Sairam Parthasarathy

Interests

Research

Sleep and circadian rhythms and inflammation in both ambulatory subjects and critically ill patients.

Teaching

Sleep medicine, sleep health, critical care, systemic inflammation, positive airway pressure therapies for breathing disorders

Courses

Scholarly Contributions

Chapters

• Parthasarathy, S., & Gehlbach, B. (2015). Sleep. In Principles and Practice of Critical Care Medicine 4th edition. McGraw Hill Inc., NY (In Press).

Journals/Publications

• Sans-Fuentes, M., Sierra, L. A., Cruz, N. S., Rubio, V., Lutrick, K., Hamm, K., Connick, E., Shroff, P., Billheimer, D., Sorensen, R., Dinsmore, A., Wolfersteig, W., Ayers, S., Nikolich-Zugich, J., Doubeni, C., Tilburt, J., Rosales, C., Moreno, F., Derksen, D., , Oesterle, S., et al. (2024). Temporal Changes in Vaccine-Specific Willingness Across Race/Ethnicity Following Serious Adverse Event Reports. American journal of public health, 114(S1), S37-S40.
• 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.
• Ashouri, Y., Parthasarathy, S., Ghaderi, I., Combs, D. A., Helmick, S., Khokhar, M., Ho, K., Rangan, P., Rihawi, A., & Mashaqi, S. (2023). The impact of bariatric surgery on breathing-related polysomnography parameters—Updated systematic review and meta-analysis. Frontiers in Sleep, 2.
• Bime, C., Wang, Y., Carr, G., Swearingen, D., Kou, S., Thompson, P., Kusupati, V., & Parthasarathy, S. (2023). Disparities in outcomes of COVID-19 hospitalizations in native American individuals. Frontiers in public health, 11, 1220582.
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  This study aimed to investigate COVID-19-related disparities in clinical presentation and patient outcomes in hospitalized Native American individuals.
• Chen, C., Parthasarathy, S., Leung, J. M., Wu, M. J., Drake, K. A., Ridaura, V. K., Zisser, H. C., Conrad, W. A., Tapson, V. F., Moy, J. N., deFilippi, C. R., Rosas, I. O., Prabhakar, B. S., Basit, M., Salvatore, M., Krishnan, J. A., & Kim, C. C. (2023). Distinct temporal trajectories and risk factors for Post-acute sequelae of SARS-CoV-2 infection. Frontiers in medicine, 10, 1227883.
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  The understanding of Post-acute sequelae of SARS-CoV-2 infection (PASC) can be improved by longitudinal assessment of symptoms encompassing the acute illness period. To gain insight into the various disease trajectories of PASC, we assessed symptom evolution and clinical factors associated with the development of PASC over 3 months, starting with the acute illness period.
• 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.
• Evans, L. A., Gomez, O., Jiménez, D. J., Williamson, H. J., Carver, A. T., Parthasarathy, S., & Sabo, S. (2023). Engaging Youth and Young Adults in the COVID-19 Pandemic Response via the "It's Our Turn" Crowdsourcing Contest. International journal of environmental research and public health, 20(6).
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  As the coronavirus disease (COVID-19) pandemic continued to progress into 2021, appeals were made to take a stronger focus on the perceptions and practices of youth and young adults (YYAs) regarding COVID-19 mitigation, as well as the impact of mitigation strategies on the overall wellbeing of YYAs. In this paper, we describe our efforts to increase YYA engagement in Arizona's COVID-19 response by pairing embedded values from youth participatory action research (YPAR) with a crowdsourcing challenge contest design. The research protocol and implementation are described, followed by a thematic analysis of YYA-led messaging portrayed in 23 contest submissions and reflections formed by 223 community voters after viewing contest submissions. The authors conclude that a YYA-led crowdsourcing contest presented an opportunity to (a.) investigate the perceptions and behaviors of YYAs and their networks regarding the COVID-19 pandemic and mitigation efforts (b.) amplify the voices of YYAs in the pandemic response. Perhaps even more importantly, this approach also offered insight into the exacerbated impact of the pandemic on YYA mental health and wellbeing, and the utility of YPAR in raising awareness of these effects among the contexts and social networks of YYAs.
• Ghani, S. B., Granados, K., Wills, C. C., Alfonso-Miller, P., Buxton, O. M., Ruiz, J. M., Parthasarathy, S., Patel, S. R., Molina, P., Seixas, A., Jean-Louis, G., & Grandner, M. A. (2023). Association of Birthplace for Sleep Duration, Sleep Quality, and Sleep Disorder Symptoms, at the US-Mexico Border. Behavioral sleep medicine, 1-17.
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  The present study investigated the roles birthplace and acculturation play in sleep estimates among Hispanic/Latino population at the US-Mexico border.
• Horwitz, L. I., Thaweethai, T., Brosnahan, S. B., Cicek, M. S., Fitzgerald, M. L., Goldman, J. D., Hess, R., Hodder, S. L., Jacoby, V. L., Jordan, M. R., Krishnan, J. A., Laiyemo, A. O., Metz, T. D., Nichols, L., Patzer, R. E., Sekar, A., Singer, N. G., Stiles, L. E., Taylor, B. S., , Ahmed, S., et al. (2023). Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PloS one, 18(6), e0286297.
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  SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.
• Imran Patel, S., R Erwin, M., Olmstead, R., Jean-Louis, G., Parthasarathy, S., & D Youngstedt, S. (2023). Comparisons of Sleep, Demographics, and Health-Related Variables in Older Long and Average Duration Sleepers. Sleep science (Sao Paulo, Brazil), 16(2), 165-173.
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   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.  Across 5 sites, adults aged 60-80 years who reported sleeping 8-9 h ("long sleepers", n = 95) or 6-7.25 h ("average sleepers", n = 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.  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.  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.
• Jergović, M., Watanabe, M., Bhat, R., Coplen, C. P., Sonar, S. A., Wong, R., Castaneda, Y., Davidson, L., Kala, M., Wilson, R. C., Twigg, H. L., Knox, K., Erickson, H. E., Weinkauf, C. C., Bime, C., Bixby, B. A., Parthasarathy, S., Mosier, J. M., LaFleur, B. J., , Bhattacharya, D., et al. (2023). T-cell cellular stress and reticulocyte signatures, but not loss of naïve T lymphocytes, characterize severe COVID-19 in older adults. GeroScience, 45(3), 1713-1728.
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  In children and younger adults up to 39 years of age, SARS-CoV-2 usually elicits mild symptoms that resemble the common cold. Disease severity increases with age starting at 30 and reaches astounding mortality rates that are ~330 fold higher in persons above 85 years of age compared to those 18-39 years old. To understand age-specific immune pathobiology of COVID-19, we have analyzed soluble mediators, cellular phenotypes, and transcriptome from over 80 COVID-19 patients of varying ages and disease severity, carefully controlling for age as a variable. We found that reticulocyte numbers and peripheral blood transcriptional signatures robustly correlated with disease severity. By contrast, decreased numbers and proportion of naïve T-cells, reported previously as a COVID-19 severity risk factor, were found to be general features of aging and not of COVID-19 severity, as they readily occurred in older participants experiencing only mild or no disease at all. Single-cell transcriptional signatures across age and severity groups showed that severe but not moderate/mild COVID-19 causes cell stress response in different T-cell populations, and some of that stress was unique to old severe participants, suggesting that in severe disease of older adults, these defenders of the organism may be disabled from performing immune protection. These findings shed new light on interactions between age and disease severity in COVID-19.
• Jiménez, D. J., Gomez, O., Meraz, R., Pollitt, A. M., Evans, L., Lee, N., Ignacio, M., Garcia, K., Redondo, R., Redondo, F., Williamson, H. J., Oesterle, S., Parthasarathy, S., & Sabo, S. (2023). Community Engagement Alliance (CEAL) Against COVID-19 Disparities: Academic-community partnership to support workforce capacity building among Arizona community health workers. Frontiers in public health, 11, 1072808.
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  The COVID-19 pandemic has both highlighted and worsened existing health inequities among communities of color and structurally vulnerable populations. Community Health Workers, inclusive of Community Health Representatives (CHW/Rs) have entered the spotlight as essential to COVID-19 prevention and control. To learn about community experiences and perspectives related to COVID-19 and inform CHW/R workforce capacity building efforts, a series of focus groups were conducted with CHW/Rs throughout Arizona at two time points in 2021. Throughout the data collection and analysis process, researchers and community partners engaged in ongoing and open dialogue about what CHW/Rs on the ground were reporting as priority community concerns, needs, and challenges. Thus, CHW/Rs informed the development of culturally and linguistically relevant health education messages, materials, and training for CHW/Rs. In this community case study, we detail the efforts of partnership between a statewide CHW professional association and an academic research team that facilitated rapid decision-making and knowledge sharing to create community-grounded tools and resources supportive of CHW/R workforce capacity building in the context of the COVID-19 pandemic.
• Knauert, M. P., Ayas, N. T., Bosma, K. J., Drouot, X., Heavner, M. S., Owens, R. L., Watson, P. L., Wilcox, M. E., Anderson, B. J., Cordoza, M. L., Devlin, J. W., Elliott, R., Gehlbach, B. K., Girard, T. D., Kamdar, B. B., Korwin, A. S., Lusczek, E. R., Parthasarathy, S., Spies, C., , Sunderram, J., et al. (2023). Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement. American journal of respiratory and critical care medicine, 207(7), e49-e68.
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  Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.
• Mashaqi, S., Rangan, P., Saleh, A. A., Abraham, I., Gozal, D., Quan, S. F., & Parthasarathy, S. (2023). Biomarkers of gut barrier dysfunction in obstructive sleep apnea: A systematic review and meta-analysis. Sleep medicine reviews, 69, 101774.
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  We conducted this systematic review and meta-analysis to evaluate the impact of obstructive sleep apnea (OSA) on gut barrier dysfunction as represented by the following biomarkers: zonulin, lipopolysaccharide, lipopolysaccharide binding protein, intestinal fatty acid binding protein, and lactic acid. A comprehensive search of the literature was conducted in Ovid MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov without language restrictions from inception to October 2022. The analysis of all outcomes was performed using a random-effects model. We included eight studies (seven cross sectional and one case control) in the final quantitative synthesis with a total of 897 patients. We concluded that OSA was associated with higher levels of gut barrier dysfunction biomarkers [Hedges' g = 0.73 (95%CI 0.37-1.09, p 
• May, A. M., Patel, S. R., Yamauchi, M., Verma, T. K., Weaver, T. E., Chai-Coetzer, C. L., Thornton, J. D., Ewart, G., Showers, T., Ayas, N. T., Parthasarathy, S., Mehra, R., & Billings, M. E. (2023). Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement. American journal of respiratory and critical care medicine, 207(3), 244-254.
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  Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Modifications to the current policies for PAP insurance coverage could improve health disparities.
