Angela Morielli
Montreal Children's Hospital
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Angela Morielli.
The Journal of Pediatrics | 1996
Karen A. Waters; Anne Gonzalez; Catherine Jean; Angela Morielli; Robert T. Brouillette
OBJECTIVEnTo determine the frequency and physiologic consequences of the face-straight-down (FSD) position, a postulated mechanism for the sudden infant death syndrome in prone-sleeping infants.nnnSTUDY DESIGNnA survey of 151 infants, aged 1 to 7 months, in Montreal showed that 33% slept prone. Ten healthy prone-sleeping infants were studied in their homes at age 10 to 22 weeks. Infrared video and cardiorespiratory recordings were made on 3 consecutive nights in the prone (nights 1 and 3) and lateral (night 2) positions.nnnRESULTSnInfants maintained the prone position during 17 of 19 studies, but only 4 of 9 infants maintained the lateral position. The FSD position was observed 27 times in 17 prone nights: median frequency, 0.6 times per night (interquartile range, 0 to 4), and median total duration, 3.3 minutes (0.8% of total sleep time). A related position, the face-near-straight-down (FNSD) position, occurred more often, 5.3 (1 to 10) time per prone night, for 22.4 minutes (5.8% of total sleep time). Most periods in the FSD and FNSD position had no physiologic consequences; however, 14% of FSD and 3% of FNSD episodes were associated with airway obstruction as indicated by snoring, paradoxical respiratory movements, apnea, and/or increased partial pressure of transcutaneous carbon dioxide. Spontaneous arousal and head turning terminated the FSD and FNSD episodes.nnnCONCLUSIONnThe FSD and FNSD positions occur commonly in healthy prone-sleeping infants, and these positions can cause airway obstruction. We speculate that those infants with sudden infant death syndrome found in the FSD or FNSD position either have a congenital or an acquired defect in the arousal-head turning response or have encountered insurmountable environmental factors that prevent effective head turning.
The Journal of Pediatrics | 1998
Karen A. Waters; Patricia A. Forbes; Angela Morielli; Cindy Hum; Augustin M. O'Gorman; Olivier Vernet; G. Michael Davis; Ted L. Tewfik; Francine Ducharme; Robert T. Brouillette
BACKGROUNDnAlthough patients with myelomeningocele and the Chiari II malformation are known to have sleep apnea and respiratory control deficits, the prevalence, types, severities, and associations of sleep-disordered breathing (SDB) have not been adequately defined.nnnMETHODSnA cross-sectional study of our myelomeningocele clinic population was undertaken to correlate polysomnographic results with historical data and findings from magnetic resonance imaging of the Chiari malformation, pulmonary function results, and nocturnal pulse oximetry.nnnRESULTSnA questionnaire survey of symptoms was available for 107 of 109 children (98% of the clinic population), and 83 patients agreed to undergo overnight polysomnography. Breathing during sleep was classified as normal in 31 cases (37%), mildly abnormal in 35 cases (42%), and moderately/severely abnormal in 17 cases (20%). Among the 17 patients with moderately/severely abnormal SDB, 12 patients had predominantly central apneas and 5 had predominantly obstructive apnea. Patients with a thoracic or thoracolumbar myelomeningocele, those who had previously had a posterior fossa decompression operation, those with more severe brain-stem malformations, and those with pulmonary function abnormalities were more likely to have moderately/severely abnormal SDB, relative risks (95% confidence intervals) 9.2 (2.9 to 29.3), 3.5 (1.3 to 8.9), 3.0 (0.9 to 10.5), and 11.6 (1.6 to 81.3), respectively. Failure of obstructive SDB to resolve after adenotonsillectomy in four patients suggested abnormal control of pharyngeal airway patency during sleep. Nocturnal pulse oximetry accurately predicted moderately/severely abnormal SDB with a sensitivity of 100% and a specificity of 67%.nnnCONCLUSIONSnThe pathogenesis of SDB in patients with myelomeningocele involves the functional level of the spinal lesions, congenital and acquired brainstem abnormalities, pulmonary function abnormalities, disorders of upper airway maintenance, and sleep state. Polysomnography and nocturnal pulse oximetry should be performed in high-risk patients to detect and classify SDB.
