Christopher M Cielo
VerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 2012–2026
About
Christopher M Cielo, DO, is an Associate Professor of Pediatrics specializing in Pulmonary Medicine at the Children's Hospital of Philadelphia. He serves as the Sleep Core Director at the Center for Human Phenomics Science. His clinical expertise focuses on sleep disorders in children and pulmonary conditions in children. His research involves clinical and translational studies related to the evaluation, mechanisms, management, and effects of obstructive sleep apnea in children, with particular emphasis on infant populations, children with craniofacial differences and other high-risk conditions, and the use of MRI and other imaging modalities to understand structural contributors to OSA. Dr. Cielo's work also includes the development of novel diagnostic modalities for sleep testing.
Research topics
- Medicine
- Pediatrics
- Internal medicine
- Anesthesia
- Physical therapy
Selected publications
Multidisciplinary care of pediatric obesity and its impact on sleep: a review
Frontiers in Sleep · 2026-01-02
articleOpen accessSenior authorCorrespondingPediatric obesity has emerged as a significant global health issue with multifaceted consequences, including its impact on sleep health. Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) are among the serious sleep-related comorbidities in obese children, contributing to impaired quality of life, cognitive deficits, and cardiovascular risks. These conditions frequently coexist with other obesity-related complications such as insulin resistance, type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). This review explores the importance of multidisciplinary care in addressing pediatric obesity, emphasizing early diagnosis, nutritional counseling, physical activity interventions, psychological support, and pharmacologic therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. The role of global trends, academic performance, and wellbeing clinics are also discussed. Although promising, the use of GLP-1s and surgical interventions in pediatrics remains constrained by limited data, particularly concerning their impact on sleep disorders. Further research is essential to clarify the long-term effects of GLP-1 receptor agonists and bariatric surgery not only on obesity and sleep-related comorbidities such as OSA and OHS, but also on cognitive function, psychosocial wellbeing, and overall health outcomes-thereby informing evidence-based, multidisciplinary approaches to pediatric obesity management.
1004 Counting Sheep at Home: Advancing Pediatric Sleep Apnea Testing
SLEEP · 2025-05-01
articleOpen accessSenior authorAbstract Introduction In-laboratory polysomnography (PSG) is currently the standard clinical test for evaluating obstructive sleep apnea (OSA) in children, but barriers including cost, accessibility, and discomfort highlight the critical need for alternative testing modalities such as home sleep apnea testing (HSAT) in pediatrics. Level II HSAT with electroencephalogram (EEG) may be more accurate for the diagnosis of OSA in children but requires a technologist to set up the equipment compared with Level III HSAT without EEG. We aimed to compare the accuracy of Level II HSAT versus Level III HSAT for the diagnosis of pediatric OSA. Methods Children aged 2 through 17-years-old completed Level II HSAT as part of a larger study comparing HSAT with PSG. Level II HSAT was scored using AASM pediatric scoring rules. EEG was removed from the montage and HSAT studies were re-scored as Level III studies by investigators blinded to the Level II scoring. An obstructive apnea hypopnea index (OAHI) of 2 events/hour was the threshold used for a diagnosis of OSA. Level II and Level III HSAT OAHI were compared using sign rank test, Spearman’s rank correlation, and Lin’s test of concordance. Results Fifteen participants, including 10 (67%) females were included. Median (range) age was 6.0 (Range: 2.9, 17.1) years. Level III HSAT OAHI was 1.0 (0.2, 9.2), and Level II HSAT OAHI, was 1.8 (Range: 0.3, 23), p = 0.15. By Level III HSAT, obstructive hypopnea index was 0.3 (0, 1.6), and Level II HSAT was 1.2 (0.1, 13), p= 0.002. Six (0.4) participants had a diagnosis of OSA by Level II HSAT and 2 (0.13) by Level III HSAT (p=0.09). There was a moderate correlation between Level II HSAT and Level III HSAT (Spearman r=0.61, p=0.02) but poor concordance (concordance correlation coefficient=0.5). Conclusion In this pediatric pilot study, there was a moderate correlation between Level II and Level III HSAT OAHI, but poor concordance. Removal of HSAT EEG resulted in significantly less obstructive hypopneas and underestimation of OSA. These findings suggest a potential difference between the two testing methods for detecting pediatric OSA, but future studies comparing HSAT to PSG with larger cohorts are needed. Support (if any)
Journal of Clinical Sleep Medicine · 2025-03-07
articleShort-term and four-year feeding and respiratory outcomes of infants with micrognathia
Journal of Perinatology · 2025-04-12
articleOpen accessSenior authorOBJECTIVE: To describe feeding and respiratory outcomes at discharge and at the most recent follow-up visit prior to four years old in infants evaluated for micrognathia. STUDY DESIGN: Single-center retrospective analysis of 218 patients admitted and evaluated with congenital micrognathia during infancy. Outcomes were compared based on treatment (medical, mandibular distraction osteogenesis, or tracheostomy), and also compared based on syndromic status. RESULTS: Tube feeding was required by 81% of infants at discharge and 41% at follow-up. Respiratory support was required by 32% at discharge and 22% at follow-up. There were no differences in feeding and respiratory support at discharge and at follow-up between medical treatment and mandibular distraction osteogenesis. Tracheostomy was associated with more tube feeding and respiratory support at both discharge and at follow-up. Genetic syndromes were more likely to require tube feeding and respiratory support. CONCLUSION: Long-term feeding and respiratory support are common in infants hospitalized with micrognathia.