• Palomares, D. E., Tran, P. L., Jerman, C., Momayez, M., Deymier, P., Sheriff, J., Bluestein, D., Parthasarathy, S., & Slepian, M. J. (2023). Vibro-Acoustic Platelet Activation: An Additive Mechanism of Prothrombosis with Applicability to Snoring and Obstructive Sleep Apnea. Bioengineering (Basel, Switzerland), 10(12).
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  Obstructive sleep apnea (OSA) and loud snoring are conditions with increased cardiovascular risk and notably an association with stroke. Central in stroke are thrombosis and thromboembolism, all related to and initiaing with platelet activation. Platelet activation in OSA has been felt to be driven by biochemical and inflammatory means, including intermittent catecholamine exposure and transient hypoxia. We hypothesized that snore-associated acoustic vibration (SAAV) is an activator of platelets that synergizes with catecholamines and hypoxia to further amplify platelet activation. Gel-filtered human platelets were exposed to snoring utilizing a designed vibro-acoustic exposure device, varying the time and intensity of exposure and frequency content. Platelet activation was assessed via thrombin generation using the Platelet Activity State assay and scanning electron microscopy. Comparative activation induced by epinephrine and hypoxia were assessed individually as well as additively with SAAV, as well as the inhibitory effect of aspirin. We demonstrate that snore-associated acoustic vibration is an independent activator of platelets, which is dependent upon the dose of exposure, i.e., intensity x time. In snoring, acoustic vibrations associated with low-frequency sound content (200 Hz) are more activating than those associated with high frequencies (900 Hz) (53.05% vs. 22.08%, = 0.001). Furthermore, SAAV is additive to both catecholamines and hypoxia-mediated activation, inducing synergistic activation. Finally, aspirin, a known inhibitor of platelet activation, has no significant effect in limiting SAAV platelet activation. Snore-associated acoustic vibration is a mechanical means of platelet activation, which may drive prothrombosis and thrombotic risk clinically observed in loud snoring and OSA.
• Parthasarathy, S. (2023). Flatten the curve: bending the trajectory of respiratory disease-related mortality. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 19(11), 1855-1856.
• Parthasarathy, S., Arzt, M., & Javaheri, S. (2023). A call for precision medicine: Facing the challenge of sleep-disordered breathing in heart failure. Sleep medicine, 112, 129-131.
• Parthasarathy, S., Hyman, D., Doherty, J., Saad, R., Zhang, J., Morris, S., Eldemir, L., Fox, B., Ying Vang, M. K., Schroeder, J., Marshall, N. J., & Parks, G. S. (2023). A real-world observational study assessing relationships between excessive daytime sleepiness and patient satisfaction in obstructive sleep apnea. Sleep medicine, 114, 42-48.
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  To estimate prevalence and severity of excessive daytime sleepiness among patients with obstructive sleep apnea (OSA) who were prescribed treatment; assess perception and satisfaction of OSA-related care; describe relationships between excessive daytime sleepiness, treatment adherence, and patient satisfaction.
• Parthasarathy, S., Sahni, j., Patel, S. I., Estep, L., Combs, D. A., Quan, S. F., William, M., Mashaqi, S., Parthasarathy, S., Sahni, j., Patel, S. I., Estep, L., Combs, D. A., Quan, S. F., William, M., & Mashaqi, 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.
• 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.
• Perumal, R., Shunmugam, L., Naidoo, K., Abdool Karim, S. S., Wilkins, D., Garzino-Demo, A., Brechot, C., Parthasarathy, S., Vahlne, A., & Nikolich, J. Ž. (2023). Long COVID: a review and proposed visualization of the complexity of long COVID. Frontiers in immunology, 14, 1117464.
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  Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2) infection, or Long COVID, is a prevailing second pandemic with nearly 100 million affected individuals globally and counting. We propose a visual description of the complexity of Long COVID and its pathogenesis that can be used by researchers, clinicians, and public health officials to guide the global effort toward an improved understanding of Long COVID and the eventual mechanism-based provision of care to afflicted patients. The proposed visualization or framework for Long COVID should be an evidence-based, dynamic, modular, and systems-level approach to the condition. Furthermore, with further research such a framework could establish the strength of the relationships between pre-existing conditions (or risk factors), biological mechanisms, and resulting clinical phenotypes and outcomes of Long COVID. Notwithstanding the significant contribution that disparities in access to care and social determinants of health have on outcomes and disease course of long COVID, our model focuses primarily on biological mechanisms. Accordingly, the proposed visualization sets out to guide scientific, clinical, and public health efforts to better understand and abrogate the health burden imposed by long COVID.
• Puebla Neira, D., Zaidan, M., Nishi, S., Duarte, A., Lau, C., Parthasarathy, S., Wang, J., Kuo, Y. F., & Sharma, G. (2023). Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization. International journal of chronic obstructive pulmonary disease, 18, 1827-1835.
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  There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.
• Simon, S. L., Stephenson, J. J., Haynes, K., Kennedy, E. R., Frydman, G., Amdur, A., & Parthasarathy, S. (2023). The lived experience of positive airway pressure therapy in patients with obstructive sleep apnea across the lifespan: a qualitative study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Although treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy is effective, adherence is often poor. Understanding the patient perspective is needed to inform adherence-promoting interventions. This qualitative study assessed the experiences, preferences, facilitators, and barriers surrounding PAP therapy for the management of OSA in patients from adolescence to older adulthood.
• Sumar, K., Blue, L., Fatahi, G., Bhatti, A., Sumar, M., Alvarez, S., Cons, P., Valencia, N., Williams, Z., Parthasarathy, S., & Doubeni, C. A. (2023). The Effect of Adding Physician Recommendation in Digitally-Enabled Outreach for COVID-19 Vaccination in Socially/Economically Disadvantaged Populations Subtitle: A Randomized Controlled Trial. Research square.
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  People from backgrounds that are economically/socially disadvantaged experienced disproportionately high COVID-19 death rates and had lower vaccination rates. Effective outreach strategies for increasing vaccine uptake during the pandemic are not fully known. Among patients receiving care at a Federally Qualified Health Center, we tested whether community engaged digitally-enabled outreach increased COVID vaccine uptake.
• Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C., Atchley-Challenner, R., Alba, G. A., Alicic, R., Altman, N., Anglin, K., , Argueta, U., et al. (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934-1946.
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  SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.
• , A. B., Lundgren, J. D., Grund, B., Barkauskas, C. E., Holland, T. L., Gottlieb, R. L., Sandkovsky, U., Brown, S. M., Knowlton, K. U., Self, W. H., Files, D. C., Jain, M. K., Benfield, T., Bowdish, M. E., Leshnower, B. G., Baker, J. V., Jensen, J. U., Gardner, E. M., Ginde, A. A., , Harris, E. S., et al. (2022). Responses to a Neutralizing Monoclonal Antibody for Hospitalized Patients With COVID-19 According to Baseline Antibody and Antigen Levels : A Randomized Controlled Trial. Annals of internal medicine, 175(2), 234-243.
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  In a randomized, placebo-controlled, clinical trial, bamlanivimab, a SARS-CoV-2-neutralizing monoclonal antibody, given in combination with remdesivir, did not improve outcomes among hospitalized patients with COVID-19 based on an early futility assessment.
• , A. S., Rogers, A. J., Wentworth, D., Phillips, A., Shaw-Saliba, K., Dewar, R. L., Aggarwal, N. R., Babiker, A. G., Chang, W., Dharan, N. J., Davey, V. J., Higgs, E. S., Gerry, N., Ginde, A. A., Hayanga, J. W., Highbarger, H., Highbarger, J. L., Jain, M. K., Kan, V., , Kim, K., et al. (2022). The Association of Baseline Plasma SARS-CoV-2 Nucleocapsid Antigen Level and Outcomes in Patients Hospitalized With COVID-19. Annals of internal medicine, 175(10), 1401-1410.
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  Levels of plasma SARS-CoV-2 nucleocapsid (N) antigen may be an important biomarker in patients with COVID-19 and enhance our understanding of the pathogenesis of COVID-19.
• Fox, R. S., Gaumond, J. S., Zee, P. C., Kaiser, K., Tanner, E. J., Ancoli-Israel, S., Siddique, J., Penedo, F. J., Wu, L. M., Reid, K. J., Parthasarathy, S., Badger, T. A., Rini, C., & Ong, J. C. (2022). Optimizing a Behavioral Sleep Intervention for Gynecologic Cancer Survivors: Study Design and Protocol. Frontiers in neuroscience, 16, 818718.
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  Sleep difficulties, particularly symptoms of insomnia and circadian disruption, are among the primary complaints of gynecologic cancer survivors before, during, and after treatment. Moreover, difficulty sleeping has been linked to poorer health-related quality of life and elevated symptom burden in this population. Although leading behavioral sleep interventions have demonstrated efficacy among cancer survivors, up to 50% of survivors are non-adherent to these treatments, likely because these interventions require labor-intensive behavior and lifestyle changes. Therefore, there is a need for more effective and acceptable approaches to diminish sleep disturbance among cancer survivors. This manuscript describes the methodology of a two-part study guided by the Multiphase Optimization Strategy (MOST) framework to identify a streamlined behavioral sleep intervention for gynecologic cancer survivors. Three candidate intervention components previously shown to decrease sleep disturbance will be evaluated, including sleep restriction, stimulus control, and systematic bright light exposure. Participants will be adult women with a history of non-metastatic gynecologic cancer who have completed primary treatment and who report current poor sleep quality. Fifteen participants will be recruited for Part 1 of the study, which will utilize qualitative methods to identify barriers to and facilitators of intervention adherence. Results will inform changes to the delivery of the candidate intervention components to promote adherence in Part 2, where 80 participants will be recruited and randomized to one of eight conditions reflecting every possible combination of the three candidate intervention components in a full factorial design. Participants will complete assessments at baseline, post-intervention, and 3-months post-intervention. Part 2 results will identify the combination of candidate intervention components that yields the most efficacious yet efficient 6-week intervention for diminishing sleep disturbance. This is the first known study to apply the MOST framework to optimize a behavioral sleep intervention and will yield a resource-efficient treatment to diminish sleep disturbance, improve health-related quality of life, and decrease symptom burden among gynecologic cancer survivors. ClinicalTrials.gov Identifier: NCT05044975.
• Ignacio, M., Oesterle, S., Mercado, M., Carver, A., Lopez, G., Wolfersteig, W., Ayers, S., Ki, S., Hamm, K., Parthasarathy, S., Berryhill, A., Evans, L., Sabo, S., & Doubeni, C. (2022). Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake. Journal of behavioral medicine, 1-13.
