571 Repolarization Variability Predicts Cardiovascular Death in Obstructive Sleep Apnea. Sleep, 43(Supplement_1), A219-A219. doi:10.1093/sleep/zsaa056.568
• Parthasarathy, S., Patel, S. I., Berryhill, S., Provencio, N., Combs, D., & Havens, C. (2019). 0998 Cloud-Based Evaluation of Wearable-Derived Sleep Data in Insomnia Trials. Sleep, 42(Supplement_1), A402-A402. doi:10.1093/sleep/zsz067.995
• Parthasarathy, S., Patel, S. I., Wendel, C., Berryhill, S., Provencio, N., DeArmond, R., Quan, S. F., Combs, D., & Skrepnek, G. H. (2019). 0511 Health Benefits to Peers Participating in a Mentoring program for Treatment Adherence in Patients with Sleep Apnea. Sleep, 42(Supplement_1), A205-A205. doi:10.1093/sleep/zsz067.509
• Patel, S. I., Ackerman, M. J., Shamoun, F. E., Geske, J. B., Ommen, S. R., Love, W. T., Cha, S. S., Bos, J. M., & Lester, S. J. (2019). QT prolongation and sudden cardiac death risk in hypertrophic cardiomyopathy. Acta cardiologica, 74(1), 53-58.
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  Risk assessment for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains complex. The goal of this study was to assess electrocardiogram (ECG)-derived risk factors on SCD in a large HCM population Methods: Retrospective review of adults with HCM evaluated at Mayo Clinic, Rochester, MN from 1 December 2002 to 31 December 2012 was performed. Data inclusive of ECG and 24-hour ambulatory Holter monitor were assessed. SCD events were documented by ventricular fibrillation (VF) noted on implantable cardioverter defibrillator (ICD), or appropriate VT or VF-terminating ICD shock.
• Patel, S. I., Shamoun, F. E., Esser, H., Parthasarathy, S., Ackerman, M. J., Geske, J. B., Ommen, S. R., Love, W. T., Sommers, V. K., Chahal, A. A., Bos, J. M., Cha, S. S., & Lester, S. J. (2019). Sleep Disordered Breathing in Hypertrophic Cardiomyopathy. Sleep and Vigilance. doi:10.1007/s41782-019-00080-6
• Firth, C., Shamoun, F., Cha, S., Zhang, N., Patel, S., Wennberg, P., Amer, H., Wadei, H., Heilman, R., & Keddis, M. (2018). Cardiac Troponin T Risk Stratification Model Predicts All-Cause Mortality Following Kidney Transplant. American journal of nephrology, 48(4), 242-250.
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  We evaluated the role of increased cardiac troponin T (cTnT), vascular, and cardiac diseases in predicting 5 and 10-year all-cause mortality after kidney transplantation.
• Joppa, S. A., Salciccioli, J., Adamski, J., Patel, S., Wysokinski, W., McBane, R., Al-Saffar, F., Esser, H., & Shamoun, F. (2018). A Practical Review of the Emerging Direct Anticoagulants, Laboratory Monitoring, and Reversal Agents. Journal of clinical medicine, 7(2).
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  Millions of patients in the United States use anticoagulation for a variety of indications, such as the prevention of stroke in those with atrial fibrillation (AF) and the treatment and prevention of venous thrombosis. For over six decades warfarin was the only available oral anticoagulant, but now several DOACs are available and their use has become more prevalent in recent years. In spite of this increased use, many physicians remain reluctant to prescribe DOACs due to concerns about bleeding and reversibility.
• Patel, S. I., Gay, P., Morgenthaler, T. I., Olson, E. J., Shamoun, F. E., Kashyap, R., Herold, D., McNamara, S., & Selim, B. (2018). Practical Implementation of a Single-Night Split-Titration Protocol With BPAP-ST and AVAPS in Patients With Neuromuscular Disease. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(12), 2031-2035.
