Pediatric Sleep Apnea Treatments with Drs. Saied Ghadersohi and Taher Valika

August 20, 2024

A good night's sleep is critical to the health and well being of children, but undiagnosed or untreated obstructive sleep apnea can prevent kids from getting much needed rest and is associated with cardiovascular complications, impaired growth, learning problems, and behavioral problems. In this episode of Precision, Drs. Saied Ghadersohi and Taher Valika discuss the importance of sleep for children and the impact of obstructive sleep disordered breathing, which affects nearly 5 percent of the youth population in the United States. They offer advice to parents and share insights on advanced treatments at Lurie Children’s which are helping kids get the rest they need.

“We're really starting to scratch the surface on how important sleep is to a child's development. As we learn more and more, it really behooves us as both parents and providers to ensure that our kids are getting the most optimal sleep possible.”

Saied Ghadersohi, MD
Attending Physician, Otorhinolaryngology-Head & Neck Surgery
Director, Complex Sleep Program
Resident Education Site Director
Assistant Professor of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine

“Our goal is to take care of your child. We hope to have that trust and build that relationship that we are working together as a team to make sure that your child has the best outcome.”

Taher Valika, MD
Attending Physician, Otorhinolaryngology-Head & Neck Surgery
Medical Director, Aerodigestive Program
Member, Lurie Children's Surgical Foundation
Assistant Professor of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine

Show Notes

Obstructive sleep disordered breathing is an umbrella term describing a continuum of increasing upper airway resistance, and includes conditions such as snoring, upper airway resistance syndrome, and obstructive sleep apnea.
The mildest form of obstructive sleep disordered breathing is snoring and affects about 8% of children. Other forms include Upper Airway Resistance Syndrome, and Obstructive Sleep Apnea (OSA).
Common causes of these disorders are enlarged tonsils and adenoids as well as obesity, which can exacerbate the condition.
Diagnosing and treating obstructive sleep apnea include consulting a pediatrician, potentially leading to referrals to specialists. Treatments range from medical management with nasal sprays or steroids, sleep studies, to surgical options like tonsillectomy and adenoidectomy.
Surgery for tonsil and adenoid removal can effectively treat sleep apnea in many children, but a multidisciplinary approach is essential for more complex cases.
Dr. Valika helped create the Care Companion app that lets parents have direct contact with doctors treating their children and manage the recovery of their surgeries at Lurie Children’s.
Lurie Children’s has developed and implemented a unique procedure, the Fluoroscopic-Assisted Tongue Suspension, which specifically targets tongue-based collapse to avoid more invasive measures like tracheostomies.
Parents should consider Lurie Children’s for their child’s obstructive sleep disordered breathing issues as it is the top ranked institution in the Midwest with a multidisciplinary approach led by doctors like Dr. Chadersohi and Dr. Valika who are always striving to do better to achieve the best possible outcomes for their patients.

Transcript

[00:00:00] Erin Spain, MS: This is Precision Perspectives on Children's Surgery from Ann & Robert H. Lurie Children's Hospital of Chicago. I'm your host, Erin Spain. On this podcast, we introduce you to surgeons at one of the country's most renowned children's hospitals to find out how they are transforming pediatric medicine. A good night's sleep is critical to the health and well being of children, but undiagnosed or untreated obstructive sleep apnea can prevent kids from getting much needed rest and is associated with cardiovascular complications, impaired growth, learning problems, and behavioral problems. It's estimated that at least 5 percent of American children have this condition, and kids with Down Syndrome are at more risk, with an estimated 53 percent to 76 percent having sleep apnea. Ear, nose, and throat surgeons in the division of Otorhinolaryngology, Head and Neck Surgery at Lurie Children's are providing leading edge procedures to treat even the most complex cases of obstructive sleep apnea and help kids get the critical sleep they need. Two of those surgeons join me today to discuss this topic. Doctors Taher Valika and Saied Gadersohi are both pediatric otolaryngologists. Dr. Valika is also the medical director of the Aerodigestive Program at Lurie Children's, one of the nation's largest airway reconstruction programs. And Dr. Ghadersohi is the director of the Complex Sleep Program here. Welcome, both of you, to the podcast.

[00:01:34] Dr. Saied Ghadersohi: Thank you for having us.