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  The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.
• 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.
• Mashaqi, S., Laubitz, D., Morales, E. J., De Armond, R., Alameddin, H., Ghishan, F. K., Kiela, P. R., & Parthasarathy, S. (2022). Interactive Effect of Combined Intermittent and Sustained Hypoxia and High-Fat Diet on the Colonic Mucosal Microbiome and Host Gene Expression in Mice. Nature and science of sleep, 14, 1623-1639.
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  Gut dysbiosis can cause cardiometabolic disease. Gut dysbiosis can be independently caused by high-fat diet (HFD) and intermittent hypoxia (IH; characterizing obstructive sleep apnea), but the interactive effect of combined intermittent and sustained hypoxia (IH+SH) (characterizing obesity hypoventilation syndrome) and HFD on gut dysbiosis is unclear. We aimed to investigate the interactive effect of a combination of IH and SH and HFD on proximal colonic microbiota and colonic gene expression pattern.
• Molina, P., Ruiz, J. M., Ruiz, J. M., Parthasarathy, S., Wills, C. C., Seixas, A., Patel, S. R., Parthasarathy, S., Okuagu, A. C., Jean-louis, G., Haynes, P. L., Grandner, M. A., Granados, K., Ghani, S. B., Delgadillo, M. E., Buxton, O. M., & Alfonso-miller, P. (2022). Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border.. Behavioral sleep medicine, 20(2), 212-223. doi:10.1080/15402002.2021.1902814
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  Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration.Methods: Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status.Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint.Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.
• O'Brien, M. P., Forleo-Neto, E., Sarkar, N., Isa, F., Hou, P., Chan, K. C., Musser, B. J., Bar, K. J., Barnabas, R. V., Barouch, D. H., Cohen, M. S., Hurt, C. B., Burwen, D. R., Marovich, M. A., Brown, E. R., Heirman, I., Davis, J. D., Turner, K. C., Ramesh, D., , Mahmood, A., et al. (2022). Effect of Subcutaneous Casirivimab and Imdevimab Antibody Combination vs Placebo on Development of Symptomatic COVID-19 in Early Asymptomatic SARS-CoV-2 Infection: A Randomized Clinical Trial. JAMA, 327(5), 432-441.
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  Easy-to-administer anti-SARS-CoV-2 treatments may be used to prevent progression from asymptomatic infection to symptomatic disease and to reduce viral carriage.
• Parthasarathy, S., Asghari, M., Ruiz, M., Peña, M., Johnson, H., & Toosizadeh, N. (2022). ASSOCIATION BETWEEN UPPER EXTREMITY FUNCTION AND ADVERSE OUTCOMES IN OLDER ADULTS WITH COPD. Innovation in Aging, 6(Supplement_1), 623-623. doi:10.1093/geroni/igac059.2316
• 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.
• Quan, S., Patel, I., Parthasarathy, S., Patel, S., Zareba, W., Perez, K., Wendel, C., Xia, X., Grandner, M., Youngstedt, S., Miller, J., & Woosley, R. (2022). 0696 The Application of a QTc Risk Score in Patients with Obstructive Sleep Apnea. Sleep, 45(Supplement_1), A305-A305. doi:10.1093/sleep/zsac079.692
• 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.
• , A. L., Lundgren, J. D., Grund, B., Barkauskas, C. E., Holland, T. L., Gottlieb, R. L., Sandkovsky, U., Brown, S. M., Knowlton, K. U., Self, W. H., Files, D. C., Jain, M. K., Benfield, T., Bowdish, M. E., Leshnower, B. G., Baker, J. V., Jensen, J. U., Gardner, E. M., Ginde, A. A., , Harris, E. S., et al. (2021). A Neutralizing Monoclonal Antibody for Hospitalized Patients with Covid-19. The New England journal of medicine, 384(10), 905-914.
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  LY-CoV555, a neutralizing monoclonal antibody, has been associated with a decrease in viral load and the frequency of hospitalizations or emergency department visits among outpatients with coronavirus disease 2019 (Covid-19). Data are needed on the effect of this antibody in patients who are hospitalized with Covid-19.
• Combs, D. A., Combs, D. A., Combs, D. A., Goodwin, J. L., Goodwin, J. L., Goodwin, J. L., Quan, S. F., Quan, S. F., Quan, S. F., Morgan, W. J., Morgan, W. J., Morgan, W. J., Shetty, S., Shetty, S., Shetty, S., Parthasarathy, S., Parthasarathy, S., & Parthasarathy, S. (2015). Impact of Insomnia in Children in a Longitudinal Seven Year Cohort. Scientific Reports.
• Ghani, S. B., Delgadillo, M. E., Granados, K., Okuagu, A. C., Wills, C. C., Alfonso-Miller, P., Buxton, O. M., Patel, S. R., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Jean-Louis, G., & Grandner, M. A. (2021). Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border. Behavioral sleep medicine, 1-12.
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  : Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration. Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status. Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint. Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.
• Harris, D. T., Badowski, M., Jernigan, B., Sprissler, R., Edwards, T., Cohen, R., Paul, S., Merchant, N., Weinkauf, C. C., Bime, C., Erickson, H. E., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., El Aini, T., Rischard, F., Campion, J., , Chopra, M., et al. (2021). SARS-CoV-2 Rapid Antigen Testing of Symptomatic and Asymptomatic Individuals on the University of Arizona Campus. Biomedicines, 9(5).
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  SARS-CoV-2, the cause of COVID19, has caused a pandemic that has infected more than 80 M and killed more than 1.6 M persons worldwide. In the US as of December 2020, it has infected more than 32 M people while causing more than 570,000 deaths. As the pandemic persists, there has been a public demand to reopen schools and university campuses. To consider these demands, it is necessary to rapidly identify those individuals infected with the virus and isolate them so that disease transmission can be stopped. In the present study, we examined the sensitivity of the Quidel Rapid Antigen test for use in screening both symptomatic and asymptomatic individuals at the University of Arizona from June to August 2020. A total of 885 symptomatic and 1551 asymptomatic subjects were assessed by antigen testing and real-time PCR testing. The sensitivity of the test for both symptomatic and asymptomatic persons was between 82 and 90%, with some caveats.
• Hay, M., Ryan, L., Huentelman, M., Konhilas, J., Hoyer-Kimura, C., Beach, T. G., Serrano, G. E., Reiman, E. M., Blennow, K., Zetterberg, H., & Parthasarathy, S. (2021). Serum Neurofilament Light is elevated in COVID-19 Positive Adults in the ICU and is associated with Co-Morbid Cardiovascular Disease, Neurological Complications, and Acuity of Illness. Cardiology and cardiovascular medicine, 5(5), 551-565.
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  In critically ill COVID-19 patients, the risk of long-term neurological consequences is just beginning to be appreciated. While recent studies have identified that there is an increase in structural injury to the nervous system in critically ill COVID-19 patients, there is little known about the relationship of COVID-19 neurological damage to the systemic inflammatory diseases also observed in COVID-19 patients. The purpose of this pilot observational study was to examine the relationships between serum neurofilament light protein (NfL, a measure of neuronal injury) and co-morbid cardiovascular disease (CVD) and neurological complications in COVID-19 positive patients admitted to the intensive care unit (ICU). In this observational study of one-hundred patients who were admitted to the ICU in Tucson, Arizona between April and August 2020, 89 were positive for COVID-19 (COVID-pos) and 11 was COVID-negative (COVID-neg). A healthy control group (n=8) was examined for comparison. The primary outcomes and measures were subject demographics, serum NfL, presence and extent of CVD, diabetes, sequential organ failure assessment score (SOFA), presence of neurological complications, and blood chemistry panel data. COVID-pos patients in the ICU had significantly higher mean levels of Nfl (229.6 ± 163 pg/ml) compared to COVID-neg ICU patients (19.3 ± 5.6 pg/ml), Welch's t-test, p =.01 and healthy controls (12.3 ± 3.1 pg/ml), Welch's t-test p =.005. Levels of Nfl in COVID-pos ICU patients were significantly higher in patients with concomitant CVD and diabetes (n=35, log Nfl 1.6±.09), and correlated with higher SOFA scores (r=.5, p =.001). These findings suggest that in severe COVID-19 disease, the central neuronal and axonal damage in these patients may be driven, in part, by the level of systemic cardiovascular disease and peripheral inflammation. Understanding the contributions of systemic inflammatory disease to central neurological degeneration in these COVID-19 survivors will be important to the design of interventional therapies to prevent long-term neurological and cognitive dysfunction.
• Haynes, P. L., Emert, S. E., Epstein, D., Parthasarathy, S., Wilcox, J., & Perkins, S. (2015). Using Fuzzy Set Qualitative Comparative Analysis to Examine the Relationship between Sleep and PTSD Psychotherapy Outcome.. Behavior Research and Therapy.
• Haynes, P. L., Skobic, I., Epstein, D. R., Emert, S., Parthasarathy, S., Perkins, S., & Wilcox, J. (2021). Cognitive Processing Therapy for Posttraumatic Stress Disorder Is Associated with Negligible Change in Subjective and Objective Sleep. Behavioral sleep medicine, 18(6), 809-819.
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  : Patients receiving Cognitive Processing Therapy (CPT), an evidence based therapy for posttraumatic stress disorder (PTSD), report improved sleep quality. However, the majority of studies have examined residual sleep disturbance via self-report surveys or separate items on PTSD measures. This study examined whether CPT delivered to veterans in a VA setting improved sleep indices using state-of-the-art objective and subjective insomnia measures. : Participants were war veterans with a current PTSD diagnosis scheduled to begin outpatient individual or group CPT at two Veteran's Affairs (VA) locations (n = 37). : Sleep symptom severity was assessed using the recommended research consensus insomnia assessment, the consensus daily sleep diary and actigraphy. PTSD symptomatology pre- and post-treatment were assessed using the Clinician Administered PTSD Scale. : A small to moderate benefit was observed for the change in PTSD symptoms across treatment (ES = .43). Effect sizes for changes on daily sleep diary and actigraphy variables after CPT were found to be negligible (Range ES = - .16 to .17). Sleep indices remained at symptomatic clinical levels post-treatment. : These findings support previous research demonstrating a need for independent clinical attention to address insomnia either before, during, or after PTSD treatment.
• Kamdar, B. B., Knauert, M. P., Jones, S. F., Parsons, E. C., Parthasarathy, S., & Pisani, M. A. (2015). Perceptions and Practices Regarding Sleep in the ICU: A Survey of 1,223 Critical Care Providers. American Journal of Respiratory and Critical Care Medicine.
• 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., Lee-Iannotti, J., Rangan, P., Celaya, M. P., Gozal, D., Quan, S. F., & Parthasarathy, S. (2021). Obstructive sleep apnea and COVID-19 clinical outcomes during hospitalization: a cohort study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(11), 2197-2204.
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  Obstructive sleep apnea (OSA) is an extremely common sleep disorder. A potential association between OSA and coronavirus disease 2019 (COVID-19) severity has been proposed on the basis of similar comorbid medical conditions associated with both OSA and COVID-19.
• 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.