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  At the sleep laboratory, noninvasive positive pressure ventilation titration protocols in patients with neuromuscular disease (NMD) are based on standard pressure cycle devices in a spontaneous/timed mode (BPAP-ST). Experience integrating protocols on average volume-assured pressure support (AVAPS) mode is limited, prompting us to develop a practical single-night titration protocol that provides information to assist clinicians and patients as they decide between BPAP-ST and AVAPS modes.
• Parsons, C., Patel, S. I., Cha, S., Shen, W. K., Desai, S., Chamberlain, A. M., Luis, S. A., Aguilar, M. I., Demaerschalk, B. M., Mookadam, F., & Shamoun, F. (2017). CHADS-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation. Mayo Clinic proceedings, 92(3), 360-369.
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  To determine if the CHADS-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices.
• Patel, S. I., Chakkera, H. A., Wennberg, P. W., Liedl, D. A., Alrabadi, F., Cha, S. S., Hooley, D. D., Amer, H., Wadei, H. M., & Shamoun, F. E. (2017). Peripheral arterial disease preoperatively may predict graft failure and mortality in kidney transplant recipients. Vascular medicine (London, England), 22(3), 225-230.
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  Patients with end-stage renal disease undergoing kidney transplant often have diffuse atherosclerosis and high cardiovascular morbidity and mortality rates. We analyzed the correlation of peripheral arterial disease (PAD), here quantified by an abnormal ankle-brachial index (ABI) measured within the 5 years prior to kidney transplant, with graft failure and mortality rates (primary end points) after adjusting for known cardiovascular risk factors (age, sex, smoking history, hypertension, diabetes, stroke, known coronary artery disease or heart failure, years of dialysis). Of 1055 patients in our transplant population, 819 had arterial studies within the 5 years prior to transplant. Secondary end points included myocardial infarction; cerebrovascular accident; and limb ischemia, gangrene, or amputation. Low ABI was an independent and significant predictor of organ failure (OR, 2.77 (95% CI, 1.68-4.58), p
• Patel, S. I., Cherington, C., Scherber, R., Barr, K., McLemore, R., Morisky, D. E., Cha, S., Mookadam, F., & Shamoun, F. (2017). Assessment of Patient Adherence to Direct Oral Anticoagulant vs Warfarin Therapy. The Journal of the American Osteopathic Association, 117(1), 7-15.
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  Direct oral anticoagulants (DOACs) may be as effective as, and at times safer than, warfarin. Because DOACs do not require regular serum level monitoring, patients' interaction with the health care system may be reduced. To the authors' knowledge, although studies have evaluated warfarin adherence, few studies have evaluated the real-world adherence to DOACs.
• Patel, S. I., Miller, B. W., Kosiorek, H. E., Parish, J. M., Lyng, P. J., & Krahn, L. E. (2017). The Effect of Dogs on Human Sleep in the Home Sleep Environment. Mayo Clinic proceedings, 92(9), 1368-1372.
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  To objectively assess whether a dog in the bedroom or bed disturbs sleep.
• Tafur, A. J., Shamoun, F. E., Patel, S. I., Tafur, D., Donna, F., & Murad, M. H. (2017). Catheter-Directed Treatment of Pulmonary Embolism: A Systematic Review and Meta-Analysis of Modern Literature. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 23(7), 821-829.
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  We summarize the evidence for the safety and efficacy of catheter-directed thrombolysis (CDT) with and without ultrasound-assisted therapy for treating submassive and massive pulmonary embolism (PE) in a systematic review. The primary efficacy outcome was mortality. Outcomes were pooled across studies with the random-effects model. Twenty-four studies enrolled 700 patients in total; 653 received mechanical thromboembolectomy treatments for PE (mortality rate, 9% [95% confidence interval (CI), 6%-13%], P = .12; rate of minor complications, 6% [95% CI, 2%-13%]). In the ultrasound-accelerated thrombolysis (USAT) studies, the mortality rate was 4% (95% CI, 1%-11%) and in the non-USAT studies, it was 9% (95% CI, 6%-13%). Secondary safety outcomes were all bleeding events, which occurred in 12% (95% CI, 7%-20%) of the USAT studies and in 10% (95% CI, 5%-20%) of the non-USAT studies. Current clinical evidence does not prove USAT is superior over CDT methods.