[00:01:35] Dr. Taher Valika: Thank you so much for having us.

[00:01:36] Erin Spain, MS: Sleep research has really expanded and evolved in the past few decades in pediatrics. And like I mentioned, we know sleep is central to a healthy childhood. Yet many of us may not be familiar with the signs of sleep disordered breathing and obstructive sleep apnea. Can you explain what happens during obstructive sleep disordered breathing?

[00:01:56] Dr. Saied Ghadersohi: Obstructive sleep disordered breathing is actually kind of an umbrella term, and it describes a continuum of increasing what we call upper airway resistance, or more of an obstructive, area within the upper airway or the throat or nose. And the lowest level of that is snoring, and that affects about 8 percent of the pediatric population, where you just hear that snoring sound when they're sleeping. As we take the next step, Beyond that, we reach what's called upper airway resistance syndrome, where we're seeing the snoring and we're seeing some labored breathing, meaning that maybe the child is using a little bit more muscles to breathe, but they're not quite showing that obstructive pattern of pauses in breathing and gasping yet. And so the next step beyond that is what we call obstructive sleep apnea, which is again under the umbrella term of obstructive sleep disorder breathing. And that's where we're seeing. Not only the snoring and that labored breathing, but we're also seeing pauses in breathing that are affecting the oxygen levels or carbon dioxide levels and really disrupting the sleep pattern. And that's where we're seeing that disrupted sleep leads to kind of those daytime symptoms of tiredness or hyperactivity, where we kind of see the opposite effect of tiredness in children because they're just not getting that good quality sleep. They're not staying in that deeper or dream sleep, and they're coming into the lighter stages of sleep, which is not as restful.

[00:03:15] Erin Spain, MS: Dr. Valika, can you tell me about some of the causes of obstructive sleep apnea? We think of these young kids that are healthy, like what could possibly be causing this to take place?

[00:03:24] Dr. Taher Valika: So most commonly from an obstructive sleep apnea perspective, what we see is the tonsils and adenoids. Now we've all heard those words being thrown around, but what tonsils are and adenoids are is simply lymphoid tissue. So it's tissue that's exposed in the back of our throats and the back of our nose that can get in the way of our breathing. And for most children enlargement of the tonsils or adenoids is what results in children having obstructive sleep apnea.

[00:03:46] Erin Spain, MS: There are also some other reasons out there. Many experts believe the incidence of this condition is increasing specifically in the U. S. as a consequence of the childhood obesity epidemic. Do you see this in your clinic?

[00:03:57] Dr. Saied Ghadersohi: We definitely see this, and as Dr. Valika mentioned enlarged tonsils and adenoids is the most common cause of sleep apnea type symptoms in kids. The second most common is obesity and being overweight. And, you know, when we have big tonsils and adenoids, they're basically crowding the throat. So they're making the available space for air to pass through our throat narrower. The same effect happens with obesity, where we have extra tissue around our neck, around our throats. And so when we go to sleep and our muscles are relaxing in our throat because we're sleeping the throat tends to collapse. And we see that same type of obstructive pattern in the throat causing those same sleep symptoms.The other important aspect of the obesity epidemic is that it can kind of be a compounding issue, meaning a child or person has poor sleep, that leads to poor energy, which then leads to further obesity. And you know, because they're not able to participate in sports, they're not able to do things that would potentially help them with weight loss. And that further worsened obesity, then again, worsens the sleep apnea, which then leads to the other health consequences of obesity, which can include high blood pressure and diabetes and other heart problems and other health problems that goes along with it.

[00:05:07] Erin Spain, MS: If you're a parent listening and your child is snoring and they seem to have some of these symptoms, What's the next step? How do you get a diagnosis or how do you rule this out? And maybe it's something different?

[00:05:17] Dr. Taher Valika: Well, I think the first step is, you know, really touching base with your pediatrician. Relaying some of these concerns of what your child has experienced or what you're seeing in the home space. You know, changes in behavior, their overall quality of life, the snoring aspects that develop. Vigilance about this and recognition of this condition is important. But reeling those concerns to your pediatrician who can help you, refer you to an otolaryngologist such as us here at Lurie Children's.

[00:05:37] Erin Spain, MS: How do you treat this obstructive sleep apnea in children? What approaches do you take?

