Positional Therapy for the Treatment of Pediatric Obstructive Sleep Apnea
Childhood obstructive sleep apnea (OSA) is highly prevalent, occurring in 1-4% of children. The gold standard therapy is continuous positive airway pressure (CPAP) for persistent OSA following adenotonsillectomy. Although CPAP is highly efficacious, long-term effectiveness is limited by poor adherence rates of 50%. Given the burden of untreated OSA in children, novel alternative therapies that are effective, acceptable, and comfortable are urgently required. My research interest is in alternative therapies for childhood OSA. There is an emerging distinct clinical phenotype in children called positional OSA whereby obstructive breathing is worse in the supine position. This phenotype may be treated with positional therapy to prevent children from adopting the supine position during sleep. We are currently conducting a randomized crossover trial to examine the efficacy of positional therapy compared to an inactive control. The knowledge gained will help change the paradigm of clinical care from a one size fits all approach to a personalized treatment strategy for OSA.

Spinal Muscular Atrophy in the Era of Disease-Modifying Therapies
Spinal Muscular Atrophy (SMA) is an autosomal recessive neuromuscular disorder that commonly manifests with motor deterioration, respiratory decline, and orthopedic complications. The paradigm of care is shifting as disease-modifying therapies including nusinersen, onasemnogene abeparvovec, and risdiplam alter the disease trajectory of SMA. I have an interest in examining the respiratory characteristics, clinical outcomes, and experiences of children with SMA receiving disease-modifying therapies.

The Association between Insomnia and Positive Airway Pressure Adherence in Children
Insomnia and obstructive sleep apnea (OSA) are highly prevalent conditions in the pediatric population. There is a growing recognition that these conditions may coexist, referred to as comorbid insomnia and sleep apnea (COMISA). Importantly, COMISA is associated with greater morbidity than either condition alone. Emerging evidence suggests that coexisting insomnia may affect tolerance to the gold standard positive airway pressure (PAP) therapy for children with OSA following surgical intervention. PAP therapy is highly effective for the treatment of OSA but is limited by poor adherence rates in children. I have an interest in evaluating COMISA and its impact on health outcomes in children. Understanding the impact of coexisting insomnia on PAP adherence in children may inform future targeted treatment strategies for this population to improve PAP adherence and health outcomes.