• Patel, S. I., Thompson, B. M., McLemore, R. Y., Temkit, M., Schlinkert, R. T., Apsey, H. A., & Cook, C. B. (2016). Relationship between the timing of preoperative medical visits and day-of-surgery glucose in poorly controlled diabetes. Future science OA, 2(2), FSO123.
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  This study evaluated referral patterns for preoperative evaluations of patients with poorly controlled diabetes mellitus (DM) and determined whether intervals between evaluations and surgery day were associated with preoperative glucose levels.
• Patel, S., Cain, R., Neailey, K., & Hooberman, L. (2016). Exploring Patients' Views Toward Giving Web-Based Feedback and Ratings to General Practitioners in England: A Qualitative Descriptive Study. Journal of medical Internet research, 18(8), e217.
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  Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback.
• Patel, S. I., Obeid, H., Matti, L., Ramakrishna, H., & Shamoun, F. E. (2015). Cerebral Venous Thrombosis: Current and Newer Anticoagulant Treatment Options. The neurologist, 20(5), 80-8.
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  Cerebral venous thrombosis (CVT) is rare and involves thrombosis of the veins and sinuses of the brain, most commonly the superior sagittal sinus. Approximately 5 CVT cases occur per 1 million persons in western countries. CVT causes 0.5% of strokes. Early diagnosis is crucial to prevent such outcomes as hydrocephalus, intracranial hypertension, and further seizures. Standard medical treatment of CVT consists of low-molecular-weight heparin and endovascular thrombolysis. Small case reports have found that the newer oral anticoagulants can be used for CVT treatment; however, they are associated with increased risk of bleeding and other adverse effects.
• Patel, S. I., Rodríguez, P., & Gonzales, R. J. (2015). The Implementation of an Innovative High School Mentoring Program Designed to Enhance Diversity and Provide a Pathway for Future Careers in Healthcare Related Fields. Journal of racial and ethnic health disparities, 2(3), 395-402.
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  Although the population of diverse applicants applying to medical school has increased over recent years (AAMC Diversity in Medical Education: Facts and Figures 2012); efforts persist to ensure the continuance of this increasing trend. Mentoring students at an early age may be an effective method by which to accomplish diversity within the applicant pool. Having a diverse physician population is more likely able to adequately address the healthcare needs of our diverse population.
• Files, J. A., Schwedt, T. J., Mayer, A. P., David, P. S., Vargas, B. B., Chang, Y. H., Hunt, M., Patel, S., Ko, M. G., Tozer, B. S., Burstein, R., & Dodick, D. W. (2014). Imploding and exploding migraine headaches: comparison of methods to diagnose pain directionality. Headache, 54(6), 1010-8.
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  The study aims to compare methods of determining headache directionality (imploding, exploding, and/or ocular headaches) in women with migraine, investigate the concordance between physician assignment and patient self-assignment of pain directionality, and evaluate whether patients assigned their headaches to the same direction when queried using different methods. Directionality of migraine headache pain (imploding, exploding, or ocular) may reflect differences in the underlying pathogenesis of individual migraine attacks among and within individuals. Emerging evidence suggests that directionality of pain in migraine sufferers may predict response to onabotulinumtoxin A. The best method of determining headache directionality in migraine sufferers has not been systematically explored.
• Mayer, A. P., Blair, J. E., Ko, M. G., Patel, S. I., & Files, J. A. (2014). Long-term follow-up of a facilitated peer mentoring program. Medical teacher, 36(3), 260-6.
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  Mentoring plays an important role in career success of academic medical faculty. New mentoring models such as peer mentoring have emerged.

Proceedings Publications

• Berryhill, S., Berryhill, A., Combs, D., Dean, A., Estep, L., Gerald, L., Krishnan, J., Mashaqi, S., Morton, C., Parthasarathy, S., Patel, S., & Provencio-Dean, N. (2020). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. In Proceedings publication.
• 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. In Chest.

Presentations

• Patel, S. I. (2023). The clinical utility of echocardiography in identifying patients with heart failure at a single academic sleep center. SLEEP.