Laryngoscope | 1997
Saleh A. Al-Ghamdi Md; John J. Manoukian; Angela Morielli; Kamaldine Oudjhane; Francine M. Ducharme; Robert T. Brouillette
To determine if pediatric obstructive sleep apnea syndrome (OSAS) caused by adenotonsillar hypertrophy (ATH) could be treated by a short course of systemic corticosteroids, we conducted an openlabel pilot study in which standardized assessments of symptomatology, OSAS severity, and adenotonsillar size were performed before and after a 5‐day course of oral prednisone, 1.1 ± 0.1(± SE) mg/kg per day. Outcome measures included symptom severity, adenotonsillar size, and polysomnographic measures of OSAS. Selection criteria included age from 1 to 12 years, ATH, symptomatology suggesting OSAS, an apnea/hypopnea index (AHI) ≥ 3/hour, and intent to perform adenotonsillectomy. Only one of nine children showed enough improvement to avoid adenotonsillectomy. Symptomatology did not improve after corticosteroid treatment but did after removal of tonsils and adenoids. Polysomnographic indices of OSAS severity did not improve after corticosteroid treatment. After corticosteroids, tonsillar size decreased in only two patients, adenoidal size was only marginally reduced, and the size of the nasopharyngeal airway was not significantly increased. These results suggest that a short course of prednisone is ineffective in treating pediatric OSAS caused by ATH.
Developmental Medicine & Child Neurology | 1999
Valerie G. Kirk; Angela Morielli; Robert T. Brouillette
Moderate to severe sleep‐disordered breathing (SDB) was identified in 20% (17 of 83) of children with spina bifida/myelomeningocele (SB/MM) at the Montreal Childrens Hospital. The prevalence of SDB in patients with SB/MM elsewhere has not been determined. To establish current practices for identifying SDB in patients with SB/MM, questionnaires were sent to the coordinators of the 212 spina‐bifida clinics in Canada and in the United States. Eighty‐six (41%) questionnaires were returned, representing data on 13 349 patients. Although 67% of the responding centers reported availability of cardiorespiratory sleep studies, only 996 (7.5%) patients with SB/MM had been tested and only 418 (3.1%) patients had been diagnosed with SDB. Across clinics, the prevalence of SDB was directly related to the frequency of testing. Of 380 deaths over the past 10 years, SDB and sudden unexplained death during sleep were identified as the cause of death in 49 (12.8%) and 34 (8.9%) patients, respectively. Moderate to severe SDB may not have been identified in a significant number of patients with SB/MM because they have not been tested.
