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Dr. Groenewald is Director of Pediatric Anesthesiology Research at Stanford University School of Medicine. He conducts clinical research that crosses several areas related to child health, including epidemiology, health services research, pediatric pain, sleep deficiency, and opioid use behaviors. His research is funded by the National Institutes of Health, International Association for the Study of Pain, and the Society for Pediatric Anesthesiology. His work on pediatric pain, sleep disturbance, and opioid use has been published in JAMA Pediatrics, Pediatrics, PAIN, Journal of Pain, SLEEP, and JAMA Psychiatry. Dr. Groenewald holds national leadership positions in the United States Association for the Study of Pain, including being elected as inaugural Chair of the Pediatric Special Interest Group in 2020 and co-chair of the Advocacy committee in 2022. He serves on the editorial boards of the Journal of Pain and Pediatric Anesthesiology.
Annually 250,000 critically ill children are admitted to 350 pediatric intensive care units (ICUs) in the United States. Most (>97%) survive, however many critical illness survivors suffer significant long-term health impairments that result in lower quality of life (HRQL) and increased health care use. Acute sleep deficiency is common following critical illness. However, limited knowledge exists of the potential impact of deficient sleep on markers of health following critical illness such as physical and mental health, HRQL, or health services utilization. Thus, the primary objective of this proposal is to systematically document for the first time the impact of sleep deficiency on health, quality of life, and health care utilization in children surviving critical illness. The central hypothesis is that sleep deficiency persist and negatively impact health following critical illness.The research plan involves 2 studies: 1) a prospective cohort study using objective and subjective measures of sleep over 12 months in children with critical illness and controls (80=critically ill and 40=age and sex matched controls)(study 1), and 2) a qualitative study to understand child and parent perspectives on managing sleep deficiency following critical illness (study 2). Primary aims are to 1) characterize the nature, trajectories, and impact of sleep deficiency experienced by children following critical illness (study 1), 2) identify risk factors associated with persistent sleep deficiency over 12 months in children following critical illness (study 1), and 3) identify, directly from children and their parents, perspectives on the barriers and facilitators of implementing interventions to manage sleep deficiency following critical illness (study 2).
Prescription opioid misuse is a significant burden on adolescent public health in the United States. Opioid misuse often starts with prescribed opioids, with surgery representing a key pathway by which adolescents are first prescribed opioids for the management of acute pain. Yet, little is known about the critical period following surgery during which adolescents initiate prescription opioid misuse or the modifiable behavioral mechanisms contributing to this process. These are critical gaps in our knowledge impeding our ability to identify adolescents at increased risk for opioid misuse and to develop interventions aimed at reducing prescription opioid misuse. Sleep deficiency (including sleep deprivation, noncircadian sleep, sleep disorders, and poor sleep quality) is an important proximal risk factor for prescription opioid misuse. Sleep is often disturbed during the perioperative period, a time when many adolescents are exposed to their first opioid prescription. Indeed, in our own preliminary study, we found that sleep deficiency present both before surgery and during the immediate postsurgical period was associated with increased opioid use. However, this pilot study did not allow us to characterize aspects of sleep most strongly related to opioid use and did not allow us to evaluate mechanisms, such as pain and psychological factors, underlying the sleep – opioid use relationship. Furthermore, data are urgently needed to determine how sleep deficiency prospectively predicts the development of opioid misuse behaviors in the context of other putative factors, such as a history of substance use, pain intensity, psychosocial (e.g., depression), peer, and family factors. Given that sleep deficiency is modifiable, it is a critical focus of research aimed at reducing the development of adolescent opioid misuse behaviors. Therefore, this project aims to 1) test the direct and mediation pathways of sleep deficiency, pain, psychological factors, and opioid use following sports-injury surgery, and 2) develop and validate a multivariable prediction model to identify adolescents at increased risk of prescription opioid misuse over the 24 months following surgery. To address these aims, we propose a prospective, observational study of N= 400 adolescents (10-19 years) who receive their first ever opioid following sports injury surgery. Presurgery, participants will undergo comprehensive multimodal sleep assessments (surveys and actigraphy monitoring) to measure sleep deficiency. Participants will also report on previous substance use, pain intensity, psychosocial, peer, and family factors. Adolescents will then be followed over the first 14 days after surgery using ecological momentary assessment to capture real-time daily data on sleep, pain, psychological factors, and opioid use. We will use an innovative electronic medication monitoring methodology to accurately measure opioid use (total number of doses and duration) following surgery. Follow-up assessments at 3-months, 6-months, 12- months, and 24-months will track opioid misuse developing over time. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse.