Christopher Cielo, DO, joined the Division of Pulmonary and Sleep Medicine at Children’s Hospital of Philadelphia (CHOP) in 2010 and is an attending pulmonologist.
Dr. Cielo earned his DO (doctor of osteopathic medicine) at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (now called Rowan-Virtua School of Osteopathic Medicine). Following his residency in Pediatrics at St. Christopher's Hospital for Children, he completed a combined fellowship in both Pulmonary and Sleep Medicine at CHOP.
How did you end up attending an osteopathic medical school?
Growing up, I was inspired early on by the holistic approach that osteopathic medicine takes, and as a young college student, I had some family friends who had DO degrees and were outstanding clinicians. They mainly were in family practice but were really inspiring in terms of the care and compassion they showed for patients across the age spectrum. I thought they were great role models in terms of being good listeners to their patients and providing compassionate care. At the time, I thought I was probably going to go into family practice or maybe general pediatrics and not do anything specialized. I felt like that was going to be a great experience in terms of training, and it was. I was actually classmates with Maureen Josephson, who now directs the CHOP Heart/Lung Transplant Program.
What was your pathway into pediatric pulmonology?
I did my residency at St. Christopher's Hospital for Children and had the opportunity in my first year to do a rotation in the pediatric intensive care unit, which was unusual as a first-year resident. I loved the physiology of the ICU, including the ventilator management and the fact that you're helping the sickest patients in the hospital. I initially thought I would pursue critical care medicine, but then I realized the rewards of following patients longitudinally and getting to work with those families over time. That's where pulmonology became an early fit because I could spend some time in the intensive care unit and the clinic.
Because I made that decision in my second year of residency, I had missed the application for pulmonary fellowship, which meant I would have a gap year. That opened up the opportunity to do a sleep fellowship that year. And sleep medicine ultimately became the focus of what I do.
What is new at the Sleep Center?
We’ve seen tremendous growth in terms of the research program, the clinical program and our training programs. From a clinical standpoint, there's a huge demand for patients to be evaluated, both in our sleep laboratory and in our interdisciplinary clinic, and we are working on an overall expansion of the Sleep Center to meet the growing needs of patients.
Our research programs have grown to be among the largest across the country, and we are working on forging new collaborations across CHOP and Penn, as well as working with trainees and our own interdisciplinary team. For example, members of our team had a study published a couple of years ago that evaluated the efficacy of CPAP in infants from our program. This was the largest study to assess the effectiveness of using CPAP to treat obstructive sleep apnea in infants and the first study to provide systematic objective adherence and parent-reported barriers to adherence in infants.
What is the CHOP Sleep Center’s approach to patient care?
We have a unique interdisciplinary team approach that allows us to talk with families and figure out the issue they're dealing with and then address it holistically. The psychologist may take the lead if it's a behavioral sleep issue. If it's a medical issue, the physician may take the lead. Other patients benefit from a combination of both. Our CPAP program, a leader in the field, is also interdisciplinary and includes psychology, nursing, respiratory care and nurse practitioners in addition to physicians.
We're here to meet the needs of patients across the whole spectrum of pediatric sleep health. I see a lot of craniofacial patients from infancy through teenage and adolescent years. It's interesting how they may come to us initially with medical issues, but then more behavioral sleep issues may develop later on.
For example, if a patient is having trouble falling or staying asleep, our initial approach – even in kids with developmental differences or autism – is typically to try to make changes in their sleep habits or the timing of when they go to sleep or wake up. Patients with medical issues like sleep apnea or insomnia may need an evaluation in the sleep laboratory or a referral to one of our surgical colleagues in otolaryngology or craniofacial surgery.
We know some families come to our clinic because when the child isn’t sleeping, the parents aren’t sleeping. Our treatment plans address that routinely because we want to make sure we give recommendations that are feasible within the family’s structure.
Tell us about your research related to obstructive sleep apnea.
My research program focuses on the evaluation, management and consequences of obstructive sleep apnea in children. Some of my earlier work looked at infants with Robin sequence who have micrognathia, a congenital condition where they're born with an underdeveloped lower jaw. Those babies are at particular risk for obstructive sleep apnea and sometimes require interventions like surgery during the neonatal period to treat it. That project allowed me to form and strengthen collaborations with CHOP’s Craniofacial Center and with some imaging researchers. It also allowed me to follow babies born with that condition and a group of healthy infants we also studied as part of my K23 project.
More recently, I've been focused on home sleep apnea testing in children. One of the problems we face is that the demand for sleep apnea testing exceeds our testing capacity. We have long wait times to get into the sleep lab, something that's being seen across the country. In adult sleep medicine, they've moved to doing a lot of these tests in the home environment. Especially for families with multiple children, it may be more convenient to do their child’s test at home.
I'm directing two clinical trials right now, one funded by National Institutes of Health and one by a foundation, to compare this home sleep test with in-lab polysomnography, which is the gold standard. I’m also the vice chair of an American Academy of Sleep Medicine committee that is revisiting the guidelines for home sleep apnea testing in children.
Are there any diagnostic developments?
We are exploring some other tests and looking at using different imaging techniques, such as 3D photography, to help with diagnostics. It works by taking some photographs of a patient's face, and a computer stitches them together to create a 3D model. You can use information from that model, for example, to create a custom CPAP mask.
Some other work that we're just starting builds on prior MRI work to get a better understanding of how some of the facial features in typically developing kids or those with different craniofacial conditions might influence whether they have sleep apnea and whether they're candidates for specific tests or different treatments.
As another diagnostic approach, our ENT colleagues are starting to use drug-induced sleep endoscopy in the operating room, where they look at the patient's airway to try to determine what might cause the obstruction to help decide the therapies.
We take a holistic look at it: “Is there something we could use?” For example, is there photography or imaging we might already have of the patient from a research study — like a CT or MRI? We look at all the different possible evaluations you could use, the clinical assessment and the questionnaires we ask patients in clinic or in the primary care office.
What do you do for fun outside of work?
I have three kids who are school-age right now and involved in many different activities, and they keep my wife and me very busy. We like traveling as a family. I like watching live music of any kind and cooking and gardening. But my kids, I would say, take up most of whatever free time I have left, which is great.