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■ Sleep Tracks
By Valerie Neff Newitt
Going Night-Night
Duke’s pediatric lab drives satisfaction
with child-centered approach
The Duke Pediatric Sleep Lab in Durham, N.C., treats all
children, all the time — seven nights a week, 363 days a year. The
staff, including four sleep technologists, runs 450 studies annually,
and numbers are increasing.
Based in the division of pediatric pulmonary and sleep medicine of
Duke University Medical School’s department of pediatrics, which is
nationally ranked No. 9 by U.S. News & World Report, the Duke
Pediatric Sleep Lab does its part to uphold that lofty reputation by
earning multiple internal awards for driving high patient satisfaction.
The physical components at Duke are kid-friendly — bright colors,
a big fish tank, kid-sized equipment. And while a multidisciplinary
team of care providers ensures a diversity of expertise at the clinic, team
staffers all have one thing in common: Pediatrics. Period.
At some sleep centers that mostly serve adults and the occasional
child, their sleep techs may be competent but not necessarily adept at
working with children. “If you go to an adult lab, the vast majority of
patients are obese with sleep-disorder breathing,” explained Richard
M. Kravitz, MD, associate professor of pediatrics at Duke University
Medical School and medical director of the Duke Pediatric Sleep Lab.
“Yes, we have children with sleep-disorder breathing, but while the
disease may be the same, the etiology is different.”
Dr. Kravitz described the lab’s usual patient population: Fifty percent
have sleep-disorder breathing related to enlarged tonsils and adenoids,
20 percent are related to obesity, and 10 percent related to cranial facial
abnormalities and concerns about associated sleep apnea.
“The rest are hypersomnolent kids — they might have ADD or be
sleep-deprived because of sleep apnea,” he said. “And we’re finding more
narcolepsy among children than anyone suspected existed. It was rarely
ever diagnosed because the mindset was, ‘Children don’t get narcolepsy,
so no need to look for it.’ Now we’re realizing most narcoleptics
probably had symptoms presenting in childhood. But what you don’t
look for, you never find.”
Sleep study not a ‘given’
Securing positive outcomes for Duke’s young charges begins by taking
a history. Even at this preliminary phase, some sleep centers drop the
ball. “It’s a matter of under-recognizing kids; that’s problem number
one,” Dr. Kravitz said.
Essential inquiries include:
• Does the child snore
• If the child snores, are other things going on
• Is he doing poorly at school
• Is she drowsy
• Is there a strong history for sleep apnea
• Does he have pauses Gasps
• Does she experience restless sleep
• Is there secondary enuresis
• Does the child experience morning headaches
• Daytime tiredness
Next comes an assessment, of which a sleep study might be part.
Dr. Kravitz is adamant that too many unnecessary pediatric sleep
studies are undertaken.
“A parent could say, ‘Johnny won’t fall asleep at night. I want a sleep
study.’ So a study is done, and guess what It’s normal,” Dr. Kraviz said.
“That parent has just spent thousands of dollars on a study Johnny
never needed because he has behavioral sleep problems. Parents need
to discuss root causes and get their child proper therapy. Every child
with a sleep problem deserves a sleep assessment, but not every child
requires a sleep study.”
Patience makes the difference
Dr. Kravitz gives credit for Duke’s high patient satisfaction scores to
his sleep techs’ ability to focus simultaneously on the child and the
parent. “We tell families what to expect, and explain they have to be
comfortable before the child will be comfortable,” Dr. Kravitz said.
“An invested, cooperative parent is priceless.”
He also praises his sleep techs for their consummate calm and patience.
It’s a nightly challenge to spend a half hour or more hooking up a young
child who immediately wants to yank off the set of electrodes.
“You have to keep going into the room, explain to the child why they
have to keep all this stuff on,” said Stephen Glinka, RPSGT, lead sleep
photo COURTESY/DUKE PEDIATRICS
Lead technician Stephen Glinka, RPSGT, positions sensors
as he preps his young patient, Aaliyah Wilson, for a sleep study
at Duke Pediatric Sleep Lab in Durham, N.C.
12 ADVANCE for Healthcare Careers