[00:05:41] Dr. Saied Ghadersohi: It's really important to make a thorough assessment of what's actually going on and , you know, assessing the symptoms both during the nighttime and during the daytime is key to kind of start the process and then taking into account other medical problems and other complexities in terms of the child's medical history such as other syndromes or their weight and things like that need to be taken into account as well. Then doing a thorough exam. To kind of evaluate the tonsils , evaluate some of the tissues in the nose and other areas on the neck to assess to see if those are some of the problematic sites. And oftentimes we'll identify enlarged tonsils and adenoids as the cause. So that brings us to kind of our primary treatment paradigm, or the first steps in terms of management of this. And we can take kind of one of three different steps. One is medical therapy or medical management, where that could include starting nasal sprays or nasal steroids in an effort to try and shrink some of those lymphoid tissues such as the tonsils and adenoids. This is something that we undertake for patients that have more mild symptoms. In other patients that may have more complex associated medical problems, we may consider starting with a sleep study, because that just gives us more objective information as to what's going on. And our third option would be to proceed with surgery where we remove the tonsils and the adenoids.

[00:06:52] Erin Spain, MS: A lot of parents, they're familiar with tonsils and adenoids in this surgery, and it can be done in a lot of different places, community hospitals, but talk about Lurie Children's. What makes it different having the procedure done at Lurie Children's?

[00:07:04] Dr. Taher Valika: Think one of the benefits of being at a dedicated, freestanding, pediatric only children's hospital is the impact of everything else that comes with it, right? It's not just a surgeon that is your pediatric surgeon, but it's our anesthesia teams. It's our nursing staff. When your child comes in for surgery here, that walking into a hospital is not technically reassuring for anybody. Nobody necessarily wants to be here. But seeing the environment, seeing that our nurses are child centric. We're family centric. When you go back to the operating room, having our Child Life Specialists, anything that can provide that comfort and reassurance in a time of stress for your children, and you know what you're getting is that top line of care because this is what we do day in and out. This is not a small adult to us. This is our bread and butter and the patients we take care of day in and day out.

[00:07:49] Erin Spain, MS: As you were saying, there's a multidisciplinary team here at Lurie Children's and their specialties, such as bariatric surgery, which may apply to some of your patients. Dr. Ghadersohi, could you please talk to me a little bit about that. How you're able to really help your patients find more care that they may need .

[00:08:04] Dr. Saied Ghadersohi: Lurie Children's is really a wonderful place. We have so many experts in so many different fields. And oftentimes, the success rate for tonsillectomy and adenoidectomy in treating sleep apnea can be quite effective in healthy kids, up to about 80%. But, in patients that are a little bit more complicated, maybe they have obesity, maybe they have other syndromes or disorders, it's not as effective. And so we're left with residual or persistent sleep apnea. After the tonsils and adenoids have come out. And so in those scenarios, we really rely on that multidisciplinary team of experts that we have here at Lurie Children's to care for those patients. And that can range from, our expertise, the pediatric otolaryngology team. We have dedicated pediatric sleep medicine physicians. We have pediatric orthodontists and dentists that can help if there's a craniofacial or dental issue. We have bariatric surgeons in our pediatric surgery department that can help with surgical measures for weight loss. So again, we would be able to bring that full breadth of expertise and provide whatever your child needs to, treat that sleep apnea fully.And more often than not, parents want a comprehensive care plan for their child for complex medical situations. And I think that's what we're able to provide because it's not just one surgeon walking into a clinic saying, Your child needs surgery. We're going to take care of it. It's, have you done the due diligence for my child to tell me this is the right next step? And as a team here, that's what we're able to provide.

[00:09:26] Erin Spain, MS: This is often the first surgical procedure a child will undergo. How do you keep them and their families comfortable before, during, and after surgery?

[00:09:35] Dr. Saied Ghadersohi: As Dr. Valika mentioned, we are very child centric here at Lurie Children's. This is all we do. And during the process of signing up patients for the surgery, we really have a thorough discussion of risks and benefits, what to expect after the procedure. When you get here on the day of surgery, you'll meet our pediatric anesthesiologist, you'll meet our child life specialists that will help kind of ease that anxiety, all the emotions that kind of go around the time of having surgery, both for the child and for parents as well. And then afterwards we have a number of different tools and ways to kind of access straight to us to be able to ask any questions you have or discuss any issues that come up along the way. And Dr. Valika has helped develop our MyChart app to be able to even be more effective in that realm.

