Q&A: Pediatric pulmonologist, sleep medicine specialist wins Excellence in Education Award

Key takeaways:

• The American Academy of Sleep Medicine gives out five awards each year, one of which centers on education.
• The 2024 winner is involved in research on congenital central hypoventilation syndrome.

The American Academy of Sleep Medicine recently presented Iris A. Perez, MD, pediatric pulmonologist and sleep medicine specialist, with the Excellence in Education Award at the annual SLEEP meeting.

According to the Academy, one individual receives this award each year due to “outstanding contributions in the teaching of sleep medicine.”

Perez, who is the director of the congenital central hypoventilation syndrome and diaphragm pacing program at Children’s Hospital Los Angeles (CHLA), has served as a mentor for almost 50 individuals, according to a press release.

To learn more about her successes as an educator and most impactful work, Healio spoke with Perez, who is also an associate professor of clinical pediatrics at the Keck School of Medicine of University of Southern California.

Healio: Why is mentoring important for young physicians in sleep medicine?

Perez: Sleep medicine is still a relatively new field, and an effective mentor can make a positive impact with young physicians. Mentors can provide a realistic view of sleep medicine as a career. They can inspire a young generation of sleep physicians and physicians-to-be, provide avenues for them to thrive, assist them in finding their niche in our field and make significant contributions to research, education and patient care. Ultimately, a great mentorship will move our sleep medicine specialty forward.

Healio: Do you have any specific successes as an educator that you would like to spotlight?

Perez: I consider my successes as an educator in being able to provide professional and research mentorship to learners of different levels from undergraduate to junior faculty.

I see my successes through the successes of my students and mentees — seeing them present their work with confidence and shine at national and international meetings, receive awards for their work and publish their work as first authors. Some of the trainees I worked with went on to pursue a career in sleep medicine and now hold leadership roles in their institutions and organizations.

Last but not least, one of my mentees, Ajay Kasi, MD, pediatric pulmonologist at Children’s Healthcare of Atlanta and assistant professor of pediatrics at Emory University, went on to carve a niche in congenital central hypoventilation syndrome (CCHS) and diaphragm pacing, as he is now considered a leader in this field.

The CCHS and Diaphragm Pacing Program at CHLA is one of the oldest and largest programs in the U.S. The program cares for many children with CCHS every year, and it collaborates with physicians and providers nationally and internationally.

Healio: Why is CCHS such an important research topic?

Perez: CCHS is a rare disorder that affects control of breathing and function of the autonomic nervous system. It manifests in a variety of ways, from the most severe recurrent apneas and hypoventilation to apneas that present when exposed to stressors such as anesthesia or mild respiratory illnesses. This condition can result in significant morbidity and even mortality. Early identification of this disorder will lead to earlier interventions that can improve outcome and quality of life.

Since the identification of the PHOX2B gene in 2003 as a disease defining gene, these individuals have been diagnosed earlier. Many who were diagnosed in infancy are now adults who lead productive lives. However, there are still various areas that require understanding, which could directly affect the lives of these individuals and trigger a change in practice to improve safety and quality of life.

Healio: Are there any discoveries/findings from your research that you are especially proud of or consider most impactful?

Perez: I consider my most impactful work to center around describing the variable respiratory and autonomic nervous system phenotype of CCHS because they underscore the need for attentive and individualized management of these patients. For example, our findings challenged the previously accepted recommendations that patients will need full time ventilatory support when carrying a certain genotype associated with CCHS, changing the paradigm in management.

My research team at CHLA reported the outcomes of patients when undergoing anesthesia, highlighting the neurodepressant cardiorespiratory effects of sedative medications on these patients, and their need for vigilant monitoring throughout the perioperative period. We have reported that all patients with CCHS are at elevated risk for life-threatening cardiac arrhythmias regardless of genotype, emphasizing the importance of screening for symptoms and routine cardiac ambulatory monitoring.

We also found that patients with CCHS sleep through their monitoring alarms, a major safety consideration particularly when independent living is considered.

Most recently, we reported that patients with CCHS may not have hypoventilation initially and that obstructive sleep apnea can be the primary initial sleep-related breathing disorder, expanding our understanding of this disease.

Beyond CCHS, we reported our findings that infants with spina bifida repaired prenatally have persistent central and obstructive apneas and sleep-related hypoxemia similar to those who had undergone repair postnatally. Our findings indicated that the timing of closure of the defect does not affect the presence or severity of the sleep-related breathing disorders and that these infants require screening and surveillance after birth with polysomnography, or other equivalent continuous monitoring, prior to discharge to home.

Healio: What are some of the big challenges in sleep medicine at the moment?

Perez: There remains a dearth of sleep physicians, particularly in certain parts of the country. In practice, the balance of patients that need to be seen and the time required to provide optimal care for each patient can be a challenge. For pediatric patients particularly in the younger age range, there is room to grow in the available interventions and equipment necessary in the management of sleep-related breathing disorders and other sleep disorders.

Healio: What are some of the biggest innovations you have seen recently?

Perez: Some examples of recent and big innovations include:

• The implementation of telehealth in the practice of sleep medicine broadening access to care.
• The availability of remote monitoring and device downloads, which has allowed earlier interventions and improved care of patients with sleep-related breathing disorders. It would be great to have remote monitoring and device downloads with algorithms that are specific for children.
• The FDA approval of hypoglossal nerve stimulation for treatment of OSA in adolescents with Trisomy 21. These patients can have difficulty tolerating positive airway pressure therapy. Hence this option can be beneficial for this population.

Additionally, I am excited about the digital cognitive behavioral therapy for insomnia, or CBTi, as a resource for patients and providers.

Healio: What advice do you have for pediatric pulmonologists and sleep medicine specialists in training?

Perez: For trainees in pediatric pulmonology, sleep medicine is a great career extension due to the unique relationship of breathing on sleep and the effects of sleep on breathing. I have found that combining these two specialties has greatly enriched my academic and clinical practice.

Partnering with a sleep medicine specialist will enhance patient care. For example, addressing insomnia may improve their adherence to positive airway pressure therapy and treatment of their sleep-related breathing disorder.

On the same note, sleep physicians may help their patients with complex sleep disorders by joining forces with pulmonologists.

References:

• American Academy of Sleep Medicine awards. https://aasm.org/about/awards. Accessed Aug. 15, 2024.
• Pulmonologist receives national award from the American Academy of Sleep Medicine. https://www.newswise.com/articles/pulmonologist-receives-national-award-from-the-american-academy-od-sleep-medicine. Published July 3, 2024. Accessed July 15, 2024.