This episode of “In the Know” features conversations with Chief Medical Executive Dai Chung, M.D., and S. Kamal Naqvi, M.D., Pediatric Pulmonologist and Sleep Medicine Physician at Children’s Health and Professor at UT Southwestern Medical Center, as well as Seckin Ulualp, M.D., Pediatric Otolaryngologist (ENT) at Children’s Health and Professor at UT Southwestern Medical Center. Together, they discuss advancements in sleep solutions for pediatric patients at the Sleep Disorders Center at Children’s Health.
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Sleep Disorders Center: An In the Know Special Edition
Seckin Ulualp, MD | Kamal Naqvi, MD
Seckin Ulualp, M.D., is a board-certified pediatric otolaryngologist (ear, nose and throat - ENT doctor) with Children’s Health℠ and serves as a Professor of otolaryngology at UT Southwestern Medical Center. After receiving his medical degree from Istanbul University Cerrahpasa Faculty of Medicine, Dr. Ulualp completed his residency in otolaryngology at Haydarpasa Numune Training and Research Hospital, and his pediatric otolaryngology fellowship at the Women and Children’s Hospital of Buffalo through the State University of New York at Buffalo. Dr. Ulualp uses a multidisciplinary team approach in his practice by performing an assessment of the patient’s problem through careful listening and explaining the diagnosis and management in simple terms to achieve mutual understanding. His clinical interests include: obstructive sleep apnea, persistent obstructive sleep apnea (OSA) after tonsillectomy, development of drug induced sleep endoscopy and outcomes analysis for pediatric otolaryngologic disorders. Certified by the American Board of Otolaryngology-Head and Neck Surgery with a sub-certification in Complex Pediatric Otolaryngology, Dr. Ulualp joined Children's Health and UT Southwestern in 2007. Dr. Ulualp is an author and co-author of more than 90 peer-reviewed and invited manuscripts, abstracts and presentations.
S. Kamal Naqvi, MD is a pediatric pulmonologist and sleep medicine physician, who has been functioning as the medical director of the sleep disorders center at Children’s Health℠ for the last 15+ years. Under his leadership the center has grown from a 2-bed sleep laboratory in 2005 to a comprehensive sleep disorders center with 12 sleep beds in Dallas, 8 beds in Plano and clinics in both locations which are equipped and staffed in handling all types of sleep disorders in children. Dr. Naqvi earned his medical degree from Dow University of Health Sciences in Karachi, Pakistan. He received pediatric residency training in New York City and later completed fellowship training in pediatric pulmonary and sleep medicine from Tulane University Hospital in New Orleans, Louisiana. “Children and adolescents reach their best potential when they get optimum sleep, helping them in achieving that, is what I do every day at work and I take it as a mission.” The sleep disorders center has gathered an impressive team of dedicated staff that literally work day and night to help our patients. Dr. Naqvi is an Clinical Professor of pediatrics at UT Southwestern and is the co-director for the sleep medicine fellowship training for pediatric sleep at Children’s Health. His clinical interest is sleep disordered breathing in children with various chronic conditions, mechanical ventilation during sleep, asthma, and narcolepsy. He has been actively involved with clinical research on pediatric obstructive sleep apnea and pediatric narcolepsy. Dr. Naqvi has given lectures, grand rounds and clinical conferences in various pediatric sub-specialty divisions and supervises medical students, residents, and fellows. He has written textbook chapters on various pediatric sleep medicine topics. Dr. Naqvi likes to travel to ancient sites, hiking, classical music and reading. He and his wife enjoy spending time with their three grown children, whenever they can.
Sleep Disorders Center: An In the Know Special Edition
Bill Klaproth: Welcome to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. Today's episode is a special edition featuring our In the Know series. A new addition to our podcast lineup that brings you insightful conversations with our Chief Medical Executive, Dr. Day Chung, and expert physicians from across Children's Health. We'll be sharing these special episodes regularly to keep you informed on emerging trends and advancements in pediatric care straight from the leaders who are shaping it.
In this episode, Dr. Chung is joined by Dr. Es Kamal Nvi pediatric Pulmonologist and sleep medicine physician and Dr. Kin Ulla Pediatric otolaryngologist, both professors at UT Southwestern and experts at Children's Health. Together, they explore new advancements in pediatric sleep solutions and the collaborative work happening at our Sleep Disorder Center.
Let's dive in.
Day Chung, (Host): I'm De Chung. Welcome to the In the Know Video series.
Kamal Naqvi, MD: What we know about sleep in children is that about 25% of children have some type of a sleep disorder. It can range from breathing issues in sleep to sleep hygiene type issues. Inadequate sleep is a very big topic, and then there are some less common issues of being more sleepy, like hypersomnia type issues.