[00:10:18] Dr. Taher Valika: For our patients who are undergoing tonsillectomy, the aftercare is what's the most important aspect of your recovery process. So how do we best manage your pain control, making sure you're taking enough hydration and food intake? How do we prevent those complications that require children to potentially come back to the hospital? In this era of digital technology, through use of MyChart, we built the Care Companion app, which actually allows families to answer what their pain scores are. Is their child eating? Are they concerned about, you know, throwing up or any fevers? And those responses get recorded to our nursing team in real time fashion. So if there are concerns that develop, there's someone looking at your child's real time response, their pain scores. And we're able to reach out to you proactively, even before you call us to say there's something wrong. We're able to reach out to make sure that your child does not have to come back to the hospital and we can manage you safely and appropriately in your home setting.

[00:11:06] Erin Spain, MS: I mean, that type of communication is so valuable to families. What sort of reaction have you had from those who use the app?

[00:11:12] Dr. Taher Valika: It's been quite positive. The ability to have access to your fingertips, to your healthcare team is challenging in this day and age. So by giving these resources to our families, we are, I think, the first in the country to provide that through the Care Companion app because we built it.

[00:11:26] Erin Spain, MS: Is this something that you could see being used at other institutions? Are you going to publish about this and let other folks know how it's working?

[00:11:32] Dr. Taher Valika: We have. Our digital health team has put tremendous time and effort in this. They've presented this across the world as well as Epic Headquarters. And we're planning on potentially allowing others to sort of learn off of the time that we've placed into this to help allow care equally for families across the country.

[00:11:48] Erin Spain, MS: So what sort of thing are you looking for in this app? What symptoms come across that could be the signs of complications and what are those complications that families should be concerned about?

[00:11:58] Dr. Taher Valika: So I think the two biggest things that parents worry about after surgery is pain control, and is my child going to eat enough? And those things we're looking for is how do we make sure that, one, are you taking your pain medication? So it's a question we frequently ask. And then two, what is that pain score? And every child will be different. So if we're looking at your pain scores on a three hour or six hour basis, We're able to effectively track and understand which direction your child may potentially be heading in. We have a lot of normative data, so we know what a child is supposed to look like on day one, or two, or seven, and we counsel families as such. But if those children don't fit the patterns that we have expected by now, then we're able to proactively reach out and make those adjustments so that your child doesn't have to potentially come back to the hospital. And yes, that may still frequently happen, and that does happen in about, you know, anywhere from two to five percent of children undergoing these procedures. But we're doing our best to even lower that risk.

[00:12:49] Erin Spain, MS: Dr. Ghadersohi, you mentioned this a little bit, the child has the surgery, but they still are snoring. There's still symptoms there. How long do you wait to reassess them? If the parents say they're still snoring. What are the next steps?

[00:13:01] Dr. Saied Ghadersohi: So after the tonsils and adenoids are completed, if we notice that the child's still snoring, we usually wait about a three month period And this is to kind of let, you know, all of the post operative healing and swelling and everything go down and so that we can establish a new baseline. Around that time, if there is again still persistent symptoms, we'll obtain a sleep study. And a sleep study will help us kind of objectively define if there is sleep apnea that's still occurring and also how severe it is. And then from that point we may direct you in one of the many different kind of multidisciplinary pathways that you could go down, whether that's proceeding with CPAP, for continuous positive airway pressure further surgery options, which may start with what's called the drug induced sleep endoscopy, or if there's obesity and bariatric concerns, then we may kind of send you down that pathway to our weight and wellness team. Or if there's craniofacial or dental problems, that may kind of lead you down that pathway. And you know, the benefit of being at Lurie Children's is we have all of those providers, we have that expertise in all of those different areas for your child to, take advantage of and tailor their care to what their body needs to help treat the sleep apnea.

[00:14:10] Erin Spain, MS: For listeners who are not familiar with what a CPAP machine device is, can you explain that to me? And also tell me why some of your patients may still need to use this machine even after undergoing surgery?

