Bio

Clinical Focus


  • Sleep Medicine
  • Pediatric Pulmonary
  • Pulmonary Medicine/Cystic Fibrosis, Pediatric

Academic Appointments


Professional Education


  • Board Certification: Pediatric Pulmonary, American Board of Pediatrics (2004)
  • Board Certification: Pediatrics, American Board of Pediatrics (1999)
  • Residency:Kaiser Foundation Hospital-Oakland (1999) CA
  • Internship:Kaiser Foundation Hospital-Oakland (1997) CA
  • Board Certification: Sleep Medicine, American Board of Pediatrics (2009)
  • Board Certification, Sleep Medicine, American Board of Sleep Medicine (2005)
  • Fellowship:Children's Hospital of Los Angeles (2003) CA
  • Medical Education:Hahnemann University Hospital (1996) PA

Research & Scholarship

Current Research and Scholarly Interests


My research interests are concentrated on the pulmonary complications due to neuromuscular disease, cerebral palsy/hypertonicity, scoliosis, and sleep disorders in the pediatric population.

Clinical Trials


  • The EPIC Observational Study Not Recruiting

    The purpose of this study is to better define risk factors preceding first isolation of Pseudomonas aeruginosa (Pa) from respiratory cultures in cystic fibrosis (CF) lung disease and to better define clinical outcomes associated with acquisition of Pa. This study will also collect and bank DNA samples for current and future studies designed to enhance the understanding of the pathogenesis of CF.

    Stanford is currently not accepting patients for this trial. For more information, please contact Colleen Dunn, (650) 736 - 0388.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Effects of noninvasive ventilation on sleep outcomes in amyotrophic lateral sclerosis. Journal of clinical sleep medicine Katzberg, H. D., Selegiman, A., Guion, L., Yuan, N., Cho, S. C., Katz, J. S., Miller, R. G., So, Y. T. 2013; 9 (4): 345-351

    Abstract

    The objective was to study the effects on noninvasive ventilation on sleep outcomes in patient with ALS, specifically oxygenation and overall sleep quality.Patients with ALS who met criteria for initiation of NIV were studied with a series of 2 home PSG studies, one without NIV and a follow-up study while using NIV. Primary outcome was a change in the maximum overnight oxygen saturation; secondary outcomes included change in mean overnight oxygen saturation, apnea and hypopnea indexes, sleep latency, sleep efficiency, sleep arousals, and sleep architecture.A total of 94 patients with ALS were screened for eligibility; 15 were enrolled; and 12 completed study procedures. Maximum overnight oxygen saturation improved by 7.0% (p = 0.01) and by 6.7% during REM sleep (p = 0.02) with NIV. Time spent below 90% oxygen saturation was also significant-ly better with NIV (30% vs 19%, p < 0.01), and there was trend for improvement in mean overnight saturation (1.5%, p = 0.06). Apnea index (3.7 to 0.7), hypopnea index (6.2 to 5.7), and apnea hypopnea index (9.8 to 6.3) did not significantly improve after introducing NIV. NIV had no effect on sleep efficiency (mean change 10%), arousal index (7 to 12), or sleep stage distribution (Friedman chi-squared = 0.40).NIV improved oxygenation but showed no significant effects on sleep efficiency, sleep arousals, restful sleep, or sleep architecture. The net impact of these changes for patients deserves further study in a larger group of ALS patients.

    View details for DOI 10.5664/jcsm.2586

    View details for PubMedID 23585750

  • Neuromuscular disease and the pulmonologist CURRENT OPINION IN PEDIATRICS Yuan, N. 2012; 24 (3): 336-343