For example, obstructive sleep apnea is at least as common as asthma. Now, we all know about asthma, and asthma obviously is a big topic, but sleep apnea is as common. We work very closely with our ENT group, with neurology group, and many other surgical groups like bariatric surgery, neurosurgery. At this time, I am working closely with the ENT group and they are very active in sleep medicine research.
And we are working towards learning the hypoglossal nervous stimulator, uh, device, which is also called Inspire.
Seckin Ulualp, MD: Inspire therapy is an FDA approved small hypoglossal nerve stimulator that is, uh, pro at an innovation treatment for children with Down syndrome, with persistent severe sleep apnea or other children who cannot use a CPAP therapy.
So it essentially keeps the airway open so that we can breathe regularly and sleep soundly. The surgery itself involves placing an implant near the patient's collar bone. And the second incision is made in the neck, which connects the, uh, implant to the nerve in the neck that controls the tongue so that the tongue doesn't obstruct the airway while we sleep.
And it's very easy to use. When the children are ready for bed, basically they click, uh, the button on the remote, it turns the therapy on. In the morning, patients click on the remote again, it turns off and Inspire has a another option, which means children can go to sleep and the implant is gonna turn on by itself, and after a certain time of activation therapy, then it turns off.
Kamal Naqvi, MD: It is a multicenter project and we have a large patient population and this group is actively doing the surgery.
Seckin Ulualp, MD: This started as part of an NIH clinical trial. Now as part of this clinical trial, we conducted these studies now FDA approved the Inspire therapy for children with Down Syndrome.
Day Chung, (Host): You think that'll be expanded to other cohort of patients or,
Seckin Ulualp, MD: That's what I am hoping, because children have difficulty using the mask. It's not, even adults have difficulty using the mask. Traditionally, removing the tonsils and the adenoids helped children with obstructive sleep apnea. That was the traditional knowledge. And then when we look at the studies, not all children are getting better after tonsil and adenoid surgery. We have to come up with some additional solutions for these patients.
Day Chung, (Host): Is it life changing for not only the kids, but parents?
Kamal Naqvi, MD: Exactly. You know? Yes. When we treat a child for sleep, we sort of indirectly treat a parent also and maybe sometimes siblings.
Seckin Ulualp, MD: To see the parents and children's face, once you tell them that, oh, your sleep apnea is resolved, you don't need to use a mask, you don't need to take any the medication. It is so rewarding.
Day Chung, (Host): That's great. I mean, I'm sure there's so much known now better about sleep disorder in kids, but there's probably still quite a bit of uncharted territory, so to speak. Right?
Kamal Naqvi, MD: There is. We are doing over 5,000 pediatric sleep studies in a year. I can tell you that some of the bigger centers in pediatrics do not have this many sleep studies.
Seckin Ulualp, MD: 15 years ago or so, I started drug induced sleep endoscopy evaluation to find out where the airway obstruction is in children who continue to have persistent severe sleep apnea after adenoid and tonsil surgery. It is called DISE. DISE has been used in adults, but in children it wasn't used widely, so it was a novel idea.
Kamal Naqvi, MD: The current projects, or maybe a more recent one where we were part of a drug trial for narcolepsy in children, which is sodium oxybate. And that was a multicenter, sort of an international study project. And we were able to contribute patients and learn about the medication effect. And as a result, we were able to get this medication approved for children down to age seven.
So that was a big landmark study. And you know, with two campuses and 12 beds, sleep labs in Plano and Dallas and the clinic with staff.
Seckin Ulualp, MD: We all need to sleep to refresh our uh, body. But how to sleep is not that easy. So the quality of sleep is very important. Children are not different, so they may encounter problems during their daily life. They may have some issues regarding their school performance. They may have challenges with the speaking, they may have challenges with their behavior. All of these may come from the sleep issues, so it is very important to focus on the sleep aspect of our children. We have pediatric pulmonologists, Pediatric Sleep Medicine physicians, our sleep labs in Dallas location as well as Plano location are very active and they are well regarded nationally. So we enjoy the advantage of having this quality sleep center so that we can offer a comprehensive care for our patients.
Kamal Naqvi, MD: The association of UT Southwestern and Children's Health has been very effective for us. When I came here for a position in pediatric pulmonary and sleep medicine, there was a big potential in this place, and I can build something to make it a more comprehensive sleep medicine center. And I think that was the difference. The department has always supported us in our clinical work, in our recruitment efforts, and then at UT there is a sleep medicine fellowship program and we are part of that.
Seckin Ulualp, MD: Basically collaboration provides us the innovation and the great outcomes. Yeah, so I'm very glad that, uh, we have a strong collaboration.
Bill Klaproth: Thanks for listening to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. We'll be back soon with another special edition featuring our In the Know series with Chief Medical Executive Dr. Day Chung, where he interviews expert physicians from across Children's Health. You can find out more at children's.com/sleep or children's.com/ent. And if you found this podcast helpful, please rate and review or share this episode and please follow Children's Health on your social channels.