[00:14:22] Dr. Saied Ghadersohi: CPAP stands for Continuous Positive Airway Pressure. And basically it's a kind of a respiratory assistive device that pumps air through a mask into your mouth and nose and essentially holds the throat open kind of like a balloon in a way by putting pressure inside it. As we kind of scratched upon the surface of the multidisciplinary care that patients need if they have persistent sleep apnea, CPAP is one of those tools. It's the go to, it's the first line treatment in adults. In kids, it's just as effective if the patient's able to tolerate wearing it. If they can keep the mask on all night, it works really well. So the key there is just finding the right patients and finding the patients that are able to tolerate it so that the CPAP can treat their sleep apnea while they're sleeping.

[00:15:04] Dr. Taher Valika: And parents would ask us, then, why would I even do surgery and not just use CPAP? And I think it's understanding that it's not as simple as just putting a face mask on, right? When you're having pressure to stent open your child's airway, that can be quite uncomfortable for your child. So one wearing a mask on your face. Keeping the mask on your face while your child is tossing and turning, potentially. And then also, the impact of the mask that is potentially strapped onto your face quite tightly can change this to facial growth. So for children who sometimes wear a mask all the time, it actually inhibits their facial growth, potentially in the future resulting in further need for either orthodontic procedures or having worsening OSA because it impacts the way your face grows. So ideally in the youngest of young kids, when our two year olds, five year olds, seven year olds, your face is still growing. Right? So once you're 16, 18, those are sometimes more realistic options, but even through our sleep medicine colleagues, one, they may say, well, this is going to inhibit their facial growth, and it would not be the recommendation. The other aspect of CPAP is, when we look through those drug induced sleep endoscopy and look at the airway, there are potential situations where we don't have a surgical option, where the best option may be, I think your child would benefit from CPAP. And that's where Dr. Ghadersohi may walk out and say, hey, we look at this. There's multiple sites of airway obstruction. We may not be able to correct it. Have a realistic, one on one conversation with our care providers and our team to understand that the best option for your child may not be surgery, and CPAP may be the best thing.

[00:16:22] Erin Spain, MS: Keeping an open mind about treatment options is important because the data shows that while tonsils and adenoids are the first line of treatment. It isn't always successful for all children.

[00:16:33] Dr. Taher Valika: Taking care of your tonsils and adenoids as treatment for sleep apnea helps resolve the sleep apnea in about 60 to 90 percent of kids. But if you flip it and actually think about it, that leaves 10 to 40 percent of children who still have a risk of having residual sleep apnea. And, you know, we don't talk about those children as often. And that's where, you know, in that population that could potentially still have sleep apnea, whether you're just a regular child who doesn't have any other underlying comorbidity or other medical conditions. But there are certain populations that are at higher risk of having sleep apnea. That children with hypotonia, craniofacial anomalies, underlying syndromic aspects. Those populations are at higher risk and may not always be recognized. other than assuming that's how my child is. And that's the expertise we provide here in that capacity. And as Dr. Ghadersohi mentioned, once you've taken care of that first line aspect, that re-evaluation, that reassessment via drug induced sleep endoscopy, can be quite beneficial to understand what levels of airway obstruction are persisting and how can we be of further assistance.

[00:17:31] Erin Spain, MS: Let's dig into that a little bit more. There's a couple of options out there that you can go through if a child continues to have sleep apnea after the tonsil and adenoid surgery. Could we walk through some of these procedures?

[00:17:41] Dr. Taher Valika: So as Dr. Ghadersohi, he mentioned, once you've done a sleep endoscopy to help identify the levels of airway obstruction, then we can have a very different conversation with the family, right? The sleep endoscopy, we actually record and walk the parents through afterwards to show you. For a lot of our population, it's quite often either the back of the tongue is collapsing, the muscles of the throat or the voice box, like the epiglottis or your supraglottis, in terms of children having laryngomalacia, is collapsing. Most commonly for us, from an upper airway perspective, meaning above the voice box that we deal with, is either the supraglottoplasty, in terms of for children with laryngomalacia or a floppy voice box, as they say. The back of the tongue, potentially with either shaving down the lingual tonsils, which is quite often in some populations, the 50 to 80 percent of the site of residual airway obstruction. Other sites, some children can just have a big tongue and the tongue collapses backwards and can be the way their anatomy is and we can navigate some of those procedures. In terms of tongue based collapse, this can be quite a challenging surgical site to manage in our population. When we've looked at the literature, we realize tongue based collapse is actually one of the highest reasons why some children end up with a tracheostomy. At Lurie Children's, we actually developed a new tongue based procedure that we created here. Fluoroscopic Assisted Tongue Suspension has been utilized at Lurie Children's now for the last five years. We capture in a live-time x-ray, in the operating room, of that area of collapse. We are able to fix that tongue sight specifically and we get a result in real time that when I'm walking out of the OR, I can tell you that we threw the stitch exactly where it needs to go and this is the outcome we expect. And that's provided significant improvement outcomes. We've had certain families who have come in needing a tracheostomy and in over 90 percent of these kids so far, at least when we look through our literature and our data, these patients have been able to avoid a tracheostomy. Every one of these children is unique and different but we understand that through our tailored approach, what we're looking at is we're not treating a child like the book they're supposed to get A, B, C, and D. Through our teamwork, through our expertise, we're able to tailor care for your child specifically and to be able to give you that opinion to make sure that it's the right thing for you.

