Dr. Malhotra's clinical responsibilities include attending in the Medical Intensive Care Unit at Beth Israel Deconess Medical Center. Over the past two years, he has also attended in the Surgical Intensive Care Unit at Brigham and Women's Hospital and Medical Intensive Care Unit at Massachusetts General Hospital, and seen patients in the Interstitial Lung Disease Clinic in the Center for Chest Disease at BWH. He has also overseen the Pulmonary and Critical Care fellows in outpatient clinic, and seen patients in Sleep Clinic.
His teaching commitments include co-directing the HST 100 course in Respiratory Physiology and Pathophysiology, small group sessions for New Pathway students at Harvard Medical School, resident lectures at MGH and BIDMC approximately once per week, and lectures to the Pulmonary and Critical Care Fellows in the Harvard Combined Program on a weekly basis.
The broad goal of Dr. Malhotra's research is to study the biomechanics and neurophysiology of the upper airway in humans. Obstructive sleep apnea is a common condition, which is poorly understood despite substantial consequences. He is involved in a number of research projects which address the study of the anatomy and physiology of the upper airway and how these variables are influenced by aging, gender, and obesity. He is also in the process of developing a multivariate predictive model to predict apnea propensity on the basis of these measurements. By carefully studying a large number of individuals with and without apnea, he hopes to define the underlying mechanisms that predispose a given individual to the development of OSA. By determining the factor(s), which lead to apnea, his hope is that new therapeutic targets will emerge. Moreover, in collaboration with other members of his laboratory, he is developing animal and computational models to further define the role of specific variables and their influence on pathogenesis of obstructive sleep apnea.
Dr. Malhotra also participates in numerous other studies, which are seeking to determine the mechanisms governing pharyngeal patency during wakefulness, as well as to define the influence of sleep on these neuromuscular reflexes. He has recently completed a number of studies defining the influences of mechanoreceptive and chemoreceptive stimuli on pharyngeal muscle dilator activation. Recently, Dr. Malhotra has begun research involving the cardiovascular complications of sleep disorders, such as sleep apnea. He has received funding from Respironics Inc. to perform experiments designed to identify those mechanisms important in linking sleep disorders with cardiovascular diseases.
Most recently, Dr. Malhotra has been collaborating with Robert Kacmarek, PhD and Stephen H. Loring, MD to study various aspects of the Acute Respiratory Distress Syndrome. The studies include a randomized trial in humans to optimize ventilator settings based on lung and chest wall mechanics, as well as a series of studies in a sheep model of ARDS to study the impact of suctioning, recruitment, and manipulations in mechanical ventilator settings.
Dr. Malhotra has been funded by the National Institutes of Health (AG024837-01), American Heart Association (Beginner’s Grant in Aid and Scientific Development Grant), and Medical Research Council of Canada (Clinician Scientist Award).
Publications:
- Schwartz, D., Maroo, A., Malhotra, A., and Kesselman, H., Negative pressure pulmonary hemorrhage, Chest 1999, 115:1194-1198.
- Fogel R.B., Malhotra A., Shea S.A., Edwards J.K., White D.P. Reduced genioglossal activity with upper airway anesthesia in awake patients with OSA. J. Appl. Physiol. 2000, 88:1346-1354.
- Malhotra, A., Fogel, R., Edwards, J., Shea, S., and White, D.P., Local mechanisms drive pharyngeal muscle dilator activation in obstructive sleep apnea, Am. J. Respir. Crit. Care Med. 2000, 161: 1746-1749.
- Pillar, G., Malhotra, A., Edwards, J., Beauregard, J. Fogel, R., Shea, S. and White, D.P., Upper Airway Muscle Responsiveness To Rising PCO2 during NREM Sleep, J. Appl. Phys. 2000, 89:1275-1282.
- Malhotra, A., Pillar, G., Edwards, J., Beauregard, J., Fogel, R., and White, D.P., Upper airway collapsibility: measurement and sleep effects, Chest 2001, 120:156-161.
- Fisher, D., Pillar, G., Malhotra, A., Peled, N., Lavie, P., Long term follow-up of untreated patients with obstructive sleep apnea syndrome, Respir. Med. 2002, 96: 337-343.
