Kamal Naqvi, MD, Laloria Mobley, and Larry Brewer (pictured left to right) are leading the way in treating teenagers with sleep disorders.

Any parent knows that teenagers today live in a supersaturated environment, mixing demanding schedules at school with friends and family, computers, television, iPods, and more. No wonder so many high-schoolers suffer from sleep problems at a time in their lives when they require substantial rest.

The under-18 population in suburban north Dallas is expected to grow faster than the national average and is anticipated to dramatically increase within the next 10 years. That’s why the Sleep Disorders Center at Children’s Medical Center Dallas, which is affiliated with the University of Texas Southwestern Medical Center, is expanding its reach. The main branch, which has been open since 1987, was renovated in 2006 to upgrade its diagnostic equipment and again in 2007 to make it feel more like an outpatient facility. And a new branch opened just a few months ago in Plano, where Children’s Medical Center Legacy is under construction.

Children and teenagers are plagued with just as many sleep problems as adults, though clinical manager Larry Brewer notes that many of his center’s patients have a sleep disorder not as a primary condition but rather as a result of an existing illness, which makes collaborating with academic specialists essential to improving patient outcomes.

“Most often, pediatric patients have sleep disorders because they have other problems—pulmonary disease, neuromuscular disease, large tonsils,” Brewer explains. “We work really closely with a certain number of specialists, neurologists, pulmonologists, cardiologists. Doctors are becoming more aware of the relationship between their patients’ health and their sleep.”

The main branch of the Sleep Disorders Center boasts 15 employees, including three sleep specialists, and has four dedicated beds; the new Plano facility has three dedicated beds. The two treat the same patient population, Brewer says, exept for acutely ill patients, who are treated at Children’s Dallas on an inpatient basis. “We see infants down to 28 weeks to teenagers up to the age of 18, and where we’ll see them depends on whether we need to see them in an inpatient or outpatient way,” he says.

UP TO THE CHALLENGE

Treating such a wide age range comes with inherent clinical challenges. “No specialty other than pediatrics can prepare you to deal with different ages,” notes Kamal Naqvi, MD, medical director of the Sleep Disorders Center and assistant professor of pediatrics at UT Southwestern Medical Center. “It’s a unique training because you grow with your children. The sleep conditions that children have, and that includes teenagers, are evaluated differently compared to adults. You can’t use the adult criteria and norms for children less than 18 years of age. Diagnosing sleep apnea in an adult takes a different set of parameters than diagnosing the condition in a teenager or a younger child.”

Having the right staff is critical. The team of technicians in the lab needs to be trained in dealing with children and teenagers, and should be more flexible when dealing with their issues than they would be working with adults, according to Naqvi. No one knows the meaning of those words better than Laloria Mobley.

“Working with younger children is challenging,” reiterates Mobley, a sleep technologist who has been with Children’s a little more than a year. Prior to joining the team at the Sleep Disorders Center, Mobley worked at an adult sleep lab, but when the youngest of her two children developed sleep problems, she became interested in pediatric sleep centers. “They’re in a hospital setting and they’re dealing with pain, so sometimes it can be a little difficult.

“Working with teenagers is pretty interesting,” she continues. “They have a lot of questions. For any technician coming into pediatrics, it’s going to take a lot of patience. A lot of technicians actually fear going into pediatrics.” The secret, according to Mobley? “You have to really know your stuff.”

The patient load is much larger at the Sleep Disorders Center than at the adult facilities Mobley has worked for in the past. “We see a lot of kids here,” she says, “and several of these kids come back two to three times. Last night, we had a patient that I ran back in May. The parents feel really good when they see a familiar face, and I really like that.”

The center offers inpatient and outpatient sleep studies for issues ranging from pulmonary or neuromuscular disease to craniofacial sleep disorders to nascent narcolepsy. But what the staff at the Sleep Disorders Center primarily sees is sleep apnea and narcolepsy, especially in teens. “For teens, there are a number of issues,” says Naqvi. “We frequently see that they don’t sleep enough. They have so many things to do, school and parents and friends and technology. They have so many gadgets to deal with, phones, Internet, television, music, and they have it all in the bedroom, so parents don’t even know when they’re awake or why. And then there are some other issues that are even more organic.”

The number one culprit in that category, unsurprisingly, is obesity. “Obesity causes a lot of disrupted sleep and disordered breathing, including sleep apnea,” Naqvi says. So collaborating with the parents becomes critical, because they generally control their households’ dietary choices. “Whatever Mom brings home from the store is what the teenager is going to consume. If she’s not doing smart shopping, you can’t blame the teenager.”

Parents also play a crucial role in making sure children and teenagers make the necessary lifestyle changes to combat sleep disorders. “Whenever we see patients, we have one of the parents with the child, and that helps, of course,” Naqvi says. “We discuss all of the issues with them and tell them how to cope with the problem at home, how to monitor their kids, how to make changes in their environment. Parents play the most important role because what we deal with in children is directly related to parents.”

From left, Diana Palmer, a polysomnographic technician, prepares 13-year-old Savannah Steed for a sleep study. Another polysomnographic technician, Melanie Steed, assists.

Working with teenagers is one of the principal nonclinical challenges of treating the pediatric population, Naqvi notes. “Teenagers are, of course, very different from children,” he says. “They’re difficult. They deal with problems they don’t know how to express or don’t want to express. Sometimes they don’t even complain. They think that it’s not right to tell others about their problems because they’re invincible. They think they’re above the world.”

That degree of stubbornness leads to unique difficulties in the lab. “There are teenagers who go to bed late, past midnight, and when you do a sleep study in the lab, you have to let them fall asleep at the time that’s normal for them,” Naqvi says. “They’re a specific group of patients with different sleep habits, and have to be treated differently. To gain confidence and cooperation, you have to use different techniques.”

Occasionally working with teens comes with staffing challenges as well, Mobley says. “Especially with teenage girls and changing bodies, and even with teenage boys, they can be kind of particular about whether they have a male or female technologist,” she says. “I make sure we’re balancing out on staffing.”

FUTURE GOALS

The Sleep Disorders Center’s immediate goal is expansion, says Brewer. The facility in Dallas currently runs 6 nights a week, while its younger sibling in Plano runs 3 nights a week. “By July 2008, we want to see that location running 6 nights a week, and then we’ll probably consider another site in the Dallas-Ft Worth area,” he says. “There are other facilities in the area doing pediatric sleep studies, but if the patient has an acute illness and they can’t handle it, many times they’ll refer over to us. We do have to compete, but we made up this term ‘coop-tition,’ cooperative competition. The ultimate goal in the community is to increase awareness and improve care.”

Cat Vasko is a contributing writer for Sleep Review. She can be reached at [email protected].