The Journal of Pediatrics | 1999
Evelyn Constantin; Karen A. Waters; Angela Morielli; Robert T. Brouillette
Abstract Background: Term infants may die of sudden infant death syndrome (SIDS) when they assume the face-straight-down or the face-near-straight-down head positions. Preterm infants have a higher SIDS rate, but it is not known how often they assume the face-straight-down and face-near-straight-down positions. Objectives: To determine the frequency and cardiorespiratory consequences of head turning and face-down head positioning in prone-sleeping premature infants. Study design: Supervised overnight cardiorespiratory and audiovisual recordings were conducted in 15 prone-sleeping preterm infants nearing hospital discharge: birth weight, 1178 ± 101 (SEM) g, postconceptional age, 40 ± 1.0 weeks. Results: The preterm infants, studied at a younger postconceptional age than previously reported term infants, seldom turned their heads during sleep; therefore they rarely assumed the face-straight-down position (6 episodes in 3 infants) or the face-near-straight-down position (30 episodes in 6 infants). Conclusions: Prematurely born infants, known to be at increased risk of SIDS, rarely assume face-down positions when sleeping prone at approximately 40 weeks postconceptional age. These results suggest that head turning during sleep is developmentally regulated and may have relevance to understanding the age distribution of SIDS. (J Pediatr 1999;134:558-62)
Pediatric Research | 1999
Robert T. Brouillette; Angela Morielli; A Leimanis; Karen A. Waters; R Luciano; Francine Ducharme
OBJECTIVEnTo determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children.nnnMETHODSnWe performed a cross-sectional study of 349 patients referred to a pediatric sleep laboratory for possible OSA. A mixed/obstructive apnea/hypopnea index (MOAHI) greater than or equal to 1 on nocturnal polysomnography (PSG) defined OSA. A sleep laboratory physician read nocturnal oximetry trend and event graphs, blinded to clinical and polysomnographic results. Likelihood ratios were used to determine the change in probability of having OSA before and after oximetry results were known.nnnRESULTSnOf 349 patients, 210 (60%) had OSA as defined polysomnographically. Oximetry trend graphs were classified as positive for OSA in 93 and negative or inconclusive in 256 patients. Of the 93 oximetry results read as positive, PSG confirmed OSA in 90 patients. A positive oximetry trend graph had a likelihood ratio of 19.4, increasing the probability of having OSA from 60% to 97%. The median MOAHI of children with a positive oximetry result was 16.4 (7.5, 30.2). The 3 false-positive oximetry results were all in the subgroup of 92 children who had diagnoses other than adenotonsillar hypertrophy that might have affected breathing during sleep. A negative or inconclusive oximetry result had a likelihood ratio of.58, decreasing the probability of having OSA from 60% to 47%. Interobserver reliability for oximetry readings was very good to excellent (kappa =.80).nnnCONCLUSIONSnIn the setting of a child suspected of having OSA, a positive nocturnal oximetry trend graph has at least a 97% positive predictive value. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA attributable to adenotonsillar hypertrophy in children older than 12 months of age, or 2) quickly and inexpensively identify children with a history suggesting sleep-disordered breathing who would require PSG to elucidate the type and severity. A negative oximetry result cannot be used to rule out OSA.
Pediatric Research | 1999
Evelyn Constantin; Karen A. Waters; Angela Morielli; Robert T. Brouillette
BACKGROUNDnTerm infants may die of sudden infant death syndrome (SIDS) when they assume the face-straight-down or the face-near-straight-down head positions. Preterm infants have a higher SIDS rate, but it is not known how often they assume the face-straight-down and face-near-straight-down positions.nnnOBJECTIVESnTo determine the frequency and cardiorespiratory consequences of head turning and face-down head positioning in prone-sleeping premature infants.nnnSTUDY DESIGNnSupervised overnight cardiorespiratory and audiovisual recordings were conducted in 15 prone-sleeping preterm infants nearing hospital discharge: birth weight, 1178 101 (SEM) g, postconceptional age, 40 1.0 weeks.nnnRESULTSnThe preterm infants, studied at a younger postconceptional age than previously reported term infants, seldom turned their heads during sleep; therefore they rarely assumed the face-straight-down position (6 episodes in 3 infants) or the face-near-straight-down position (30 episodes in 6 infants).nnnCONCLUSIONSnPrematurely born infants, known to be at increased risk of SIDS, rarely assume face-down positions when sleeping prone at approximately 40 weeks postconceptional age. These results suggest that head turning during sleep is developmentally regulated and may have relevance to understanding the age distribution of SIDS.