- Pillar, G., Malhotra, A., Fogel, R., Beauregard, J., Schnall, R., White, D.P., Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender, Am. J. Respir. Crit. Care Med. 2000, 162: 1627-1632.
- Malhotra, A., Pillar, G., Fogel, R., Beauregard, J., Edwards, J.K., Slamowitz, D.I., Shea, S.A., White, D.P., Genioglossal but not palatal muscle activity relates closely to pharyngeal pressure, Am. J. Respir. Crit. Care Med. 2000, 162: 1058-1062.
- Hilton, M.F., Chappell, M.J., Bartlett, W.A., Malhotra, A., Beattie, J.M., and Cayton, R.M., The Sleep Apnea/Hypopnea Syndrome Depresses Waking Vagal Tone Independent of Sympathetic Activation, Eur. Respir. J. 2001, 17:1-9.
- Fogel, R.B., Malhotra, A., Pillar, G., Pittman, S.D., Dunaif, A., and White, D.P., Increased Prevalence of Obstructive Sleep Apnea Syndrome in Obese Women with Polycystic Ovary Syndrome, J. Clin. Endo. Met. 2001, 86: 1175-1180.
- Pillar, G., Fogel, R., Malhotra, A., Edwards, J., Beauregard, J., Shea, S.A., White, D.P., Genioglossal Inspiratory Activation: Central Respiratory versus Mechanoreceptive Influences, Respiration Physiology 2001, 127: 23-38.
- Malhotra, A., Pillar, G., Fogel, R., Beauregard, J., Edwards, J., Ayas, N., Hess, D., White, D.P., Pharyngeal Pressure and Flow Effects on Genioglossus Activation in Normal Subjects, Am. J. Respir. Crit. Care Med. 2002, 165:71-77.
- Pittman, S.D., Hill, P.D., Malhotra, A., Ayas, N., Fogel, R., White, D.P, Stabilizing Cheyne Stokes Respiration Associated with Congestive Heart Failure Using Computer-Assisted Positive Airway Pressure, Computers in Cardiology 2000, 27: 201-204.
- Pittman, S.D., Tal, N., Pillar, G., Malhotra, A., Hilton, M., Fogel, R., Ayas, N., White, D.P., Automated detection of obstructive sleep-disordered breathing events using peripheral arterial tonometry and oximetry, Computers in Cardiology 2000, 27:485-488.
- Fogel, R.B., Malhotra, A., Pillar, G., Edwards, J.K., Beauregard, J., Shea, S.A., and White, D.P., Genioglossal Activation in Patients with Obstructive Sleep Apnea versus Controls: Mechanisms of Muscle Control, Am. J. Respir. Crit. Care Med 2001, 164:2025-2030.
- Stanchina, M., Malhotra, A., Fogel, R., Edwards, JK, Schory, K, Ayas, N, White, DP, Genioglossal Muscle Responsiveness to Chemical and Mechanical Loading during NREM Sleep, Am. J. Respir. Crit. Care Med. 2002, 165: 945-949.
- Malhotra, A., Muse, V., Mark, E, Clinical Pathological Case: An 82 year old man with dyspnea and pulmonary abnormalities, New England Journal of Medicine 2003, 348:1574-1585.
- Ayas, N, White, DP, Manson, J., Stampfer, MJ, Speizer, FE, Malhotra, A., Hu, F., A Prospective Study of Sleep Duration and Coronary Heart Disease in Women, Archives of Internal Medicine 2003, 163:205-209.
- Patel, SR, White, DP, Malhotra, A., Stanchina, ML, Ayas, NT, Continuous Positive Airway Pressure Therapy for Treating Sleepiness in a Diverse Population With Obstructive Sleep Apnea: Results of a Meta-analysis, Archives of Internal Medicine 2003, 163:565-571.
- Karmpaliotis, D, Kosmidou, I, Ingenito, EP, Hong, K, Malhotra, A, Sunday, ME, Haley, KJ, Angiogenic Growth Factors in the Pathophysiology of a Murine Model of Acute Lung Injury, Am. J. Physiol. 2002, 283: L585-595.