Performance of an automated sleep scoring approach for actigraphy data in children and adolescents
SLEEP · 2025-09-18 · 2 citations
articleOpen accessSTUDY OBJECTIVES: GGIR is an R package for processing raw acceleration data to estimate sleep health parameters. We aimed to (1) assess the performance of three sleep algorithms within GGIR against PSG for detecting sleep/wake in clinically referred, typically-developing children (criterion validity); and (2) describe GGIR-derived sleep estimates from typically developing children enrolled in multiple cohort studies (face validity). METHODS: For criterion evaluation, children (8-16 years, N = 30) wore an actigraphy device for one night during in-lab polysomnography with performance assessed using epoch-by-epoch analyses. For face validity evaluation, four community/free living datasets were used: (1) Bone Mineral Accretion in Young Children (3-5 years, N = 310), (2) School Summer Sleep (5-8 years, N = 118), (3) Sleep and Growth Study 2 (12-13 years; N = 291), and (4) Early Life Exposure to Environmental Toxicants (9-18 years; N = 543). All raw acceleration data were processed using GGIR (v.3.0-0) with the Cole-Kripke (CK), Sadeh (S), and van Hees (vH) algorithm settings. RESULTS: Following the in-lab test, 60 per cent of children were diagnosed with mild to severe obstructive sleep apnea (OSA). For criterion evaluation, the 30-s epoch-by-epoch analyses revealed that average balanced accuracies were 0.80 (Sensitivity = 0.80; Specificity = 0.79), 0.76 (Sensitivity = 0.86; Specificity = 0.65), and 0.67 (Sensitivity = 0.95, Specificity = 0.39) for GGIR-CK, GGIR-vH, and GGIR-S, respectively. For face validity evaluation, sleep estimates mirrored the in-lab performance metrics (e.g. sleep duration estimates were similar when using GGIR-CK and GGIR-VH but approximately 1 h longer when using GGIR-S). CONCLUSIONS: The in-lab performance metrics from typically developing children with and without OSA and cohort-based descriptive statistics from samples of typically developing children provide benchmark data to guide investigators on the suitability of GGIR for automated processing of raw acceleration data for pediatric sleep estimation.
POINT: Is Watchful Waiting an Appropriate Treatment for OSA in Children? Yes
CHEST Journal · 2025-03-01 · 1 citations
editorial1st authorSLEEP · 2025-05-01
articleOpen accessAbstract Introduction Congenital central hypoventilation syndrome(CCHS) is a rare disorder of autonomic nervous system dysregulation affecting control of breathing. Ten percent of cases result from non-polyalanine repeat expansion mutations(NPARM) of the paired-like homeobox 2B(PHOX2B) gene. NPARM are often associated with severe phenotypes, such as the need for invasive mechanical ventilation in the neonatal period, malignant neuroblastoma, and severe Hirschsprung’s disease. Children with NPARM with mild ventilatory abnormalities are rare. We present a case of a 4-year-old child with metastatic neuroblastoma, later diagnosed with CCHS, following acute respiratory failure after dinutuximab. Report of case A four-year-old full-term male with past history of congenital bilateral ptosis and metastatic neuroblastoma status post surgical resection was admitted for dinutuximab immunotherapy. During pathologic analysis of neuroblastoma, it was found to have NPARM of PHOX2B (c.691_698dup). Following dinutuximab infusion, he developed fever, pain requiring opioid medications, acute hypercarbic respiratory failure, and mental status change, initially concerning for iatrogenic oversedation related to opioids or infusion side effects. Laboratory results showed mild hyponatremia(135 mmol/L), hypokalemia(3.6 mmol/L), elevated bicarbonate(28 mmol/L). Venous blood gas showed acute respiratory acidosis with severe hypercarbia(pH 7.2, pCO2 113 mmHg). He required intubation and mechanical ventilation. Brain imaging revealed microhemorrhages in dorsal pons and thalamocapsular regions, but clinical significance was