    Abstract

    The heterogeneous nature of neuromuscular disorders (NMDs) continues to promote slow but steady advances in diagnosis, classification, and treatment. This review focuses on the updates in the general management and treatment of NMDs, with emphasis on key updates in muscular dystrophy, myotonic dystrophy, mitochondrial myopathy, spinal muscular atrophy, and hereditary neuropathies.Current research shows that improvements in morbidity and mortality in various NMDs may be possible. Key components include advances in identification and classification of individual NMDs; attention to anesthetic and surgical risks; aggressive pulmonary care; and implementations of a proactive, multidisciplinary, standard-of-care approach. Innovative molecular and pharmaceutical therapeutic options are being investigated in many of these disorders, but unfortunately no new intervention has borne out.Important advances were made in the last year in the field of neuromuscular disease. However, because of their heterogeneous nature and rarity, diagnosis and treatment of these disorders either as a single disorder or as a group continue to be both a clinical and a research challenge. It is of utmost importance that clinicians and researchers be aware of these disorders to aid in identification and treatment.

    View details for DOI 10.1097/MOP.0b013e3283531bb0

    View details for Web of Science ID 000303910700009

    View details for PubMedID 22498673

  • Consensus Statement on Standard of Care for Congenital Myopathies JOURNAL OF CHILD NEUROLOGY Wang, C. H., Dowling, J. J., North, K., Schroth, M. K., Sejersen, T., Shapiro, F., Bellini, J., Weiss, H., Guillet, M., Amburgey, K., Apkon, S., Bertini, E., Bonnemann, C., Clarke, N., Connolly, A. M., Estournet-Mathiaud, B., Fitzgerald, D., Florence, J. M., Gee, R., Gurgel-Giannetti, J., Glanzman, A. M., Hofmeister, B., Jungbluth, H., Koumbourlis, A. C., Laing, N. G., Main, M., Morrison, L. A., Munns, C., Rose, K., Schuler, P. M., Sewry, C., Storhaug, K., Vainzof, M., Yuan, N. 2012; 27 (3): 363-382

    Abstract

    Recent progress in scientific research has facilitated accurate genetic and neuropathological diagnosis of congenital myopathies. However, given their relatively low incidence, congenital myopathies remain unfamiliar to the majority of care providers, and the levels of patient care are extremely variable. This consensus statement aims to provide care guidelines for congenital myopathies. The International Standard of Care Committee for Congenital Myopathies worked through frequent e-mail correspondences, periodic conference calls, 2 rounds of online surveys, and a 3-day workshop to achieve a consensus for diagnostic and clinical care recommendations. The committee includes 59 members from 10 medical disciplines. They are organized into 5 working groups: genetics/diagnosis, neurology, pulmonology, gastroenterology/nutrition/speech/oral care, and orthopedics/rehabilitation. In each care area the authors summarize the committee's recommendations for symptom assessments and therapeutic interventions. It is the committee's goal that through these recommendations, patients with congenital myopathies will receive optimal care and improve their disease outcome.

    View details for DOI 10.1177/0883073812436605

    View details for Web of Science ID 000301794400011

    View details for PubMedID 22431881

  • Safety, Tolerability, and Efficacy of High-Frequency Chest Wall Oscillation in Pediatric Patients With Cerebral Palsy and Neuromuscular Diseases: An Exploratory Randomized Controlled Trial JOURNAL OF CHILD NEUROLOGY Yuan, N., Kane, P., Shelton, K., Matel, J., Becker, B. C., Moss, R. B. 2010; 25 (7): 815-821

    Abstract

    Airway secretions and infections are common in cerebral palsy and neuromuscular diseases. Chest physiotherapy is standard therapy but effort is substantial. High-frequency chest wall oscillation is used in cystic fibrosis but tolerability and safety data in cerebral palsy and neuromuscular disease are limited. A prospective, randomized, controlled trial of high-frequency chest wall oscillation and standard chest physiotherapy was performed in participants with neuromuscular disease or cerebral palsy. Outcome measures included respiratory-related hospitalizations, antibiotic therapy, chest radiographs, and polysomnography. Care-givers were questioned regarding therapy adherence. A total of 28 participants enrolled, 23 completed (12 chest physiotherapy, mean study period 5 months). No adverse outcomes were reported. Adherence to prescribed regimen was higher with high-frequency chest wall oscillation (P = .036). Our data suggest safety, tolerability, and better compliance with high-frequency chest wall oscillation. Improvement in airway clearance may help prevent hospitalizations. Larger controlled trials are required to confirm these results.