[00:19:40] Erin Spain, MS: And how life changing that could be not to have the tracheotomy to be able to avoid that type of invasive device. That must mean a lot to parents.

[00:19:48] Dr. Taher Valika: Indeed, the feedback we've had has been excellent, and it provides, you know, that reassurance that you're doing some good in the world.

[00:19:53] Erin Spain, MS: Dr. Ghadersohi, you're among the few in the region that's trained to surgically implant a Hypoglossal Nerve Stimulator Device in some young patients, specifically teenage patients with Down Syndrome, which we mentioned at the beginning of the show, many children with Down syndrome do have obstructive sleep apnea. Now this innovative procedure can eliminate the need for some of the patients to use a CPAP machine to manage sleep apnea, which is a very big deal. Explain this procedure to me.

[00:20:20] Dr. Saied Ghadersohi: As Dr. Valika mentioned, tongue based collapse is really a challenging area to treat for obstructive sleep apnea patients. And unfortunately for our kind of adolescent and beyond Down Syndrome populations, this seems to be one of the primary sites that's problematic for them. And this Hypoglossal Nerve Stimulator Device was actually originally introduced in the adult population roughly 10 years ago, and it's shown significant success for those patients that really just don't tolerate CPAP, so we're able to treat that tongue base collapse area. Now, the way the device works is it has a battery simulator pack similar to a pacemaker. It sits kind of in the right upper chest and it has a wire or a lead that comes out. It travels up the neck and it loops around the what's called the hypoglossal nerve, which is the primary nerve that provides motor movement or muscle movement to our tongue. And then it has another leader wire that sits within the chest wall and what the device does is it actually senses every time the patient or child breathes in and then sends an impulse or a pulse down the other lead to the nerve that controls the muscle movement of the tongue. And so every time the patient breathes in, it pushes the tongue forward. So it effectively reverses that tongue base collapse that we see. It's a very straightforward device to operate afterwards. It doesn't have a lot of the problems and issues that we see CPAP tolerance and having to wear a mask on the face. It's actually operated by a simple remote. You just turn it on when you go to bed and when you wake up, you turn it off and it's been shown to work.

[00:21:48] Erin Spain, MS: And how do the patients tolerate the surgery and living with the device?

[00:21:51] Dr. Saied Ghadersohi: This device is really targeted to patients that don't tolerate CPAP. And you take a population of patients that has not been able to wear CPAP effectively to treat their sleep apnea. And what the data has shown is that with this device, they're able to tolerate it for about 9 hours per night. And that means that on average, they're getting 9 hours of good sleep quality restful sleep, which can really make a difference for those children.

[00:22:15] Dr. Taher Valika: And especially in this population that has already high risks from a sleep apnea perspective, there are cognitive changes, the neurologic outcomes, the cardiac risk. By minimizing that OSA impact and improving their overall sleep really pertains to better future outcomes, longevity, and reducing their overall morbidity from the consequences of sleep apnea.

[00:22:34] Erin Spain, MS: And as you mentioned right now, this is just being used at Lurie and teenage patients with Down Syndrome. Do you think this could be something offered to other children in the future?