• Motoo, Y., Combs, D. A., & Parthasarathy, S. (2015). The Black Box Needs To Be Examined [Letter]. New England Journal of Medicine.
• O'Brien, M. P., Forleo-Neto, E., Musser, B. J., Isa, F., Chan, K. C., Sarkar, N., Bar, K. J., Barnabas, R. V., Barouch, D. H., Cohen, M. S., Hurt, C. B., Burwen, D. R., Marovich, M. A., Hou, P., Heirman, I., Davis, J. D., Turner, K. C., Ramesh, D., Mahmood, A., , Hooper, A. T., et al. (2021). Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19. The New England journal of medicine, 385(13), 1184-1195.
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  REGEN-COV (previously known as REGN-COV2), a combination of the monoclonal antibodies casirivimab and imdevimab, has been shown to markedly reduce the risk of hospitalization or death among high-risk persons with coronavirus disease 2019 (Covid-19). Whether subcutaneous REGEN-COV prevents severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and subsequent Covid-19 in persons at high risk for infection because of household exposure to a person with SARS-CoV-2 infection is unknown.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Klewer, S. E., Edgin, J. O., & Combs, D. (2019). Obstructive sleep apnea and neurocognitive impairment in children with congenital heart disease. CHEST.
• Parthasarathy, S., Krishnan, J. A., Gerald, L. B., Combs, D., Estep, L., Patel, S. I., Provencio-Dean, N., Berryhill, A., Dean, A., Morton, C. J., & Berryhill, S. (2019). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. Journal of Clinical Sleep Medicine.
• 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.
• Raschke, R. A., Stoffer, B., Assar, S., Fountain, S., Olsen, K., Heise, C. W., Gallo, T., Padilla-Jones, A., Gerkin, R., Parthasarathy, S., & Curry, S. C. (2021). The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation. PloS one, 16(8), e0255812.
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  To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients.
• Snider, J. M., You, J. K., Wang, X., Snider, A. J., Hallmark, B., Zec, M. M., Seeds, M. C., Sergeant, S., Johnstone, L., Wang, Q., Sprissler, R., Carr, T. F., Lutrick, K., Parthasarathy, S., Bime, C., Zhang, H. H., Luberto, C., Kew, R. R., Hannun, Y. A., , Guerra, S., et al. (2021). Group IIA secreted phospholipase A2 is associated with the pathobiology leading to COVID-19 mortality. The Journal of clinical investigation, 131(19).
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  There is an urgent need to identify the cellular and molecular mechanisms responsible for severe COVID-19 that results in death. We initially performed both untargeted and targeted lipidomics as well as focused biochemical analyses of 127 plasma samples and found elevated metabolites associated with secreted phospholipase A2 (sPLA2) activity and mitochondrial dysfunction in patients with severe COVID-19. Deceased COVID-19 patients had higher levels of circulating, catalytically active sPLA2 group IIA (sPLA2-IIA), with a median value that was 9.6-fold higher than that for patients with mild disease and 5.0-fold higher than the median value for survivors of severe COVID-19. Elevated sPLA2-IIA levels paralleled several indices of COVID-19 disease severity (e.g., kidney dysfunction, hypoxia, multiple organ dysfunction). A decision tree generated by machine learning identified sPLA2-IIA levels as a central node in the stratification of patients who died from COVID-19. Random forest analysis and least absolute shrinkage and selection operator-based (LASSO-based) regression analysis additionally identified sPLA2-IIA and blood urea nitrogen (BUN) as the key variables among 80 clinical indices in predicting COVID-19 mortality. The combined PLA-BUN index performed significantly better than did either one alone. An independent cohort (n = 154) confirmed higher plasma sPLA2-IIA levels in deceased patients compared with levels in plasma from patients with severe or mild COVID-19, with the PLA-BUN index-based decision tree satisfactorily stratifying patients with mild, severe, or fatal COVID-19. With clinically tested inhibitors available, this study identifies sPLA2-IIA as a therapeutic target to reduce COVID-19 mortality.
• Stahl, C., Frederick, K., Chaudhary, S., Morton, C. J., Loy, D., Muralidharan, K., Sorooshian, A., & Parthasarathy, S. (2021). Comparison of the Filtration Efficiency of Different Face Masks Against Aerosols. Frontiers in medicine, 8, 654317.
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  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic can spread through virus-containing aerosols ( ≤ 5 μm) and larger airborne droplets. Quantifying filtration efficiency of different kinds of masks and linings for aerosols that fall within the most penetrating particle size (80-400 nm) is critical to limiting viral transmission. The objective of our experiment was to compare the "real-world" filtering efficiency of different face masks for fine aerosols (350 nm) in laboratory simulations. We performed a simulated bench test that measured the filtering efficiency of N95 vs. N99 masks with elastomeric lining in relation to baseline ("background") aerosol generation. A mannequin head was placed within a chamber and was attached to an artificial lung simulator. Particles of known size (350 ± 6 nm aerodynamic diameter) were aerosolized into the chamber while simulating breathing at physiological settings of tidal volume, respiratory rate, and airflow. Particle counts were measured between the mannequin head and the lung simulator at the tracheal airway location. Baseline particle counts without a filter (background) were 2,935 ± 555 (SD) cm, while the N95 (1348 ± 92 cm) and N99 mask with elastomeric lining (279 ± 164 cm;
• 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.
• Weiss, C. H., Krishnan, J. A., Au, D. H., Bender, B. G., Carson, S. S., Cattamanchi, A., Cloutier, M. M., Cooke, C. R., Erickson, K., George, M., Gerald, J. K., Gerald, L. B., Goss, C. H., Gould, M. K., Hyzy, R., Parthasarathy, S., Kahn, J. M., Lederer, D. J., Mittman, B. S., , Moseson, E., et al. (2015). An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine. American Journal of Respiratory and Critical Care Medicine.
• 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). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. 2020 meeting of the Associated Professional Sleep Societies.
• 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.
• Billings, M. E., Cohen, R. T., Baldwin, C. M., Johnson, D. A., Palen, B. N., Parthasarathy, S., Patel, S. R., Russell, M., Tapia, I. E., Williamson, A. A., & Sharma, S. (2020). Disparities in Sleep Health and Potential Intervention Models: A Focused Review. Chest.
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  Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.
• Brown, M. K., Laposky, A. D., Buckler, A. G., Perrotte, B. M., Parthasarathy, S., Twery, M. J., & Sharkey, K. (2020). NIH Research Conference on Sleep and the Health of Women. Journal of women's health (2002), 29(3), 427-429.
• Budhiraja, R., Javaheri, S., Parthasarathy, S., Berry, R. B., & Quan, S. F. (2020). Incidence of hypertension in obstructive sleep apnea using hypopneas defined by 3 percent oxygen desaturation or arousal but not by only 4 percent oxygen desaturation. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(10), 1753-1760.
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  This analysis determined ∼5-year incident hypertension rates using the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines in individuals with obstructive sleep apnea (OSA) with hypopneas defined by a ≥ 3% oxygen desaturation or arousal but not by a hypopnea criterion of ≥ 4% oxygen desaturation (4% only).
• 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.
• Combs, D., Hsu, C. H., Bailey, O., Patel, S. I., Mashaqi, S., Estep, L., Provencio-Dean, N., Lopez, S., & Parthasarathy, S. (2020). 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.
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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.
• Ghani, S. B., Delgadillo, M. E., Granados, K., Okuagu, A. C., Alfonso-Miller, P., Buxton, O. M., Patel, S. R., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Williams, N., Jean-Louis, G., & Grandner, M. A. (2020). Acculturation Associated with Sleep Duration, Sleep Quality, and Sleep Disorders at the US-Mexico Border. International journal of environmental research and public health, 17(19).
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  Sleep disparities exist among Hispanics/Latinos, although little work has characterized individuals at the United States (US)-Mexico border, particularly as it relates to acculturation. This study examined the association of Anglo and Mexican acculturation to various facets of sleep health among those of Mexican descent at the US-Mexico border. Data were collected from = 100 adults of Mexican descent in the city of Nogales, Arizona (AZ). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II). Insomnia was assessed with the Insomnia Severity Index (ISI), sleepiness was assessed with the Epworth Sleepiness Scale (ESS), sleep apnea risk was assessed with the Multivariable Apnea Prediction (MAP) index, weekday and weekend sleep duration and efficiency were assessed with the Sleep Timing Questionnaire, sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and sleep duration and sleep medication use were assessed with PSQI items. No associations were found between Mexican acculturation and any sleep outcomes in adjusted analyses. Anglo acculturation was associated with less weekend sleep duration and efficiency, worse insomnia severity and sleep quality, and more sleep apnea risk and sleep medication use. These results support the idea that sleep disparities may depend on the degree of acculturation, which should be considered in risk screening and interventions.
• Grandner, M. A., Olivier, K., Gallagher, R., Hale, L., Barrett, M., Branas, C., Killgore, W. D., Parthasarathy, S., Gehrels, J. A., & Alfonso-Miller, P. (2020). Quantifying impact of real-world barriers to sleep: The Brief Index of Sleep Control (BRISC). Sleep health, 6(5), 587-593.
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  Lack of control over sleep may contribute to population-level sleep disturbances, yet relatively little work has explored the degree to which an individual's sense of control over their sleep may represent an important factor.
• 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. (2020). 0414 Chronotype and Sleep Among Ovarian Cancer Survivors Participating in a Lifestyle Intervention. Sleep, 43(Supplement_1), A158-A159. doi:10.1093/sleep/zsaa056.411
