Overview

I am a Pediatric Respirologist and Sleep Physician with clinical and research expertise in Pediatric Sleep Medicine and Long-Term Ventilation. Using a wide range of methodologies including randomized controlled trials, qualitative methods, and observational designs, my research focuses on improving health outcomes for children with sleep-disordered breathing. I am interested in evaluating interventions for sleep-disordered breathing, assessing models of care, and evaluating patient and family caregiver experiences with long-term ventilation and sleep disorders.

Publications

Volume assured pressure support mode use for non-invasive ventilation in pediatrics
Pediatric Pulmonology
Nisha Cithiravel and Lena Xiao and Jenny Shi and Jackie Chiang and Reshma Amin
DOI: 10.1002/ppul.26721
01/2024

Understanding caregiver experiences with disease-modifying therapies for spinal muscular atrophy: a qualitative study
Archives of Disease in Childhood
Lena Xiao and Sohee Kang and Djurdja Djordjevic and Hernan Gonorazky and Jackie Chiang and Munazzah Ambreen and Elisa Nigro and Eugenia Law and Lauren Weinstock and Melissa McCradden and Reshma Amin
DOI: 10.1136/archdischild-2023-325762
11/2023

Polysomnography in hospitalized children: Characteristics and clinical practice at a single tertiary care center
Pediatric Pulmonology
Kanokkarn Sunkonkit and Mohammed Alzaid and Lena Xiao and Colin Massicotte and Suhail Al-Saleh and Reshma Amin
DOI: 10.1002/ppul.26567
09/2023

Neurocognition, Behavior, Socioeconomic, and Health Outcomes of Pediatric Obstructive Sleep Apnea
American Journal of Respiratory and Critical Care Medicine
Lena Xiao and Kanokkarn Sunkonkit and Jenny Shi and Indra Narang
DOI: 10.1164/rccm.202201-0051RR
04/2023

Unexplained Significant Central Sleep Apnea in Infants: Clinical Presentation and Outcomes
Sleep and Breathing
Lena Xiao and Kanokkarn Sunkonkit and Jackie Chiang and Indra Narang
DOI: 10.1007/s11325-022-02612-3
03/2023

Respiratory characteristics in children with spinal muscular atrophy type 1 receiving nusinersen
Pediatric Pulmonology
Lena Xiao and Jackie Chiang and Maria Castro-Codesal and Hanna Kolski and Prabhjot Bedi and Fatema Al Amrani and Hernan D. Gonorazky and Reshma Amin
DOI: 10.1002/ppul.26173
01/2023

Long-term mechanical ventilation and transitions in care: A narrative review
Chronic Respiratory Disease
Lena Xiao and Reshma Amin and Mika Laura Nonoyama
DOI: 10.1177/14799731231176301
01/2023

Sleep disordered breathing in infants identified through newborn screening with spinal muscular atrophy
Sleep Medicine
Chiang, J. and Xiao, L. and Nigro, E. and St-Laurent, A. and Weinstock, L. and Law, E. and Janevski, J. and Kuyntjes, S. and Cithiravel, N. and Tran, T. and Wolter, N.E. and Gonorazky, H. and Amin, R. and Dowling, J.J. and McKinnon, N. and Johnstone, J. and McAdam, L.
DOI: 10.1016/j.sleep.2023.09.019
2023

Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study
European Journal of Pediatrics
Lena Xiao and Nicholas Barrowman and Franco Momoli and Kimmo Murto and Matthew Bromwich and Sherri L. Katz
DOI: 10.1007/s00431-022-04438-3
06/2022

Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO-CON debate
Pediatric Pulmonology
Lena Xiao and Kimberley Kaspy and David Zielinski and Reshma Amin
DOI: 10.1002/ppul.25773
03/2022

Narcolepsy Treatment: Voices of Adolescents
Behavioral Sleep Medicine
Lena Xiao and Anna Chen and Arpita Parmar and Lucy Frankel and Alene Toulany and Brian J. Murray and Indra Narang
DOI: 10.1080/15402002.2021.1916496
03/2022

Scoliosis in Spinal Muscular Atrophy Type 1 in the Nusinersen Era
Neurology: Clinical Practice
Al Amrani, F. and Amin, R. and Chiang, J. and Xiao, L. and Boyd, J. and Law, E. and Nigro, E. and Weinstock, L. and Stosic, A. and Gonorazky, H.D.
DOI: 10.1212/CPJ.0000000000001179
2022

Paradigm shift in the era of disease-modifying therapies for Spinal Muscular Atrophy type 1: respiratory challenges and opportunities
Sleep Medicine
Lena Xiao and Jackie Chiang and Reshma Amin
DOI: 10.1016/j.sleep.2021.06.022
10/2021

Positional device therapy for the treatment of positional obstructive sleep apnea in children: a pilot study
Sleep Medicine
Lena Xiao and Adele Baker and Giorge Voutsas and Colin Massicotte and Nikolaus E. Wolter and Evan J. Propst and Indra Narang
DOI: 10.1016/j.sleep.2021.07.036
09/2021

Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children
Journal of Clinical Sleep Medicine
Xiao, L. and Barrowman, N. and Momoli, F. and Murto, K. and Bromwich, M. and Proulx, F. and Katz, S.L.
DOI: 10.5664/jcsm.9420
2021

The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity
Journal of Clinical Sleep Medicine
DOI: 10.5664/jcsm.10706

Research

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.

Grants

Co-Principal Investigator. Establishing the Top Ten Research Priorities for Respiratory Care of Pediatric Neuromuscular Disease. Funding Source: Muscular Dystrophy Canada

Co-Principal Investigator. Single Site Feasibility and Safety Study of Home Initiation of Noninvasive Positive Pressure Ventilation in Children with Medical Complexity. Funding Source: Baxter Corporation Endowment Fund for Home Care

Principal Investigator. The Association Between Insomnia and Positive Airway Pressure Adherence in Children. Funding Source: International Pediatric Sleep Association and Sleep Research Society Foundation Small Research Grant

Honours & Awards

2023 - Ontario Graduate Scholarship, Institute of Health Policy, Management, and Evaluation

2021 - The Frederick Banting and Charles Best Canada Graduate Scholarships Master’s Award, Canadian Institutes of Health Research

2021 - Clinician-Scientist Training Program Award, The Hospital for Sick Children

2021 - Academic Sleep Pulmonary Integrated Research/Clinical Fellowship (ASPIRE Fellowship), American Thoracic Society

Research Group Members

Diana Kagan, FLEX Research Trainee