unclear. Electroencephalogram was normal. Infectious work up was negative. After extubation, diagnostic polysomnography was performed to evaluate control of breathing and revealed severe central sleep apnea(CAHI=100.2 events/hour), obstructive sleep apnea (OAHI=5.2 events/hour), and non-apneic hypoxemia(SpO2< 90% for 107 minutes) with no significant hypoventilation (TCO2>50 mmHg for 13% total sleep time). After starting 0.25L/min supplemental oxygen, CAHI improved to 31.2 events/hour, OAHI to 0.4 events/hour. Unfortunately, hypoventilation was induced with application of supplemental oxygen(TCO2>50 mmHg for 48% total sleep time), limiting further titration. He was discharged on supplemental oxygen pending further evaluation. Conclusion NPARM in PHOX2B are rare and typically result in severe hypoventilation during the neonatal period. This unique presentation of an older child with NPARM in PHOX2B, severe central sleep apnea but without hypoventilation, discovered subsequent to neuroblastoma evaluation. This case highlights there may be a broader spectrum of late-onset presentations of CCHS in children with NPARM in PHOX2b. Support (if any)
D49. Conservative Management of Macroglossia In Beckwith-Wiedemann Syndrome
Plastic & Reconstructive Surgery Global Open · 2025-05-01
articleOpen accessPURPOSE: While severe macroglossia in Beckwith-Wiedemann Syndrome (BWS) is often treated with tongue reduction surgery, most patients with mild to moderate macroglossia are non-surgically managed. Given that outcomes for these conservatively managed patients are not well characterized, this study aims to describe the natural history of patients with macroglossia and BWS who did not undergo early surgery. METHODS: Records of patients with BWS and macroglossia seen between 2004-2024 were reviewed. Conservative management was defined as not having had surgery during the first three years of life. Macroglossia was rated using the BWS index of macroglossia (BIG) scale to stratify phenotypic severity. Relationships among polysomnography data, surgical incidence, percentage mosaicism, and clinical scores were assessed. RESULTS: Three hundred twenty patients with BWS and macroglossia were included, 231 (72.2%) of whom were conservatively managed. As BIG scores increased from BIG1 (mild) to BIG2 (moderate) to BIG3 (severe), both obstructive sleep apnea (OSA) severity (p<0.001) and surgical incidence increased (p<0.001). Among conservatively managed patients, obstructive apnea-hypoxia index (OAHI) improved from 4.5 (interquartile range: 2.7-11.2) events/hour (age 0.4 (0.2-0.7) years) to 3.6 (1.3-6.1) events/hour (age 2.2 (1.7-2.6) years, p=0.025). BIG scores also improved in this cohort from 2.0 (1.0-2.0) at 0.8 (0.4-1.5) years of age to 1.0 (1.0-2.0) at 2.6 (2.2-3.7) years of age (p=0.019). CONCLUSION: Non-surgical management in the first three years of life for mild and moderate macroglossia in Beckwith-Wiedemann syndrome is associated with favorable outcomes. Obstructive sleep apnea and macroglossia often improve as the facial skeleton grows to accommodate the tongue.
Sleep problems in youth with WAGR syndrome
Sleep Medicine · 2025-02-17 · 1 citations
articleSenior authorCorrespondingJournal of Clinical Sleep Medicine · 2025-03-24 · 2 citations
articleSenior author
Recent grants
Mechanisms of obstructive sleep apnea syndrome in infants with micrognathia
NIH · $540k · 2018–2022
Frequent coauthors
- 106 shared
Ignacio E. Tapia
- 59 shared
Jesse A. Taylor
Children's Hospital of Philadelphia
- 45 shared
Melissa S. Xanthopoulos
Philadelphia University
- 44 shared
Carole L. Marcus
Children's Hospital of Philadelphia
- 25 shared
Jennifer M. Kalish
University of Pennsylvania
- 21 shared
Joel Traylor
Children's Hospital of Philadelphia
- 21 shared
Suzanne E. Beck
Children's Hospital of Philadelphia
- 21 shared
Ariel A. Williamson
Children's Hospital of Philadelphia
Labs
Sleep Core, Center for Human Phenomics SciencePI
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