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  Abstract Introduction Chronotype is defined as an individual’s propensity to sleep at a specific time in a 24-hour cycle with late chronotype associated with poorer health outcomes including cancer. The role of chronotype on lifestyle behaviors remains relatively undefined in ovarian cancer. The Lifestyle Intervention for oVarian cancer Enhanced Survival study is testing whether 1205 women randomized to a diet and physical activity intervention for 24-months will have longer progression-free survival versus attention control. Here we determine the frequency and predictors of late versus early and mid chronotypes in disease-free ovarian cancer survivors. Methods 894 ovarian cancer survivors with baseline measures were included in analyses. Chronotypes were determined using self-reported time to bed (early- < 9 pm; mid- ≥ 9 pm - ≤12 am; late- >12 am) captured through the Pittsburgh Sleep Quality Index. Demographic, diet and physical activity data were captured with validated questionnaires and BMI measured in clinic. Descriptive statistics and logistic regression, adjusted for smoking status and race, were performed. Results 12.4% of women were late chronotype with significant differences between chronotypes observed for race, smoking history, sleep duration, and physical activity (p < 0.05). Late chronotype reported fewer hours of sleep per night (6.54 ± 1.51hrs) compared to mid (7.10± 1.31hrs) and early (7.74 ± 1.30hrs) chronotype. Blacks had higher odds of being late chronotype, OR 4.28 (95% CI 2.16-8.46). Late chronotype were more likely to report a history of smoking and lower recreational activity and had a higher mean BMI of 29.1± 6.0 kg/m2 compared to mid and early chronotype 27.8± 6.2 kg/m2 and 27.4± 5.4kg/m2, respectively. No significant differences were observed for sleep or diet quality, age, education or employment status. Conclusion Results of this analysis are consistent with other community-based population studies with regard to chronotype and race. Ovarian cancer is aggressive and late chronotype are more likely to have other risk factors that elevate risk of recurrence (obesity, tobacco use and inactivity. Six-month data are being analyzed by treatment arm and will provide important insights as to the role of sleep phase and lifestyle behaviors in this vulnerable population. Support NCT00719303; NCI R01CA186700-01A1
• 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.
• Quan, S. F., Budhiraja, R., Javaheri, S., Parthasarathy, S., & Berry, R. B. (2020). The Association Between Obstructive Sleep Apnea Defined by 3 Percent Oxygen Desaturation or Arousal Definition and Self-Reported Cardiovascular Disease in the Sleep Heart Health Study. Southwest journal of pulmonary & critical care, 21(4), 86-103.
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  Studies have established that OSA defined using a hypopnea definition requiring a ≥4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a ≥3% oxygen desaturation or an arousal (AHI3%A) is associated with CVD/CHD.
• Ripperger, T. J., Uhrlaub, J. L., Watanabe, M., Wong, R., Castaneda, Y., Pizzato, H. A., Thompson, M. R., Bradshaw, C., Weinkauf, C. C., Bime, C., Erickson, H. L., Knox, K., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., Aini, T. E., Rischard, F., , Campion, J., et al. (2020). Detection, prevalence, and duration of humoral responses to SARS-CoV-2 under conditions of limited population exposure. medRxiv : the preprint server for health sciences.
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  We conducted an extensive serological study to quantify population-level exposure and define correlates of immunity against SARS-CoV-2. We found that relative to mild COVID-19 cases, individuals with severe disease exhibited elevated authentic virus-neutralizing titers and antibody levels against nucleocapsid (N) and the receptor binding domain (RBD) and the S2 region of spike protein. Unlike disease severity, age and sex played lesser roles in serological responses. All cases, including asymptomatic individuals, seroconverted by 2 weeks post-PCR confirmation. RBD- and S2-specific and neutralizing antibody titers remained elevated and stable for at least 2-3 months post-onset, whereas those against N were more variable with rapid declines in many samples. Testing of 5882 self-recruited members of the local community demonstrated that 1.24% of individuals showed antibody reactivity to RBD. However, 18% (13/73) of these putative seropositive samples failed to neutralize authentic SARS-CoV-2 virus. Each of the neutralizing, but only 1 of the non-neutralizing samples, also displayed potent reactivity to S2. Thus, inclusion of multiple independent assays markedly improved the accuracy of antibody tests in low seroprevalence communities and revealed differences in antibody kinetics depending on the viral antigen. In contrast to other reports, we conclude that immunity is durable for at least several months after SARS-CoV-2 infection.
• Ripperger, T. J., Uhrlaub, J. L., Watanabe, M., Wong, R., Castaneda, Y., Pizzato, H. A., Thompson, M. R., Bradshaw, C., Weinkauf, C. C., Bime, C., Erickson, H. L., Knox, K., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., El Aini, T., Rischard, F., , Campion, J., et al. (2020). Orthogonal SARS-CoV-2 Serological Assays Enable Surveillance of Low-Prevalence Communities and Reveal Durable Humoral Immunity. Immunity, 53(5), 925-933.e4.
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  We conducted a serological study to define correlates of immunity against SARS-CoV-2. Compared to those with mild coronavirus disease 2019 (COVID-19) cases, individuals with severe disease exhibited elevated virus-neutralizing titers and antibodies against the nucleocapsid (N) and the receptor binding domain (RBD) of the spike protein. Age and sex played lesser roles. All cases, including asymptomatic individuals, seroconverted by 2 weeks after PCR confirmation. Spike RBD and S2 and neutralizing antibodies remained detectable through 5-7 months after onset, whereas α-N titers diminished. Testing 5,882 members of the local community revealed only 1 sample with seroreactivity to both RBD and S2 that lacked neutralizing antibodies. This fidelity could not be achieved with either RBD or S2 alone. Thus, inclusion of multiple independent assays improved the accuracy of antibody tests in low-seroprevalence communities and revealed differences in antibody kinetics depending on the antigen. We conclude that neutralizing antibodies are stably produced for at least 5-7 months after SARS-CoV-2 infection.
• Toosizadeh, N., Ehsani, H., Parthasarathy, S., Carpenter, B., Ruberto, K., Mohler, J., & Parvaneh, S. (2020). Frailty and heart response to physical activity. Archives of gerontology and geriatrics, 93, 104323.
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  Although previous studies showed that frail older adults are more susceptible to develop cardiovascular diseases, the underlying effect of frailty on heart rate dynamics is still unclear. The goal of the current study was to measure heart rate changes due to normal speed and rapid walking among non-frail and pre-frail/frail older adults, and to implement heart rate dynamic measures to identify frailty status.
• Waldman, L. T., Parthasarathy, S., Villa, K. F., Bron, M., Bujanover, S., & Brod, M. (2020). Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative study. Health and quality of life outcomes, 18(1), 128.
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  Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient's health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL.
• Wickwire, E. M., Albrecht, J. S., Dorsch, J. J., Parthasarathy, S., Collen, J., Capaldi, V. F., Johnson, A., Vadlamani, A., & Scharf, S. M. (2020). Practice patterns of board-certified sleep medicine providers: a national analysis among older adult Medicare beneficiaries. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(5), 689-694.
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  To examine the proportion of Medicare beneficiaries with sleep disorders who were evaluated by board-certified sleep medicine providers (BCSMPs).
• Wickwire, E. M., Jobe, S. L., Parthasarathy, S., Collen, J., Capaldi, V. F., Johnson, A., Vadlamani, A., Levri, J. M., Scharf, S. M., & Albrecht, J. S. (2020). Which older adults receive sleep medicine specialty care? Predictors of being seen by a board-certified sleep medicine provider. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(11), 1909-1915.
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  The aim of this study was to characterize older adult Medicare beneficiaries seen by board-certified sleep medicine providers (BCSMPs) and identify predictors of being seen by a BCSMP.
• 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.
• Budhiraja, R., Javaheri, S., Parthasarathy, S., Berry, R. B., & Quan, S. F. (2019). The Association Between Obstructive Sleep Apnea Characterized by a Minimum 3 Percent Oxygen Desaturation or Arousal Hypopnea Definition and Hypertension. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(9), 1261-1270.
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  The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O₂ desaturation. However, the American Academy of Sleep Medicine (AASM) recommends using a 3% O₂ desaturation or an arousal. This analysis assesses the relationship between OSA and hypertension utilizing the AASM recommended definition and the 2018 American College of Cardiology/American Heart Association hypertension guidelines.
• Kulkarni, H., & Parthasarathy, S. (2019). Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients?. Expert review of respiratory medicine, 13(5), 407-415.
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  The role of noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) in the home-setting remains controversial. Despite studies suggesting potential benefits, there is an apparent underutilization of such therapy in patients with stable COPD in a domiciliary setting. Areas covered: The reasons for underutilization in the home-setting are multifactorial, and we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed underutilization. In this article, we will discuss continuous PAP, bilevel PAP, and non-invasive positive pressure ventilation using a home ventilator (NIPPV). Expert commentary: Many patients with stable COPD and chronic respiratory failure do not receive NIPPV therapy at home despite supportive scientific evidence. Such underutilization suggests that there are barriers to implementation that include provider knowledge, health services, and payor policies. For patients with stable COPD without chronic respiratory failure, there is inadequate scientific evidence to support domiciliary NIPPV or CPAP therapy. In patients with stable COPD without chronic respiratory failure, studies aimed at identifying patient characteristics that determine the effectiveness of domiciliary NIPPV therapy needs further study. Future implementation and health-policy research with appropriate stakeholders are direly needed to help improve patient outcomes.
• Lester, S. J., Cha, S. S., Bos, J. M., Chahal, A. A., Sommers, V. K., Love, W. T., Ommen, S. R., Geske, J. B., Ackerman, M. J., Parthasarathy, S., Esser, H., Shamoun, F. E., & Patel, S. I. (2019). Sleep Disordered Breathing in Hypertrophic Cardiomyopathy. Sleep and Vigilance. doi:10.1007/s41782-019-00080-6
• Pandi-Perumal, S. R., Zeller, J. L., Parthasarathy, S., Edward Freeman, R., & Narasimhan, M. (2019). Herding cats and other epic challenges: Creating meaningful stakeholder engagement in community mental health research. Asian journal of psychiatry, 42, 19-21.
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  Stakeholder-centered approaches, that restrict patient barriers to clinical community mental health research, affect outcomes. It is suggested that a restructuring of clinical research organizational behavior and attitudes may overcome this problem. It is further advocated that consultation with an engagement of study patient stakeholders encourages their interest in the study, and is essential for successful research. This editorial considers the concept of stakeholder participation and management in the clinical research environment. It further offers practical suggestions for fostering meaningful stakeholder engagement.
• Parthasarathy, S., Edgin, J. O., Hsu, C., Morgan, W. J., Quan, S. F., Goodwin III, J. L., & Combs, D. (2019). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. Journal of Clinical Sleep Medicine.
• Parthasarathy, S., Grandner, M., Combs, D., & Tubbs, A. S. (2019). Obstructive Sleep Apnea in Jacobsen Syndrome. Sleep and Vigilance.
• Parthasarathy, S., Quan, S. F., Provencio, N., Berryhill, S., Poongkunran, C., Patel, S., Havens, C., Sans-Fuentes, M., Combs, D., & Bailey, O. F. (2019). Delayed sleep time in African Americans and depression in a community-based population. Journal of Clinical Sleep Medicine.