[00:22:43] Dr. Saied Ghadersohi: The device was actually just approved in that population in March of 23. So it's still very new when we think about kind of medical devices and as we learn more about it, specifically kids, you know, the biggest concern being kids grow, right? A 12 year old is much smaller than an 18 year old. And so those were kind of some of the concerns with applying it in the pediatric population. As we've learned more and more about, you know, the changes that kids go through, we've shown that the device still is effective and still works despite them getting bigger, despite them getting older, and also even despite them potentially gaining weight. The device is still effective at treating sleep apnea. I think the indications should expand with time, but that will take some time to kind of iron out those kinks.

[00:23:25] Erin Spain, MS: Something that's come through during this conversation is that you're always looking for ways to innovate the latest procedures. How can we help our patients creating the app to communicate better and more thoroughly? Can you tell me a little bit about that philosophy within your team to constantly be innovating and looking for the next best way to serve your patients?

[00:23:43] Dr. Taher Valika: At the end of the day, it's about the outcomes. You want the best for your children. We are at the top ranked institution here in the Midwest to be able to provide you the best outcome. If you want good results, go to a good hospital. You will have good results, but our goal is never to stop at good enough. It's not even being the best, it's being better. And for me, it's always about what can I do better? And we have that ability through our expertise. We have care teams who can provide that top notch level of care to allow us to challenge ourselves. Because like I said, I want to be better.

[00:24:13] Dr. Saied Ghadersohi: We're always constantly looking at what things we can change, what things we can improve on. We're looking at our own data. We're looking at our outcomes and studying those very thoroughly to try and understand, is there different, potential options that are being developed or that we can develop to better treat what's going on and provide better outcomes for the patients we care for.

[00:24:31] Erin Spain, MS: So walk me through the timeline and potential outcomes for a new family who's coming to Lurie Children's for a consultation. What could they expect? What different paths could they go down?

[00:24:40] Dr. Taher Valika: I think one of the hardest challenges that parents face is that when they're concerned that their child has sleep apnea, they want to get into a physician immediately. We're here for that, and we understand. With the level of complex care that we provide, whether it's your most medically complex child or a child without any other medical conditions, our volumes and challenges can be the limiting factor. Some families will have to wait several weeks to even a month or two to get into our appointment, but understand that it's coming from the level of care that we provide. Our specialists are providing the top notch level of care, and most families, once they've had our evaluation with us, have met our teams, have undergone through the procedures and the surgical outcomes, many families come back and say, it was worth the wait. It may have cost me another one or two months of stress, but I know my child got the level of care that I would have wanted to provide them. For us, at the end of the day, that's worth the wait.

[00:25:25] Erin Spain, MS: For any parents listening who are starting this journey to getting a sleep apnea diagnosis for their child, what advice would you like to leave them with today?

[00:25:34] Dr. Saied Ghadersohi: So we're really starting to scratch the surface on how important sleep is to a child's development. And as we learn more and more, it really behooves us as both parents and providers to ensure that our kids are getting the most optimal sleep possible. And that means if we're seeing snoring, if we're seeing signs of obstructive sleep apnea, that we're working that up and we're getting adequate treatment for that so that our children are getting the best sleep possible so they can develop into the best adults they can be. They can be successful in school and whatever endeavor they take upon.

[00:26:03] Erin Spain, MS: Dr. Valika, I'd give some advice for parents.

[00:26:05] Dr. Taher Valika: We know surgery can be scary. Nobody likes the word surgery. Nobody wants surgery for their child. We understand that. Our goal here is to make sure that we provide the best care for your child. And for those parents that are coming through here, understanding that our goal is not to necessarily do surgery. Our goal is to take care of your child. We hope to have that trust and build that relationship that we are working together as a team to make sure that your child has the best outcome. And as Dr. Ghadersohi has mentioned, the consequences of sleep apnea, those long term outcomes, the cardiac, pulmonary, neurologic changes that we're so familiar with, how can we partner together to make sure that your child has the best outcome to mitigate that risk in general?

[00:26:44] Erin Spain, MS: Fantastic. Well, thank you both so much for coming on the show today, talking through the program, the different surgeries, and a lot of the innovation that's being offered through Lurie Children's. I appreciate your time.

[00:26:55] Dr. Saied Ghadersohi: Thank you for having us. Erin.

[00:26:56] Dr. Taher Valika: Thank you, Erin.

[00:26:57] Dr. Saied Ghadersohi: For more information, including how to make a referral or an appointment, visit lurie.childrens.org.