Physician is part of the team charged with establishing the new UBMD Pediatric Sleep Medicine Center and Lab at Oishei Children’s Hospital, the only one of its type in WNY
By Christopher Motola
Q: I didn’t know we had pediatric sleep labs. Are they common?
A: Most major children’s hospitals have a pediatric sleep lab, but the closest one to us that was pediatric-only was in Rochester. Pittsburgh has one as well. So it’s not uncommon in the larger children’s hospitals. We’ve been lucky enough in Western New York to have a few adult sleep providers willing and able to do pediatric sleep studies in their labs, but there had been no dedicated pediatric sleep center in Buffalo, even though we’re much larger than Rochester.
Q: What does a dedicated pediatric sleep lab provide that a standard one can’t?
A: For one, you need pediatric-sized equipment to accommodate birth- all the way to adult-sized equipment. We also need to have technicians who are both family-centered and very patient, because our younger patients who have a high rate of sleep apnea can be extremely anxious. Stranger anxiety is a normal thing in a 2-year old, but it makes it very difficult to place the 20 to 30 different monitors we need to place on them before they fall asleep in a very strange place. We also provide several more modalities of monitoring than we do in an adult sleep lab. We do continuous monitoring so we can catch things like sleepwalking or sleep talking or night terrors. We also monitor CO2 levels in children, which is not something that’s routinely done with adults in the sleep lab. We also have specialty equipment that allows us to manage patients with complex medical needs, like children who need a ventilator to breathe or who have seizures.
Q: What role did you play in getting the pediatric sleep lab off the ground?
A: Obviously I’m part of a huge team that’s made this possible. I was an attending at PICU [pediatric intensive care unit] back in 2019 and was on a phone call at 2 a.m. with the pediatric pulmonologist here who had been wanting to build this center. She’d been trying to get the sleep center going, but couldn’t find anyone to do it. So we talked about it and ended up collaborating. The sleep center is really a joint venture with UBMD Pediatrics and Kaleida and a company called Sleep & Wellness. We all worked together to figure out how to make it happen at Oishei Children’s Hospital. After being an attending in the ICU for a decade, I went back into training for sleep medicine. My husband was like, “Really?” I was then in all the planning meetings and on the frontlines when it came to getting things going. I started July 1, 2020, and the lab opened July 9. So we’ve been open a little over a year.
Q: Do children have similar sleep disorders to adults?
A: Yes, but as you can imagine they’re a little bit different in that they have a significant impact on what the child can achieve in terms of their neuro-cognitive potential. So sleep disorders can have a much more serious impact on their lives, especially if they have sleep apnea. It can create issues with how the child grows and develops. If they’re not sleeping, it really impacts the way their brain grows and their ability to learn. Children tend to outgrow sleep apnea, but the damage to their brain development is usually irreversible.
Q: Are the symptoms similar to those of adults with sleep disorders?
A: They’re actually completely paradoxical. Adults will be tired, they know their sleep is bad, they know they’re waking up, they know they’re snoring. Children don’t have the same vocabulary or understanding to explain what they’re feeling. A tired child is extremely hyperactive, refuses sleep and has trouble sitting still. To this day, I still don’t understand biologically why the human body does this. I don’t know why a tired child doesn’t want to sleep. So kids present very differently. It needs early diagnosis and treatment.
Q: How do you manage sleep apnea in a very young child?
A: It depends where the obstruction is. In early childhood it’s typically because the tonsils or adenoids have grown abnormally quickly and are taking up too much valuable real estate. So we then refer those children for surgery. If they don’t have that issue, then we have to try other things. If it’s mild, we can use medication to help with nasal swelling, or we can watch it. Often children will outgrow it. If it’s severe, though, we need to focus on surgery or have them use a CPAP machine to create continuous airway pressure while they’re sleeping.
Q: What age groups do you mainly see with sleep disorders?
A: It’s actually pretty evenly divided between young children and adolescents. There is a large group of school-aged children who are having trouble with the pandemic and insomnia. Many have increased their screen time, which has in turn affected their sleep. There are probably more toddlers, and we try to do outreach to identify sleep disorders in that age group so we can intervene before it turns into ADHD in a few years.
Q: So are sleep disorders a major cause of ADHD?
A: Yeah, very common. There have been a number of studies that have found that many children with ADHD are getting poor sleep. If you correct that, they don’t need stimulants. That’s always been something that has been perplexing to me. Why would a hyperactive child who can’t sit still need a stimulant? But it’s actually because they’re tired.
Q: Since children, especially very young ones, may not be able to communicate their sleep issues, what should parents look out for?
A: Around 18 months or 2 years of age, if they start noticing that their sleep is interrupted, more fragmented, if they are sundowning similar to the way some elderly people do, where they become very hyperactive near bedtime. That usually means they’re overtired. Sometimes bedwetting can be a sign of sleep apnea, especially if they previously were dry.
Name: Amanda B. Hassinger, M.D.
Position: Attending physician (pulmonology and sleep medicine) at Oishei Children’s Hospital
Education: University at Buffalo
Affiliations: UBMD, Kaleida; Oishei Children’s Hospital
Organizations: American Board of Pediatrics; American Association of Sleep Medicine; Society of Critical Care Medicine; Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI)
Family: Husband, twin daughters, son
Hobbies: Cooking, camping, hiking, gardening