• Parthasarathy, S., Zareba, W., Lane, R. D., Combs, D., Kobayashi, U., Martinez, L., Flores-Martinez, A., Poongkunran, C., Bailey, O., & Knitter, J. (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.
• Sweeney, N. W., Gomes, C. J., De Armond, R., Centuori, S. M., Parthasarathy, S., & Martinez, J. D. (2019). Hypoxia Suppresses High Fat Diet-Induced Steatosis And Development Of Hepatic Adenomas. Hypoxia (Auckland, N.Z.), 7, 53-63.
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  Nonalcoholic fatty liver disease (NAFLD) is considered the most common form of silent liver disease in the United States and obesity is associated with increased risk of NAFLD. Obstructive sleep apnea (OSA) which is common in obese individuals is associated with a greater incidence of NAFLD, which in turn, increases the risk for hepatocellular carcinoma (HCC). It is unclear how obesity, OSA and NAFLD interrelate nor how they collectively contribute to an increased risk for developing HCC.
• Ayas, N. T., Laratta, C. R., Coleman, J. M., Doufas, A. G., Eikermann, M., Gay, P. C., Gottlieb, D. J., Gurubhagavatula, I., Hillman, D. R., Kaw, R., Malhotra, A., Mokhlesi, B., Morgenthaler, T. I., Parthasarathy, S., Ramachandran, S. K., Strohl, K. P., Strollo, P. J., Twery, M. J., Zee, P. C., , Chung, F. F., et al. (2018). Knowledge Gaps in the Perioperative Management of Adults with Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome. An Official American Thoracic Society Workshop Report. Annals of the American Thoracic Society, 15(2), 117-126.
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  The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs. There is currently insufficient evidence to guide screening and optimization of OSA and OHS in the perioperative setting to achieve these objectives. Patients who are at greatest risk of respiratory or cardiac complications related to OSA and OHS are not well defined, and the effectiveness of monitoring and other interventions remains to be determined. Centers involved in sleep research need to develop collaborative networks to allow multicenter studies to address the knowledge gaps identified below.
• 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.
• Feemster, L. C., Saft, H. L., Bartlett, S. J., Parthasarathy, S., Barnes, T., Calverley, P., Curtis, J. R., Hickam, D. H., Mularski, R. A., Au, D. H., Chlan, L. L., Reinke, L. F., Cooke, C. R., Cox, C. E., Krishnan, J. A., Rubin, E., Shah, S., Sullivan, D. R., Kross, E. K., & , A. T. (2018). Patient-centered Outcomes Research in Pulmonary, Critical Care, and Sleep Medicine. An Official American Thoracic Society Workshop Report. Annals of the American Thoracic Society, 15(9), 1005-1015.
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  Patient-centered outcomes research (PCOR) represents a paradigm shift in research methods aimed to create the body of evidence that supports clinical practice and informs health care decisions. PCOR integrates patients and other key stakeholders including family members, policy makers, clinicians, and patient advocates and advocacy groups as research partners throughout all stages of the research process. The importance of PCOR has received increased recognition, yet there is little evidence available to help guide researchers interested in the design and conduct of PCOR. In May 2014, we convened a workshop to identify key issues related to designing, conducting, and disseminating findings from PCOR studies. Workshop participants included a diverse group of patients, patient advocates, clinicians (physicians, nurses, psychologists, and advanced practice providers), researchers, administrators, and funders within and beyond the pulmonary, critical care, and sleep medicine communities. Participants identified important issues and considerations to address when undertaking PCOR. In this report, we summarize the results of this workshop to inform members of the pulmonary, sleep, and critical care community interested in participating in PCOR. Key findings include the following: 1) requirements for research to be considered PCOR; 2) the potential significant impact of PCOR on patients, clinicians, and researchers; 3) guiding principles and practical strategies to form successful patient-centered research partnerships, conduct PCOR, and disseminate study results to a broad audience of stakeholders; 4) benefits and challenges of PCOR for researchers; and 5) resources available within the American Thoracic Society to help with the conduct of PCOR.
• Goel, K., Bailey, M., Borgstrom, M., Parthasarathy, S., Natt, B., Berry, C., & Bime, C. (2018). Trends in COPD Hospitalization and In-Hospital Deaths in the United States by Sex: 2005-2014. Annals of the American Thoracic Society.
• Parthasarathy, S. (2018). The Reply. The American journal of medicine, 131(6), e271.
• 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.
• Robbins, R., Seixas, A., Jean-Louis, G., Parthasarathy, S., Rapoport, D. M., Ogedegbe, G., & Ladapo, J. A. (2018). National patterns of physician management of sleep apnea and treatment among patients with hypertension. PloS one, 13(5), e0196981.
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  Sleep apnea is associated with hypertension, and treatment may improve outcomes. We examine national burden of sleep apnea, rates of sleep apnea treatment, and whether racial/ethnic disparities exist among patients with hypertension.
• Buysse, D. J., Parthasarathy, S., & Flygare, J. (2017). Introducing People-Centered Language to SLEEP. Sleep, 40(4).
• 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.
• Haynes, P. L., Emert, S. E., Epstein, D., Perkins, S., Parthasarathy, S., & Wilcox, J. (2017). The Effect of Sleep Disorders, Sedating Medications, and Depression on Cognitive Processing Therapy Outcomes: A Fuzzy Set Qualitative Comparative Analysis. Journal of traumatic stress, 30(6), 635-645.
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  Cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) is an effortful process requiring engagement in cognitive restructuring. Sleep disorders may lead to avoidance of effortful tasks and cognitive performance deficits. We explored whether sleep disorders, as assessed by polysomnography, were consistently associated with treatment response in combination with other factors. This study included 32 U.S. veterans who were examined both before and after CPT for combat-related PTSD. We employed a novel, case-comparative technique, fuzzy set qualitative comparative analysis (fsQCA), to identify combinations of fuzzy and crisp factors (recipes) that achieve a clinically significant outcome. Approximately one-quarter of cases experiencing clinically significant change were either (a) Vietnam era veterans without sedating medications, moderate sleep disordered breathing, and severe depression; or (b) non-Vietnam era veterans with sedating medications and without severe periodic limb movements (or significant periodic limb movement arousals). Recipes involving the absence of the relevant sleep disorder were associated with the highest coverage values. These results using fsQCA (a) provide valuable information about the heterogeneity of CPT response and (b) suggest that sleep disorders are important factors to consider in theoretical discussions of who responds to CPT for PTSD.
• Lyons, O. D., Floras, J. S., Logan, A. G., Beanlands, R., Cantolla, J. D., Fitzpatrick, M., Fleetham, J., John Kimoff, R., Leung, R. S., Lorenzi Filho, G., Mayer, P., Mielniczuk, L., Morrison, D. L., Ryan, C. M., Series, F., Tomlinson, G. A., Woo, A., Arzt, M., Parthasarathy, S., , Redolfi, S., et al. (2017). Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial. European journal of heart failure, 19(4), 579-587.
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  Both types of sleep-disordered breathing (SDB), obstructive and central sleep apnoea (OSA and CSA, respectively), are common in patients with heart failure and reduced ejection fraction (HFrEF). In such patients, SDB is associated with increased cardiovascular morbidity and mortality but it remains uncertain whether treating SDB by adaptive servo-ventilation (ASV) in such patients reduces morbidity and mortality.
• Parthasarathy, S. (2017). Stress Testing the Respiratory System: Too Little or Too Much?. American journal of respiratory and critical care medicine, 195(11), 1413-1414.
• Perger, E., Inami, T., Lyons, O. D., Alshaer, H., Smith, S., Floras, J. S., Logan, A. G., Arzt, M., Duran Cantolla, J., Delgado, D., Fitzpatrick, M., Fleetham, J., Kasai, T., Kimoff, R. J., Leung, R. S., Lorenzi Filho, G., Mayer, P., Mielniczuk, L., Morrison, D. L., , Parati, G., et al. (2017). Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(11), 1235-1241.
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  In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF.
• Pépin, J. L., Tamisier, R., Hwang, D., Mereddy, S., & Parthasarathy, S. (2017). Does remote monitoring change OSA management and CPAP adherence?. Respirology (Carlton, Vic.), 22(8), 1508-1517.
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  It is increasingly recognized that the high prevalence of obstructive sleep apnoea (OSA), and its associated cardio-metabolic morbidities make OSA a burden for society. Continuous positive airway pressure (CPAP), the gold standard treatment, needs to be used for more than 4 h/night to be effective, but suffers from relatively poor adherence. Furthermore, CPAP is likely to be more effective if combined with lifestyle changes. Thus, the remote telemonitoring (TM) of OSA patients in terms of CPAP use, signalling of device problems, following disease progression, detection of acute events and monitoring of daily physical activity is an attractive option. In the present review, we aim to summarize the recent scientific data on remote TM of OSA patients, and whether it meets expectations. We also look at how patient education and follow-up via telemedicine is used to improve adherence and we discuss the influence of the profile of the healthcare provider. Then, we consider how TM might be extended to encompass the patient's cardio-metabolic health in general. Lastly, we explore how TM and the deluge of data it potentially generates could be combined with electronic health records in providing personalized care and multi-disease management to OSA patients.
• Razjouyan, J., Grewal, G. S., Rishel, C., Parthasarathy, S., Mohler, J., & Najafi, B. (2017). Activity Monitoring and Heart Rate Variability as Indicators of Fall Risk: Proof-of-Concept for Application of Wearable Sensors in the Acute Care Setting. Journal of gerontological nursing, 43(7), 53-62.
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  Growing concern for falls in acute care settings could be addressed with objective evaluation of fall risk. The current proof-of-concept study evaluated the feasibility of using a chest-worn sensor during hospitalization to determine fall risk. Physical activity and heart rate variability (HRV) of 31 volunteers admitted to a 29-bed adult inpatient unit were recorded using a single chest-worn sensor. Sensor data during the first 24-hour recording were analyzed. Participants were stratified using the Hendrich II fall risk assessment into high and low fall risk groups. Univariate analysis revealed age, daytime activity, nighttime side lying posture, and HRV were significantly different between groups. Results suggest feasibility of wearable technology to consciously monitor physical activity, sleep postures, and HRV as potential markers of fall risk in the acute care setting. Further study is warranted to confirm the results and examine the efficacy of the proposed wearable technology to manage falls in hospitals. [Journal of Gerontological Nursing, 43(7), 53-62.].
