Complex Sleep Disorders Clinic Comprehensive pediatric sleep clinic for complex sleep disordered breathing disorders

Good sleep is key to a child’s health. Optimal growth, normal immunological function, normal brain development, and cardiovascular well-being all depend on it. Otolaryngology, in collaboration with the Pediatric Pulmonology, Asthma and Sleep Medicine Center, is establishing a multidisciplinary Complex Sleep Disorders Clinic. This clinic will evaluate patients with various medical issues affecting sleep to develop a comprehensive, multidisciplinary treatment plan.

The clinic will specialize in the medical and surgical evaluation of sleep disordered breathing in patients with complex medical conditions that include but are not limited to neuromuscular disease, genetic syndromes, craniofacial abnormalities, and morbid obesity Collaborative relationships have also been established with other relevant specialties, including psychiatry for insomnia and mental health issues, craniofacial and maxillofacial surgery, and pain management and integrative medicine

The clinic’s state-of-the-art diagnosis of children with sleep disordered breathing will employ sleep endoscopy, a technique that can identify areas of obstruction, which is important in children whose disordered sleep is not caused by their tonsils or adenoids Their apnea often can be effectively addressed with tongue-base and/or epiglottis surgery Mild palate abnormalities sometimes result in narrow airway passages that also can affect breathing during sleep; this condition can now often be successfully managed with dental appliances, again bypassing unnecessary surgery Patients who are not candidates for surgical intervention will be managed by pediatric pulmonary and sleep medicine physicians who prescribe advanced noninvasive ventilation therapy with close follow-up in the pediatric sleep clinic

The clinic’s primary goal is to provide comprehensive and multidisciplinary care for patients with complex sleep disordered breathing disorders in an efficient and effective manner, minimizing the need to make multiple appointments and reducing the time taken for diagnosis and treatment

Pediatric Anesthesiology Finding new and better ways to manage cases and to make young ENT patients comfortable through surgery

Children with congenital anomalies of their airways often require delicate and recurrent interventions and surgeries calling on several subspecialties, and the anesthesia team must be able to work closely with each of these, focused on its particular task but always keeping the big picture in mind. While clinical acumen and clear communication are two keys to successful anesthesia in any surgical field, because managing the airway is a fundamental aspect of pediatric anesthesia management, these foci are especially important when surgery is conducted around the head and neck.

Otolaryngologists and anesthesiologists have a particularly close relationship, even in a program as coordinated and multidisciplinary as Stanford Children’s Health’s ENT They work side by side in critical situations, and both manage relatively healthy patients for routine disorders of the tonsils and adenoids and for the insertion and management of ear tubes Together, they manage critical airways in operating rooms, intensive care units, and emergency departments

Many ENT patients have complex congenital heart disease, abnormal airways, or other coexisting illnesses, so their anesthesiologists must be adept at predicting and monitoring the pharmacodynamics and pharmacokinetics of drugs in the most complex ENT patients, from the smallest newborns to young adults

Undergoing ENT surgery can be especially stressful for children Stanford’s uniquely innovative academic environment brings together physicians, engineers, researchers, and child life professionals dedicated to relieving some of that stress In 2017, the pediatric anesthesia group launched the CHARIOT program, which uses virtual reality (VR) to help allay perioperative anxiety for young patients and in some cases even reduce the need for pain medication The team is currently quantifying the effectiveness of VR and is also experimenting with other simulation technologies to advance the frontiers of safe and reproducible education programs

Stanford Children’s Health’s anesthesiology research drives continual improvement in the clinical practice, while insights from the clinic inform and deepen the research, which includes studies of the management of congenital heart diseases, pediatric pain (both acute and chronic), regional anesthesia techniques for children, patient safety, and process improvement