Pediatric Research | 1997
Karen A. Waters; P. Forbes; Angela Morielli; C. Hum; A. M. O'Gorman; O. Vernet; G. M. Davis; T. L. Tewfik; E. M. Ducharme; Robert T. Brouillette
Background: Although patients with myelomeningocele and the Chiari II malformation are known to have sleep apnea and respiratory control deficits, the prevalence, types, severities, and associations of sleep-disordered breathing (SDB) have not been adequately defined. Methods: A cross-sectional study of our myelomeningocele clinic population was undertaken to correlate polysomnographic results with historical data and findings from magnetic resonance imaging of the Chiari malformation, pulmonary function results, and nocturnal pulse oximetry. Results: A questionnaire survey of symptoms was available for 107/109 children (98% of the clinic) and 83 patients agreed to overnight polysomnography. Breathing during sleep was classified as normal in 31 cases(37%), mildly abnormal in 35 cases (42%) and moderately/severely abnormal in 17 cases (20%). Amongst the 17 patients with moderately/severely abnormal SDB, 12 patients had predominantly central apneas and 5 had predominantly obstructive apnea. Failure of obstructive SDB to resolve after adenotonsillectomy in 4 patients suggested abnormal control of pharyngeal airway patency during sleep. Patients with a thoracic or thoracolumbar myelomeningocele, those who had previously had a posterior fossa decompression operation, those with more severe brainstem malformations, and those with pulmonary function abnormalities were more likely to have moderately/severely abnormal SDB: relative risks (95% confidence intervals) 9.2 (2.9-29.3), 3.5(1.3-8.9), 3.0(0.9-10.5), and 11.6(1.6-81.3), respectively. Nocturnal pulse oximetry accurately predicted moderately/severely abnormal SDB with a sensitivity of 100%. Conclusions: The pathogenesis of SDB seen in patients with myelomeningocele involves the functional level of the spinal lesions, congenital and acquired brainstem abnormalities, pulmonary function abnormalities, disorders of upper airway maintenance, and sleep state. Polysomnography and nocturnal pulse oximetry should be performed in high risk patients to detect and classify SDB.
Pediatric Research | 1996
Robert T. Brouillette; Saleh A. Al-Ghamdi Md; John J. Manoukian; Angela Morielli; Kamaldine Oudjhane; Francine M. Ducharme
There is a reason to suspect that pediatric OSA due to ATH could be treated by a short course of systemic steroids. For instance, steroids can reduce tonsillar size in infectious mononucleosis. We therefore performed assessments of symptomatology, ATH, and OSA severity before and after a 5 day course of 1 mg/kg/day of oral prednisone in 9 children (6 girls). Selection criteria included age 1-11 years, a mixed/obstructive apnea/hypopnea index (MOAHI) of≥ 3/hr, ATH, symptoms suggesting OSA, and intent to perform adenotonsillectomy. Before and after steroid treatment, physical and radiographic exams documented ATH, and home polysomnography (Ped Pul 20:241-52, 1995) and a questionnaire based OSA score (J. Ped. 105:10-14, 1984) documented severity of OSA. RESULTS. Only one child showed enough improvement to avoid operation. Clinical symptomatology did not improve after steroid treatment but did after removal of tonsils and/or adenoids: OSA score (x± SD), 1.8 ± 2.2 vs 1.5 ± 2.2 vs -2.7 ± 1.6, p<.01. Polysomnographic indices of OSA severity did not improve after steroid treatment: MOAHI, 13.9 ± 15.2 vs 9.9 ± 7.1, p=0.29. Tonsillar size decreased in only two patients; adenoid size was marginally reduced after steroids: adenoid/nasopharyngeal ratio,.69 ±.10 vs.63±.09, p=.05. CONCLUSIONS. These results suggest that a larger, double-blind placebo controlled trial of systemic corticosteroids is not warranted. However, recent data (Peds 95:355-64, 1995) suggest that a longer course of nasal steroids might reduce adenoidal size, improve symptomatology, and decrease OSA severity. Support: The Hospital for Sick Children Foundation.
Pediatrics | 2000
Robert T. Brouillette; Angela Morielli; Andra Leimanis; Karen A. Waters; Rina Luciano; Francine Ducharme