- Snow, A., Gozal, E., Malhotra, A., Tiosano, D., Perlman, R., Vega, C., Shahar, E., Gozal, D., Hochberg, A., and Pillar, G., Severe hypersomnolence after pituitary/hypothalamic surgery in children: Clinical characteristics and potential mechanisms, Pediatrics 2002, 110/E74:1-6.
- Malhotra, A., Huang, Y., White, DP, Upper Airway Mechanics: Influence of Gender, Proc. 2nd Joint EMBS/BMES Conference 2002, p.1544-1545.
- Malhotra, A., Huang, Y., Fogel, R., Pillar, G., Kikinis, R., Loring, SH, White, DP, The Male Predisposition to Obstructive Sleep Apnea – Importance of Airway Length, Am. J. Respir. Crit. Care Med. 2002, 166: 1388-1395. (International Press Release by Reuters Health)
- Wellman, A., Malhotra, A., Fogel, RB, Edwards, JK, Schory, K., White, DP, Respiratory System Loop Gain in Normal Men and Women measured with Proportional Assist Ventilation, J. Appl. Physiol. 2003, 94: 205-212.
- Fogel, RB, Malhotra, A, Dalagiorgou, G, Robinson, M., Jakab, M., Kikinis, R., Pittman, SD, White, DP. Anatomic and Physiologic Predictors of Apnea Severity in Morbidly Obese Subjects, SLEEP 2003, 26:150-155.
- Pillar, G., Schuscheim, G., Weiss, R., Malhotra, A., McCowen, KC, Shlitner, A., Peled, N., Shehadeh, N., Interactions between hypoglycemia and sleep architecture in children with type 1 diabetes mellitus, J. Ped. 2003, 142: 163-168.
- Berry, RB, White, DP, Roper, J., Pillar, G., Fogel, RB, Stanchina, M, and Malhotra, A., Negative Pressure Reflex Response of the Genioglossus in OSA Patients and Normal Subjects, J. Appl. Physiol. 2003, 94: 1875-1882.
- Fogel, RB, Trinder, J., Malhotra, A., Stanchina, M, Edwards, JK, Schory, KE, and White, DP, Within Breath Control of Genioglossal Muscle Activation in Humans: Effect of Sleep Wake State, J. Physiol. 2003, 550.3: 899-910.
- Patel, SR, Karmpaliotis, D., Ayas, NT, Mark, EJ, Wain, J., Thompson, BT, and Malhotra, A., The Role of Open Lung Biopsy in the Acute Respiratory Distress Syndrome, Chest 2004, 125:197-202.
- Huang, Y., Malhotra, A., White, DP, A computational model of upper airway collapsibility, IEEE in press.
- Stanchina, ML, Malhotra, A, Fogel, RB, Trinder, J, Ayas, N., Edwards, JK, Schory, K. and White, DP, The Influence of Changing Lung Volumes on Upper Airway Mechanics and Genioglossus Muscle Activation during Sleep, SLEEP 2003, 26: 851-856.
- Fogel, R, White, DP, Pierce, R, Malhotra, A, Edwards, J., Dunai, J., Kleverlaan, D. Trinder, J., Control of Upper Airway Muscle Activity in younger vs older men during sleep onset, J. Physiol 2003, 553: 535-544.
- Ayas, NT, Patel, SR, Malhotra, A, Schulzer, M, Malhotra, M, Jung, D, Fleetham, J, White, DP, Auto-Titrating versus Standard Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea: Results of a Meta-analysis, SLEEP 2004, 27: 249-253.
- Pittman, SD, Ayas, NT, MacDonald, MM, Malhotra, A, Fogel, RB, White, DP, Diagnosing Obstructive Sleep Apnea with a Wrist-Worn Device Based on Peripheral Arterial Tonometry: In-Laboratory Polysomnographic Validation and Ambulatory Studies in the Home, SLEEP in press.
- Malhotra, A., Trinder, J., Fogel, R., Stanchina, M., Patel, S., Schory, K., Kleverlaan, D., White, DP, Postural Effects on Pharyngeal Protective Reflex Mechanisms, SLEEP, in press.
