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Dr. Andrew Valenzuela specializes in pediatric sleep medicine, a discipline that even today he calls an underexplored field that he “stumbled upon” during his pediatric residency. “I happened to have a faculty member who practiced sleep medicine and he thought I’d be a good candidate,” Valenzuela remembers. “I knew I wanted to be in a field that had a lot of overlap with other specialties. I wanted to see complex patients and be able to have that collaboration with other clinicians. Sleep medicine was a blend of multiple specialties.”
He is with Banner Health in Phoenix, the capital and the most populous city in Arizona, and the fifth most populous city in the U.S. Despite this, the area has no more than a half-dozen pediatric sleep specialists and his peers report a significant backlog of patients in their health systems.
The good news is that clinicians from various disciplines are increasingly recognizing the importance of proper sleep, leading to greater awareness. Today, collaboration in pediatric sleep medicine often involves multiple specialties, including pulmonology, ENT, neurology, and endocrinology.
Multidisciplinary Approach
When children encounter sleep issues, Valenzuela argues that a multidisciplinary approach is ideal, with treatment tailored to each patient. Some pediatric patients are being seen in dental offices, where parents report symptoms such as teeth grinding, mouth breathing, or morning headaches. A subset of these patients have classic sleep apnea, which is a common issue, while others struggle with insomnia or difficulties in falling or staying asleep. "Many of the patients we see have breathing challenges or anatomical issues," Valenzuela notes. "We often observe craniofacial abnormalities that disrupt normal airflow."
From the standpoint of job satisfaction, improving a child’s sleep also improves the lives of parents—all amounting to a sense of accomplishment. “I have always appreciated that I sleep well and feel refreshed,” Valenzuela muses. “Then you get these patients who sleep poorly and function poorly. When you fix their sleep, the amount of functional improvement they get is phenomenal and they tend to be very happy. It really is a nice payoff at the end of the day.”
Sleepiness in Adults/Hyperactivity in Children
In adults, poor sleep typically results in sleepiness, but in children, sleep disorders often have the opposite effect. "When a child doesn't sleep well," Valenzuela explains, "they are more likely to exhibit hyperactivity, irritability, and inattentiveness—symptoms that resemble ADHD." Pediatric sleep apnea has been in the spotlight for decades, and its role in the academic performance of children is increasingly viewed as a problem, detailing the many concerns, and the role of associated professionals in detecting sleep apnea in children. “The American Heart Association says sleep apnea affects 1% to 6% of all children and 30% to 60% of obese adolescents, so it’s more common in youth than people think.”
The gold standard for diagnosing sleep apnea is an overnight sleep test conducted in a sleep center using advanced PSG equipment. However, sleeping in an unfamiliar environment can be particularly challenging, especially for children, who often find it more difficult than adults. As Valenzuela points out, "Many of our pediatric patients undergo home sleep tests, which are not only more affordable but also better tolerated."
Recommended Treatments
Valenzuela confirms that CPAP therapy can be initiated as early as age 5 or 6. Additionally, dental treatments play a significant role, including the use of oral appliances or mandibular advancement devices that reposition the jaw to open the airway. "The key professionals involved in pediatric sleep treatment are sleep medicine specialists like myself and ENT doctors, who focus on airway-centered approaches such as tissue reduction, removal of tonsils or adenoids, lingual tonsil reduction, and palatal adjustments," Valenzuela explains. Lastly, the emotional rewards of helping children in pediatric sleep medicine cannot be overstated. "It's incredibly gratifying when patients start sleeping well and their overall functioning improves," Valenzuela emphasizes.
Writer: Greg Thompson