Max Garland, Memphis Commercial Appeal Published 5:00 a.m. CT Dec. 3, 2019
Mitchell Levine wants the clinic he leads to help Shelby County Schools “educate and inform” faculty on identifying children with sleep apnea, which can hinder brain development.
“I think faculty in particular may just not be aware,” said Levine, director of the Dental Sleep Medicine Clinic at the University of Tennessee Health Science Center’s College of Dentistry. “They think the child is just not performing well or acting out. They don’t always associate it with sleep problems.”
Sleep apnea is a condition in which the airway is blocked during sleep, obstructing oxygen intake. It can increase the risk of heart disease and other disorders, according to the National Heart, Lung, and Blood Institute.
For adults, using continuous positive air pressure (CPAP) machines manages the problem. Getting children desensitized and willing to use a CPAP is “no doubt” more difficult, Levine said, and untreated sleep apnea can hinder their neurological, psychosocial and decision-making development, according to UTHSC.
That manifests itself in shortcomings at school, which could spiral into challenges beyond the classroom, said Levine, who became director Aug. 1.
“Kids who are not being managed well (with sleep breathing) puts them at a disadvantage as they continue to age,” he said.
Pediatric sleep apnea a different battle
Tackling adult sleep apnea is about managing the problem, unless there is a willingness to undergo major surgery, Levine said. CPAP or oral devices that fit like retainers and keep the airway open are typical treatment options, per UTHSC.
For pediatric sleep apnea, Levine said treating it is about “redirecting the growth processes” of the jaw to improve the effectiveness of the airway during sleep. Jaw positioning and enlarged tonsils and adenoids are connected to sleep apnea in children, Levine said.
“I think what we’re realizing is in children’s sleep problems and adults’ sleep problems is the manifestations of them seem to be a bit different,” he said.
Repositioning the jaw is effective when the child is 8 or 9 years old and growing fast. Before that age range, oral devices come in handy, because structural changes to growth aren’t as effective at 5 or 6 years old, Levine said.
An oral device may be all that’s needed for a young child with sleep apnea. Over time, natural growth may rid the child of the structural cause, Levine said.
“We had parents that would talk about kids not having nightmares anymore or sleepwalking, doing better at school and moving into their own bedrooms again,” Levine said of helping children with sleep apnea. “There is a unique opportunity on the pediatric side.”
Director: Closer SCS partnership wanted
Levine hopes UTHSC and the clinic he heads will find a role in the community beyond custom-fitted oral devices and orthodontic treatments.
Addressing children with sleep-breathing problems is a key example of that, being a new focus for the clinic. Levine said he has a different perspective than previous leadership due to his experience treating children and addressing orthodontic development.
If Shelby County Schools faculty can identify children with pediatric sleep apnea, they can direct them to resources that will address the disease, Levine said. SCS and UTHSC have a “general” partnership already, but a more direct, sleep apnea-focused effort would boost awareness regarding the issue.
Other factors can negatively affect sleep for young people outside of trouble breathing, like using electronics before bed, Levine pointed out. Blue light emitted from smartphones, tablets and other devices competes with melatonin, a natural hormone connected to the onset of sleep.
Early school start times are also a big issue, particularly among high school students with delayed sleep patterns, homework and after-school activities to manage, Levine said. Those students can be at risk for drowsy driving.
“A whole education process needs to be introduced,” he said.
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