- Jordan, AS, Wellman, DA, Ranieri, JK, Schory, K, MacDonald, M, Fogel, RB, Malhotra, A, White, DP, Respiratory Control Stability in Men and Women with Obstructive Sleep Apnea, J. Appl. Physiol. in press.
- Jordan, AS, McEvoy, RD, Raneri, JK, Schory, K., Yang, C-K, Catcheside, PG, Fogel, RB, Malhotra, A., and White, DP, The Influence of Gender and Upper airway resistance on the Ventilatory response to arousal in obstructive sleep apnea, J. Physiol. (Lond), in press.
- Pittman, SD, MacDonald, MM, Fogel, RB, Malhotra, A., Todros, K, Levy, B, Geva, AB, White, DP, Assessment of Automated Scoring of Polysomnographic Recordings in a Population with Sleep Disordered Breathing, SLEEP, in press.
- Wellman, A, Jordan, AS, Malhotra, A, Fogel, R, Katz, E, Schory, K, Edwards, J, White, DP, Ventilatory control and airway anatomy in obstructive sleep apnea, Am. J. Respir. Crit. Care Med. 2004 in press.
Reviews, Chapters and Letters:
- Malhotra, A. and Kradin, R., The Pulmonary Immune Response to Asbestos, in Asbestos and Cancer (Eds. Peters, G. A. & Peters, B. J.), 1997.
- Malhotra, A., Schwartz, D. and Schwartzstein, R., Oxygen Toxicity, for UpToDate, 1998.
- Schwartz, D., Malhotra, A., and Fink, M., Cytopathic Hypoxia in Sepsis: an Overview, for Sepsis 2:279-289, 1999.
- Schwartz, D., Malhotra, A., and Weinberger, S., Pulmonary Embolus in Pregnancy, for UpToDate, 1999.
- Schwartz, D., Malhotra, A., Kacmarek, R., Prone Positioning in Acute Respiratory Distress Syndrome, for UpToDate, 2000.
- Malhotra, A., Ayas, N., Epstein, L., The Art and Science of Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnea, for Current Opinion in Pulmonary Disease 2000, 6: 490-495.
- McCowen, K., Malhotra, A., Bistrian, B., Stress-Induced Hyperglycemia, Critical Care Clinics 2001, 17: 107-124.
- Pillar, G., Malhotra, A., Lavie, P., Post Traumatic Stress Disorder and Sleep – What a Nightmare! , Sleep Medicine Reviews 2000, 4:183-200.
- Schwartz, D., Malhotra, A. and Fink, M., Cytopathic Hypoxia in Septic Shock, for Advances in Structural Biology, Jai Press 2000, 6:65-82.
- Malhotra, A. and White, D. P., The Pathogenesis of Obstructive Sleep Apnea, book chapter in Breathing Disorders in Sleep (Eds. McNicholas, W. and Phillipson, E.), 2002, 44-64.
- Malhotra, A. and Schwartz, D., Lung Cancer, for Respiratory Care: Principles and Practice (Eds. Hess, D, MacIntyre, N., Saposnick et al.), 2002, 1151-1167.
- Malhotra, A., Fogel, R., White, D.P., Disorders of Excessive Sleepiness, for Neurological Therapeutics: Principles and Practice, Martin Dunitz Publishers, (Ed. Burgess, A.), in press.
- Malhotra, A., Fogel, R., Pillar, G., and Winkelman, J., Non-pulmonary Aspects of Sleep Medicine, for Pulmonary and Critical Care Update (PCCU), American College of Chest Physicians, 1999.
- Sabatine, M., Malhotra, A., and Systrom, D.M., Pulmonary Disease section for handbook, Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine, (Ed. Sabatine, MS), Lippincot Williams and Wilkins, 2000, 2-1 to 2-21.
- Ayas, N., Malhotra, A., and Epstein, L., Alternative Therapies for Sleep Apnea, in Drugs Today, 1999, 35: 811-821.