    View details for DOI 10.1177/0883073809350223

    View details for Web of Science ID 000279409100002

    View details for PubMedID 20357238

  • Successful pregnancy and cesarean delivery via noninvasive ventilation in mitochondrial myopathy JOURNAL OF PERINATOLOGY Yuan, N., El-Sayed, Y. Y., Ruoss, S. J., Riley, E., Enns, G. M., Robinson, T. E. 2009; 29 (2): 166-167

    Abstract

    We report a case study of a 22-year-old woman with mitochondrial thymidine kinase 2 deficiency and chronic respiratory failure due to severe neuromuscular weakness requiring noninvasive positive pressure ventilation (NIPPV) since 12 years of age. During pregnancy and cesarean delivery, she was successfully supported with NIPPV. A multidisciplinary team approach should be used in pregnant patients with these disorders with specific attention to management of pulmonary complications, selection of route of delivery, anesthesia, and analgesia.

    View details for DOI 10.1038/jp.2008.178

    View details for Web of Science ID 000263492700016

    View details for PubMedID 19177045

  • Laparoscopic Nissen fundoplication during gastrostomy tube placement and noninvasive ventilation may improve survival in type I and severe type II spinal muscular atrophy JOURNAL OF CHILD NEUROLOGY Yuan, N., Wang, C. H., Trela, A., Albanese, C. T. 2007; 22 (6): 727-731

    Abstract

    Progressive respiratory muscle weakness with bulbar involvement is the main cause of morbidity and mortality in type I and severe type II spinal muscular atrophy. Noninvasive positive pressure ventilation techniques coupled with laparoscopic gastrointestinal procedures may allow for improved morbidity and mortality. The authors present a series of 7 spinal muscular atrophy patients (6 type I and 1 severe type II) who successfully underwent laparoscopic gastrostomy tube insertion coupled with Nissen fundoplication and early postoperative extubation using noninvasive positive pressure ventilation techniques. The authors measured the length of survival and the frequencies of pneumonia and hospitalization before and after surgery as outcomes of these new surgical and medical interventions. All 7 patients had respiratory symptoms (unmanageable oropharyngeal secretions, cough, pneumonia), difficulty feeding, and weight loss. Six patients had documented reflux via diagnostic testing preoperatively. Five patients were on noninvasive positive pressure ventilation and other supportive respiratory therapies prior to surgery. All 7 patients survived the procedures. By August 2006, 5 patients with type I and 1 with severe type II spinal muscular atrophy were alive and medically stable at home 1.5 months to 41 months post-op. One patient with type I expired approximately 5 months post-op due to obstructive apnea. This case series demonstrates that laparoscopic gastrostomy tube placement coupled with Nissen fundoplication and noninvasive positive pressure ventilation can be successfully used as a treatment option to allow for early postoperative extubation and to optimize quality of life in type I and severe type II spinal muscular atrophy patients.

    View details for DOI 10.1177/0883073807304009

    View details for Web of Science ID 000247892900007

    View details for PubMedID 17641258

  • PreOperative Predictors of Prolonged Post-Operative Mechanical Ventilation in Children Following Scoliosis Repair Pediatr. Pulmonol Nanci Yuan, D.L. Skaggs, T.G. Keens 2005; 40 (5): 414-419
  • The Effect of Scoliosis Surgery on Lung Function in the Immediate Post-operative Period. SPINE Nanci Yuan, J.A. Fraire, M.M. Margetis, D.L. Skaggs, V.L. Tolo, T.G. Keens 2005; October
  • Pre-Operative Polysomnograms and Infant Pulmonary Function Tests Do Not Predict Prolonged Post-Operative Mechanical Ventilation in Children Following Scoliosis Repair. Pediatric Pulmonology Nanci Yuan, D.L. Skaggs, S.L. Davidson Ward, A.C.G. Platzker, T.G. Keens 2004; 38 (3): 256-60

Conference Proceedings


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