• Razjouyan, J., Lee, H., Parthasarathy, S., Mohler, J., Sharafkhaneh, A., & Najafi, B. (2017). Improving Sleep Quality Assessment Using Wearable Sensors by Including Information From Postural/Sleep Position Changes and Body Acceleration: A Comparison of Chest-Worn Sensors, Wrist Actigraphy, and Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(11), 1301-1310.
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  To improve sleep quality assessment using a single chest-worn sensor by extracting body acceleration and sleep position changes.
• Vasquez, M. M., McClure, L. A., Sherrill, D. L., Patel, S. R., Krishnan, J., Guerra, S., & Parthasarathy, S. (2017). Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease. The American journal of medicine, 130(7), 809-818.
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  Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a "real-world" bioinformatics study.
• Bime, C., Fiero, M., Lu, Z., Oren, E., Berry, C. E., Parthasarathy, S., & Garcia, J. G. (2016). High Positive End Expiratory Pressure is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome. The American journal of medicine.
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  In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis thus suggesting that a higher positive end expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status.
• Bime, C., Poongkunran, C., Borgstrom, M., Natt, B., Desai, H., Parthasarathy, S., & Garcia, J. G. (2016). Racial Differences in Mortality from Severe Acute Respiratory Failure in the United States, 2008-2012. Annals of the American Thoracic Society, 13(12), 2184-2189.
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  Racial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure.
• Chung, F., Memtsoudis, S. G., Ramachandran, S. K., Nagappa, M., Opperer, M., Cozowicz, C., Patrawala, S., Lam, D., Kumar, A., Joshi, G. P., Fleetham, J., Ayas, N., Collop, N., Doufas, A. G., Eikermann, M., Englesakis, M., Gali, B., Gay, P., Hernandez, A. V., , Kaw, R., et al. (2016). Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea. Anesthesia and analgesia, 123(2), 452-73.
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  The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.
• Chung, F., Memtsoudis, S., Krishna Ramachandran, S., Nagappa, M., Opperer, M., Cozowicz, C., Patrawala, S., Lam, D., Kumar, A., Joshi, G. P., Fleetham, J., Ayas, N., Collop, N., Doufas, A., Eikermann, M., Englesakis, M., Gali, B., Gay, P., Hernandes, A., , Kaw, R., et al. (2016). Society of Anesthesia and Sleep Medicine Guideline on Preoperative Screening and Assessment of Patients With Obstructive Sleep Apnea. Anesthesia and analgesia.
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  The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
• 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.
• Kamdar, B. B., Knauert, M. P., Jones, S. F., Parsons, E. C., Parthasarathy, S., Pisani, M. A., & , S. i. (2016). Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers. Annals of the American Thoracic Society, 13(8), 1370-7.
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  Poor sleep affects a majority of critically ill patients and is believed to be associated with adverse intensive care unit (ICU) outcomes such as delirium. While recent guidelines recommend sleep promotion efforts to improve delirium and other ICU outcomes, little is known about critical care providers' beliefs regarding sleep in the ICU.
• Khurana, H. S., Groves, R. H., Simons, M. P., Martin, M., Stoffer, B., Kou, S., Gerkin, R., Reiman, E., & Parthasarathy, S. (2016). Real-Time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality. The American journal of medicine, 129(7), 688-698.e2.
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  Real-time automated continuous sampling of electronic medical record data may expeditiously identify patients at risk for death and enable prompt life-saving interventions. We hypothesized that a real-time electronic medical record-based alert could identify hospitalized patients at risk for mortality.
• Natt, B. S., Desai, H., Singh, N., Poongkunran, C., Parthasarathy, S., & Bime, C. (2016). Extracorporeal Membrane Oxygenation for ARDS: National Trends in the United States 2008-2012. Respiratory care, 61(10), 1293-8.
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  Recent advances in technology and protocols have made the use of extracorporeal membrane oxygenation (ECMO) a viable rescue therapy for patients with ARDS who present with refractory hypoxemia. Despite the lack of strong evidence supporting the use of ECMO in ARDS, its use seems to be increasing. We sought to determine recent trends in the use of ECMO for ARDS. We also assessed trends in mortality among patients with ARDS in whom ECMO was used.
• Parthasarathy, S. (2016). The Positive and Negative about Positive Airway Pressure Therapy. American journal of respiratory and critical care medicine, 194(5), 535-7.
• 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.
• Shetty, S., Jaffer, F., & Parthasarathy, S. (2016). Rhythmic Electroencephalogram Activity during Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 12(10), 1426-1428.
• Shetty, S., Le, T., & Parthasarathy, S. (2016). Pulseless Electrical Activity during Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 12(5), 771-3.
• Weiss, C. H., Krishnan, J. A., Au, D. H., Bender, B. G., Carson, S. S., Cattamanchi, A., Cloutier, M. M., Cooke, C. R., Erickson, K., George, M., Gerald, J. K., Gerald, L. B., Goss, C. H., Gould, M. K., Hyzy, R., Kahn, J. M., Mittman, B. S., Mosesón, E. M., Mularski, R. A., , Parthasarathy, S., et al. (2016). An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine. American journal of respiratory and critical care medicine, 194(8), 1015-1025.
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  Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap.
• Yamauchi, M., Combs, D., & Parthasarathy, S. (2016). Adaptive Servo-Ventilation for Central Sleep Apnea in Heart Failure [Letter]. New England Journal of Medicine, 374, 687-691.
• 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.
• Bime, C., Oren, E., Fiero, M., Parthasarathy, S., & Garcia, J. G. (2015). High versus Low PEEP and ARDS Survival: Is there Effect Modification by BMI?. American Journal of Respiratory and Critical Care Medicine.
• Buterbaugh, J., & Parthasarathy, S. (2015). Cerebrovascular Reactivity in Young Subjects with Sleep Apnea. Sleep, 38(2), 241-250.
• 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., Archbold, K. H., Barber, B., Rice, S., Morgan, W. J., & Parthasarathy, S. (2015). Prevalence of Sleep-Disordered Breathing in Children with Congenital Heart Disease. American Journal of Respiratory and Critical Care Medicine.
• 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.
• Coughlin, S., Liang, W. E., & Parthasarathy, S. (2015). Retrospective Assessment of Home Ventilation to Reduce Rehospitalization in Chronic Obstructive Pulmonary Disease. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(6), 663-70.
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  Healthcare systems are attempting to reduce hospital readmissions due to chronic obstructive pulmonary disease (COPD).
• Mavanji, V., Perez-Leighton, C. E., Kotz, C. M., Billington, C. J., Parthasarathy, S., Sinton, C. M., & Teske, J. A. (2015). Promotion of Wakefulness and Energy Expenditure by Orexin-A in the Ventrolateral Preoptic Area. Sleep, 38(9), 1361-70.
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  The ventrolateral preoptic area (VLPO) and the orexin/hypocretin neuronal system are key regulators of sleep onset, transitions between vigilance states, and energy homeostasis. Reciprocal projections exist between the VLPO and orexin/hypocretin neurons. Although the importance of the VLPO to sleep regulation is clear, it is unknown whether VLPO neurons are involved in energy balance. The purpose of these studies was to determine if the VLPO is a site of action for orexin-A, and which orexin receptor subtype(s) would mediate these effects of orexin-A. We hypothesized that orexin-A in the VLPO modulates behaviors (sleep and wakefulness, feeding, spontaneous physical activity [SPA]) to increase energy expenditure.
• Mavanji, V., Perez-Leighton, C. E., Kotz, C. M., Billington, C. J., Sinton, C. M., Parthasarathy, S., & Teske, J. A. (2014). Promotion of wakefulness and energy expenditure by orexin A in the ventrolateral preoptic area.. Sleep.
• Mosier, J. M., Hypes, C., Joshi, R., Whitmore, S., Parthasarathy, S., & Cairns, C. B. (2015). Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department. Annals of emergency medicine, 66(5), 529-41.
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  Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.
• Nahapetian, R., Silva, G. E., Vana, K. D., Parthasarathy, S., & Quan, S. F. (2015). Weighted STOP-Bang and screening for sleep-disordered breathing. Sleep & breathing = Schlaf & Atmung.
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  STOP-Bang is a tool for predicting the likelihood for sleep-disordered breathing (SDB). In the conventional score, all variables are dichotomous. Our aim was to identify whether modifying the STOP-Bang scoring tool by weighting the variables could improve test characteristics.
• Parthasarathy, S., Shetty, S., & Combs, D. (2015). Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS. Sleep.
• Parthasarathy, S., Shetty, S., & Combs, D. (2015). Mend the Mind and Mind the "MCC". Sleep, 38(7), 1001-3.
• Parthasarathy, S., Shetty, S., Combs, D. A., Parthasarathy, S., Shetty, S., & Combs, D. A. (2015). Mend the Mind and Mind the “MCC”: Commentary Jae-Min Kim et al. Correlates and Escitalopram Treatment Effects on Sleep Disturbance in Patients with Acute Coronary Syndrome: K-DEPACS and EsDEPACS. SLEEP. doi:10.5665/sleep.4794
• Parthasarathy, S., Vasquez, M. M., Bootzin, R., Martinez, F. D., & Guerra, S. (2015). Insomnia Is Independently Associated With Hospitalization. American Journal of Respiratory and Critical Care Medicine.
• Parthasarathy, S., Vasquez, M. M., Halonen, M., Bootzin, R., Quan, S. F., Martinez, F. D., & Guerra, S. (2015). Persistent insomnia is associated with mortality risk. The American journal of medicine, 128(3), 268-75.e2.
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  Insomnia has been associated with mortality risk, but whether this association is different in subjects with persistent vs intermittent insomnia is unclear. Additionally, the role of systemic inflammation in such an association is unknown.
• Parthasarathy, S., Wendel, C., Friese, R. S., & Quan, S. F. (2015). Effects Of Central α2 Adrenergic Agent On Sleep And Inflammation In Critically Ill Patients With Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine.
• Poongkunran, C., John, S. G., Kannan, A. S., Shetty, S., Bime, C., & Parthasarathy, S. (2015). A meta-analysis of sleep-promoting interventions during critical illness. The American journal of medicine, 128(10), 1126-1137.e1.
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  Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with a potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients.
• Shetty, S., & Parthasarathy, S. (2015). Obesity Hypoventilation Syndrome. Current pulmonology reports, 4(1), 42-55.
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  Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleep-disordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include non-invasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesity-hypoventilation syndromes.
• Parthasarathy, S., Vasquez, M. M., Halonen, M., Bootzin, R. R., Quan, S. F., Martinez, F. D., & Guerra, S. (2014). Persistent Insomnia Is Associated With Mortality Risk. American Journal of Medicine.
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  doi: 10.1016/j.amjmed.2014.10.015

