NeurologyLive® Clinician of the Month Spotlight: John Saito, MD, FAAP, FCCP

John Saito, MD, FAAP, FCCP

Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages to manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.

In pediatric patients, sleep disturbances are very common, with a prevalence of 40%-80% in this patient population.¹ Disturbances during sleep are essentially abnormalities of the sleep-wake rhythm in a patient. This occurrence with a patient can be primarily because of sleep onset insomnia or nocturnal awakenings with difficulty in going back to sleep and can be accompanied by other sleep disorders. Especially for patients with more than one sleep disorder, they might require a more personalized and efficient therapeutic approach in their treatment plan.

John Saito, MD, FAAP, FCCP, a pediatric pulmonologist at the Children’s Hospital of Orange County (CHOC), recently sat down in an interview with NeurologyLive® to discuss his role as a neurologist in the field of pediatric sleep. He talked about some of the common sleep disorders and how he would approach diagnosis and treatment for younger patients. Saito also explained how his observation of sleep struggles in children with chronic medical conditions had led him to pursue a career in pediatric sleep medicine. In addition, he spoke about some of the major challenges he experiences in his role, especially regarding access to care and timely continuity of treatment, particularly in a Health Maintenance Organization setting.

NeurologyLive: What are some of the main responsibilities you have in your role as a pediatric sleep specialist?

John Saito, MD: I wear many hats concurrently as a pediatric sleep specialist. As a physician, I am a medical investigator, provider, and advisor. More than that, I’m also a behavioral therapist and family counselor along with being a child sleep health educator and advocate.

Could you describe a typical day in your work as a pediatric sleep specialist? 

In medical speak, I treat children with various sleep disorders such as behavioral sleep disorders, including sleep-onset association disorders, circadian rhythm disorders, restless sleep disorder/ restless leg syndrome, night terrors, sleepwalking, bed wetting, and sleep apnea along with idiopathic hypersomnia and narcolepsy.

However, in simple terms, I spend most of the day helping parents understand that childhood is a constant spectrum of neurobiological progression that is linked to sleep health. I further explain that sleep health includes everything that happens at night before, during, and after sleep. Hence, we need to investigate and determine if these domains fall out of the range of normal for a child’s age. I further explain to the parents my concept of how “TOXIC NIGHTS” and “TOXIC SLEEP” can affect brain development and/or wiring during a child’s formative years. Once the child’s sleep problem is established, I then provide anticipatory guidance, counseling, and/or medical treatment.

I should mention that I’m also a pediatric pulmonary specialist so I also address any chronic respiratory conditions that interfere with a child’s sleep health.

What motivated you to pursue a career in pediatric sleep, and when did you make this decision? 

About 18 years ago, as an assistant professor at Texas A&M Health Science Center College of Medicine and Chief of the Pediatric Pulmonary, Allergy and Immunology, and Director of the Cystic Fibrosis Center at Scott & White Hospital in Texas, I noticed that many children hospitalized with cystic fibrosis, asthma, chronic lung disease, neuromuscular disease, sickle cell disease, and cancer struggled with sleep during their hospital stay. When they followed up in our outpatient clinic, these children continued to struggle with poor sleep and it made me wonder if there was a link.

Since we did not have a pediatric sleep program at that time, this lead me to seek further training in pediatric sleep medicine.

What do you find most rewarding about your work as a pediatric sleep specialist? 

The link between adverse events in childhood to adult diseases are becoming increasingly clear, I believe that "TOXIC NIGHTS" should be considered in the same vein. There are pediatric studies linking poor sleep health to epigenetic changes to the brain, ADHD, mental health issues along with cardio-metabolic syndromes.

When I can improve a child’s sleep health, I’m gratified to know that I am not only helping the child presently but also changing the course of the child’s health span, and perhaps even life span.

As a further benefit, the effect of sleep health and education usually improves the sleep health of the child’s parents, grandparents, and extended family members in a variety of ways.

What are some of the biggest challenges you face in your role? 

I think access to pediatric specialty care and timely continuity of care are major challenges to effective therapy, especially in a Health Maintenance Organization setting.

For example, it may take multiple visits to the pediatrician before a referral is made to see a sleep specialist. Then it may take several weeks before an authorization to see a specialist is approved. This is followed by up to several months to secure an appointment to see a specialist. If a sleep study is recommended, it may take several more weeks to secure insurance authorization followed by up to several more months before a sleep study appointment can be secured. Once the sleep study is done, it may take several weeks to complete a sleep study report, followed by several more weeks to follow up with the sleep specialist for a results review. If CPAP (continuous positive airway pressure) therapy is recommended, insurance authorization is requested and this may take several weeks to secure followed by up to several months for an approved DME (durable medical equipment) company to deploy the equipment to the child.

Once the child finally receives the CPAP device, close follow up is needed to ensure adherence and therapeutic benefit… As you can guess, follow up authorization is needed and critical time is lost along with opportunities for effective intervention.

Is there something that you wish more patients and clinicians understood about the field of pediatric sleep?

Optimal sleep health leads to optimal childhood growth and development. Recognize “TOXIC NIGHTS” early to avoid the toll of negative brain changes through childhood and adulthood.

In addition to your work as a pediatric sleep specialist, what hobbies or interests do you have outside of the clinic? 

I’m a painter and have a project called “ARTinMEDICINE: The Art of Healing” where I try to capture the uniquely human area of healing. I have attached a few examples of my work.

Transcript edited for clarity.

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REFERENCES
1. Schröder CM, Broquère MA, Claustrat B, et al. Approches thérapeutiques des troubles du sommeil et des rythmes chez l’enfant avec TSA [Therapeutic approaches for sleep and rhythms disorders in children with ASD]. Encephale. 2022;48(3):294-303. doi:10.1016/j.encep.2021.08.005