• Patel, S. I., Zareba, W., Parthasarathy, S., Perez, K., Wendel, C. S., Woosley, R., Xia, X., Patel, I., Quan, S. F., Grandner, M., Youngstedt, S., & Woosley, R. (2022). The Application of a QTc Risk Score in Patients with Obstructive Sleep Apnea. SLEEP.
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  oral and poster presentation
• 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.
• Lee-Iannotti, J. K., Quan, S. F., Combs, D., Patel, S. I., Antonescu, C., Kukafka, D. S., & Parthasarathy, S. (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.
• Parthasarathy, S., Skrepnek, G. H., Combs, D., Quan, S. F., DeArmond, R. L., Provencio, N., Sarah, B., Wendel, C., & Patel, S. I. (2019, June). Effects of peer support participation on peer mentors. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• 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., Zareba, W., Couderc, J., Xia, X., LaFleur, B. J., Torabzadeh, E., Woosley, R., & Parthasarathy, S. (2020, Summer). Repolarization variabilityabnormalities predicts may lead to cardiovascular death in obstructive sleep apnea. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• 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.
• 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.
• 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. (2019, December). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. Journal of Clinical Sleep Medicine.
• Patel, S. I. (2019, Fall). Cardiorespiratory Interactions Leading to Death in Obstructive Sleep Apnea. Innovations and Inventions Conference. University of Arizona.
• Patel, S. I. (2019, Fall). Comparison of Various Forms of PAP Therapies for Sleep-disordered Breathing in Heart Failure. Sleep Review Journal Webinar. Online Webinar with 300+ attendees.

Poster Presentations

• Perez, K., Zareba, W., LaFleur, B. J., Xia, X., Woosley, R., Patel, I., Quan, S. F., Grandner, M., Youngstedt, S., Miller, J., Parthasarathy, S., & Patel, S. I. (2022). Changes in markers of ventricular repolarization and positive airway pressure therapy: A pilot study. SLEEP.
• 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.
• Parthasarathy, S., Lopez, S., Provencio-Dean, N., Estep, L., Mashaqi, S., Patel, S. I., & Combs, D. (2020, June). Objective differences in sleep timing between African Americans and Non-Hispanic Whites. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• Patel, S. I., Patel, S. I., Zareba, W., Woosley, R., Combs, D. A., LaFleur, B. J., Couderc, J., LaFleur, B. J., Xia, X., Patel, I., Mashaqi, S., Woosley, R., Combs, D. A., Parthasarathy, S., Zareba, W., Patel, I., Couderc, J., Mashaqi, S., Xia, X., & Parthasarathy, 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.
• Xia, X., Mashaqi, S., Couderc, J., Combs, D. A., Zareba, W., LaFleur, B. J., Patel, I., Parthasarathy, S., Patel, S. I., Patel, S. I., Patel, I., Parthasarathy, S., Zareba, W., LaFleur, B. J., Couderc, J., Combs, D. A., Xia, X., & 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., Mashaqi, S., Woosley, R., Woosley, R., Couderc, J., Combs, D. A., Zareba, W., LaFleur, B. J., Patel, I., Parthasarathy, S., Patel, S. I., Patel, S. I., Parthasarathy, S., Patel, I., Zareba, W., LaFleur, B. J., Couderc, J., Combs, D. A., Woosley, R., , Woosley, R., et al. (2021, June 10-13). The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality. SLEEP. Virtual: American Academy of Sleep Medicine.
• 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.
• 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., Combs, D., Parthasarathy, S., Morton, C. J., & DeArmond, R. (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.
• 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 Failure. 2019 American Heart Association Scientific Sessions. Philadelphia, PA.
• Combs, D., Abraham, I. L., Hsu, C., Morgan, W. J., Patel, S. I., & 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.
• Provencio, N., Parthasarathy, S., Morton, C. J., Quan, S. F., Wendel, C. W., Desai, B., Berryhill, S., Patel, S. I., Partha, M., Combs, D., Kulkarni, H., Kulkarni, H., Partha, M., Combs, D., Berryhill, S., Patel, S. I., Desai, B., Wendel, C. W., 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.