Proceedings Publications

• Parthasarathy, S., Patel, S. I., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. In Chest.
• 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.
• Grandner, M., Ruiz, J., Patel, S., Buxton, O., Ingram, M., Haynes, P. L., & Parthasarathy, S. (2017, April). Acculturation Associated with Sleep Duration, Insomnia, and Sleep Quality at the US-Mexico Border. In Sleep, 40, 1.
• Grandner, M., Ruiz, J., Patel, S., Buxton, O., Ingram, M., Haynes, P. L., & Parthasarathy, S. (2017, June). Acculturation Associated with Sleep Duration, Insomnia, and Sleep Quality at the US-Mexico Border. In Sleep, 40, A310.
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  Submitted version authors: Granados, K., Okuagu, A., Buxton, O., Patel, S., Ruiz, J., Parthasarathy, S., Haynes, P., Alfonso-Miller, P.., Molina, P., Seixas, A., Williams, N., Jean-Louis, G., Gehrels, J., Grandner, M. A.
• Okuagu, A., Granados, K., Alfonso-Miller, P., Buxton, O., Patel, S., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Williams, N., Girardin, J. L., Gehrels, J., & Grandner, M. (2017, June). Born in the USA or Born in Mexico? Implications for Sleep Duration, Sleep Quality, Sleep Disorders Symptoms at the US-Mexico Border. In Sleep, 40, A309.
• Haynes, P. L., Epstein, D., Parthasarathy, S., Emert, S., Kelly, M., Perkins, S., & Wilcox, J. (2016, June). Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder is Associated with Negligible Change in Daily Sleep Diary Variables. In Sleep, 39.
• Kelly, M., Haynes, P. L., Parthasarathy, S., Bootzin, R. R., & Perkins, S. (2016, June). Negative Mood Regulation Expectancies and Trauma Symptoms Following a Randomized Controlled Trial of Cognitive Behavioral Social Rhythm Group Therapy for Male Veterans with PTSD, Major Depressive Disorder, and Sleep Problems. In Sleep, 39, A299.
• Haynes, P. L., Epstein, D., Emert, S., Parthasarathy, S., & Wilcox, J. (2015, June). Determinants of Positive Response to Cognitive Behavioral Therapy for Posttraumatic Stress Disorder: Examining Sleep Disordered Breathing and Other Patient and Clinical Characteristics.. In Sleep, 38 (Abstract Supplement), A335.
• Kelly, M. R., Emert, S., Epstein, D., Parthasarathy, S., Wilcox, J., & Haynes, P. L. (2015, June). Sleep Onset Latency as a Proxy of Insomnia Severity in the Characterization of Veteran’s Positive PTSD Psychotherapy Outcomes.. In Sleep, 38 (Abstract Supplement), A336.
• Haynes, P., Parthasarathy, S., Bootzin, R. R., & Krakow, B. (2013). Motivational enhancement therapy for insomnia in OEF/OIF veterans: A treatment development study. In Sleep, 36, A232.

Presentations

• Parthasarathy, S., Esparza, L., La Rue, S., Matloff, D., Gerken, B., Van Vorce, H., Bottrell, K., Hsu, C., Swanson, J. E., & Combs, D. A. (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.
• Cooper, D. S., Parthasarathy, S., Klewer, S. E., Seckeler, M., Edgin, J. O., Hsu, C., Partha, M., & Combs, D. A. (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.
• Woosley, R., Youngstedt, S., Grandner, M., Quan, S. F., Patel, I., Xia, X., Woosley, R., Wendel, C. S., Perez, K., Parthasarathy, S., Zareba, W., & Patel, S. I. (2022). The Application of a QTc Risk Score in Patients with Obstructive Sleep Apnea. SLEEP.
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  oral and poster presentation
• Berryhill, S., Parthasarathy, S., Parthasarathy, S., Morton, C. J., Krishnan, J. A., Krishnan, J. A., Dean, A., Gerald, L. B., Gerald, L. B., Berryhill, A., Combs, D., Combs, D., Provencio-Dean, N., Estep, L., Estep, L., Patel, S. I., Patel, S. I., Patel, S. I., Estep, L., , Provencio-Dean, N., et al. (2019, December). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. Journal of Clinical Sleep Medicine.
• Combs, D. A., Barber, B. J., Seckeler, M., Parthasarathy, S., & Skrepnek, G. (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.
• Parthasarathy, S., Krishnan, J. A., Gerald, L. B., Combs, D., Estep, L., Patel, S. I., Provencio-Dean, N., Berryhill, A., Dean, A., Morton, C. J., & Berryhill, 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.
• 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., Combs, D., Guerra, S., Huang, F., Vasquez, M., & Patel, S. I. (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.
• Parthasarathy, S., Combs, D., Patel, S. I., & Huang, F. (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., 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.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., Combs, D., Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (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., Parthasarathy, S., Bailey, O., Bailey, O., Morgan, W. J., Morgan, W. J., Hsu, C., Hsu, C., Abraham, I. L., Abraham, I. L., Combs, D., & Combs, D. (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., 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.

Poster Presentations

• Patel, S. I., Parthasarathy, S., Miller, J., Youngstedt, S., Grandner, M., Quan, S. F., Patel, I., Woosley, R., Xia, X., LaFleur, B. J., Zareba, W., & Perez, K. (2022). Changes in markers of ventricular repolarization and positive airway pressure therapy: A pilot study. SLEEP.
• 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.
• Combs, D., Combs, D., Goodwin, J., Goodwin, J., Quan, S. F., Quan, S. F., Morgan, W. J., Morgan, W. J., Edgin, J. O., Edgin, J. O., Parthasarathy, S., & 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.
• 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..
• 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.
• Sternberg, E. M., Son, Y., Parthasarathy, S., Engineer, A. A., Berryhill, A., Morton, C., Hyde, J., & Chen, Y. (2021, April). Development of a complementary system for 3D personal CO2 bubble visualization to improve sleep quality and cognitive performance. Research to Innovation Showcase, BIO5 Institute, University of Arizona,. Tucson, AZ: University of Arizona.
• Xia, X., Parthasarathy, S., Couderc, J., Mashaqi, S., Zareba, W., Patel, I., Parthasarathy, S., Combs, D. A., Mashaqi, S., Woosley, R., Xia, X., Patel, I., Couderc, J., LaFleur, B. J., Combs, D. A., LaFleur, B. J., Zareba, W., Woosley, R., Patel, S. I., & Patel, S. I. (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., Xia, X., Couderc, J., Couderc, J., Zareba, W., Zareba, W., Parthasarathy, S., Parthasarathy, S., Patel, S. I., Patel, S. I., Patel, I., Patel, I., LaFleur, B. J., LaFleur, B. J., Combs, D. A., Combs, D. A., Mashaqi, S., & 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., Xia, X., Xia, X., Parthasarathy, S., Woosley, R., Woosley, R., Woosley, R., Mashaqi, S., Couderc, J., Couderc, J., Couderc, J., Patel, I., Zareba, W., Zareba, W., Zareba, W., Combs, D. A., Parthasarathy, S., Parthasarathy, S., Woosley, R., , Parthasarathy, S., 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.
• Moskowitz, A., Kondapalli, K., Parthasarathy, S., Combs, D. A., & Jain, S. (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.
• Parthasarathy, S., Combs, D., Guerra, S., Huang, F., Vasquez, M., & Patel, S. I. (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.
• Seckeler, M., Seckeler, M., Seckeler, M., Combs, D. A., Combs, D. A., Fernandez, V., Klewer, S. E., Klewer, S. E., Klewer, S. E., Fernandez, V., Parthasarathy, S., Parthasarathy, S., Barber, B. J., Parthasarathy, S., Barber, B. J., Andrews, J. G., Andrews, J. G., Morgan, W. J., Andrews, J. G., , Morgan, W. J., et al. (2020, November). Obstructive Sleep Apnea Is Associated with Cardiac Dysfunction In Children With Congenital Heart Disease. 2020 American Heart Association Scientific SessionsAmerican Heart Association.
• 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., 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.
• 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 Failur. 2019 American Heart Association Scientific Sessions. Philadelphia, PA.
• 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.
• Parthasarathy, S., Patel, S. I., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 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.
• 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. Sleep Research SocietySleep Research Society.
• 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. American Heart AssociationAmerican Heart Association.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., Combs, D., Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Combs, D. (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.
• 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. American Thoracic SocietyAmerican Thoracic Society.
• Parthasarathy, S., Combs, D., Kobayashi, U., Martinez, L., Flores Martinez, A., Poongkunran, C., Bailey, O., Patel, S., & Knitter, J. (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., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Coombs, D. (2018, Nov). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. American Heart Association. Chicago.
• Parthasarathy, S., Quan, S. F., Provencio, N., Berryhill, S., Patel, S., Poongkunran, C., Combs, D., Havens, C., Sans-Fuente, M., & Bailey, O. (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.
• Combs, D., Edgin, J. O., Barber, B. J., Morgan, W. J., Hsu, C., Abraham, I. L., Parthasarathy, S., Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (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.
• 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., 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., Edgin, J. O., Morgan, W. J., Quan, S. F., Goodwin, J., & Combs, D. (2017, June). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. 2017 meeting of the Associated Professional Sleep Societies.
• 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.
• Combs, D. A., Combs, D. A., Edgin, J. O., Edgin, J. O., Archbold, K., Archbold, K., Barber, B. J., Barber, B. J., Rice, S. A., Rice, S. A., Morgan, W. J., Morgan, W. J., Parthasarathy, S., & 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.
• 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.
• Parthasarathy, S., Vasquez, M., Halonen, M., Martinez, F., & Guerra, S. (2015, May). Insomnia is Independently Associated with Hospitalization. American Thoracic Society International Conference.

Others

• DePorter, D., Coborn, J., Parthasarathy, S., & Teske, J. (2015, Fall). Sleep deprivation reduces the effectiveness of Orexin-A to stimulate physical activity and energy expenditure. Sleep.
• Haynes, P., Epstein, D., Perkins, S., Parthasarathy, S., Wilcox, J., Haynes, P., Epstein, D., Perkins, S., Parthasarathy, S., & Wilcox, J. (2015, Fall). Determinants of positive response to cognitive behavioral therapy for PTSD: Examining configurational algorithms of sleep disordered breathing and other patient and clinical characteristics. Sleep.
• Kelly, M., Emert, S., Epstein, D., Perkins, S., Parthasarathy, S., Wilcox, J., & Haynes, P. L. (2015, Fall). Onset Latency as a Proxy of Insomnia Severity in the Characterization of Veteran’s Positive PTSD Psychotherapy Outcomes. Sleep.
• Parthasarathy, S., & Basner, R. (2015, Fall). Nocturnal Non-invasive ventilation: Theory, Evidence and Clinical Practice. Sleep.
• Shetty, S., Fernandes, A., Patel, S., & Parthasarathy, S. (2015, Fall). Clinical Prediction Rule For Patient Selection In Home Management Pathways For Obstructive Sleep Apnea. Sleep.