- Schwartz, D., Malhotra, A., Fink, M., Microcirculatory weak units- an alternative explanation, Critical Care Medicine 2000, 28: 3127-3129.
- Malhotra, A., Schwartz, D., Ayas, N., Stanchina, M., White, DP, The Treatment of Oxygen Induced Hypercarbia, The Lancet 2001, 357: 884-885.
- Stanchina, M, Patel, S, Malhotra, A, The Answer Page, web-based learning tool, wrote 20 sections on various respiratory and critical care physiology topics
- Malhotra, A., Ayas, N., Kacmarek, R., Prone positioning of patients in acute respiratory failure, New England Journal of Medicine 2002, 346: 295-297.
- Malhotra, A. and White, DP, Seminar: Obstructive Sleep Apnea Syndrome, The Lancet, 2002, 360: 237-245.
- Lavie, P, Pillar, G., Malhotra, A., Sleep disorders: diagnosis, management and treatment, Martin Dunitz Publishers, 2002, (185 page book).
- Stanchina, M, Malhotra, A., White, DP, An Evidenced Based Review of the Diagnosis and Treatment of Respiratory Disorders of Sleep, book chapter in Crapo and King, in press.
- Fogel, RB, Malhotra, A, White, DP, The Pathophysiology of Obstructive Sleep Apnea, commissioned review for Thorax, 2004, 59:159-163.
- Wellman, DA, Malhotra, A., White, DP, Atrial Pacing in Sleep Apnea Syndrome, New Engl. J. Med. 2002, 337:445-446.
- Murthy, A and Malhotra, A., Invited Commentary on the Utility of Recruitment Maneuvers in Acute Respiratory Distress Syndrome, Journal Club of the Assembly on Critical Care of the American Thoracic Society, April 2002. (www.thoracic.org/assemblies/cc/ccjcframe.html)
- Patel, SR, Harris, RS, and Malhotra, A, Comment on Dead Space and Mortality New Engl. J. Med. 2002, 347: 850-852.
- McCowen, KC and Malhotra, A, The correlation between obstructive sleep apnea and low gonadotropin secretion in men, Sleep Medicine 2003, 4:83-84.
- Murthy, A and Malhotra, A., Invited Commentary on the Use of High Frequency Oscillation in the Acute Respiratory Distress Syndrome, Journal Club of the Assembly on Critical Care of the American Thoracic Society, November 2002. (www.thoracic.org/assemblies/cc/ccjcframe.html)
- Murthy, A and Malhotra, A., Invited Commentary on the Resolution of Ventilator Associated Pneumonia, Journal Club of the Assembly on Critical Care of the American Thoracic Society, April 2003. (www.thoracic.org/assemblies/cc/ccjcframe.html)
- Carden, KA and Malhotra, A., The debate about gender differences in obstructive sleep apnea, Sleep Medicine 2003, 4: 485-487.
- Malhotra, A, Berry, R, White, DP, Central Sleep Apnea, chapter in Sleep Medicine (Lipincott), in press.
- Murthy, A and Malhotra, A., Cyclic Changes in Arterial Pulse during Respiratory Support Revisited by Doppler Echocardiography, Journal Club of the Assembly on Critical Care of the American Thoracic Society, October 2003. (www.thoracic.org/assemblies/cc/ccjcframe.html).
- Bajwa, E., Malhotra, A., Thompson, T., Monitoring of the Patient in Septic Shock, Seminars in Respiratory and Critical Care Medicine, 2004, in press.
- Murthy, A and Malhotra, A., The impact of intravenous fat emulsion administration in acute lung injury, Journal Club of the Assembly on Critical Care of the American Thoracic Society, March 2004. (www.thoracic.org/assemblies/cc/ccjcframe.html).
- Bajwa, E, Mouded, M, Systrom, DM, Malhotra, A., Pulmonary Disease section for handbook, Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine, (Ed. Sabatine, MS), Lippincot Williams and Wilkins, 2004, second edition.
- Pillar, G., Harder, L, Malhotra, A, Trauma and Post-traumatic Stress Disorder, for Encyclopedia of Sleep Medicine, John Wiley and Sons, in press.
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