In the Spotlight: Neal Nakra, M.D.

Dr. Neal NakraAs medical director of the CHOC Children’s pediatric sleep program, Dr. Neal Nakra is examining sleep study data to further analyze the relationships between sleep and obesity, metabolic syndrome and other pediatric conditions.

Dr. Nakra’s initial interests in sleep medicine deepened during his pulmonary medicine fellowship at Yale-New Haven Hospital, in Connecticut. Already well aware of the respiratory issues associated with obesity, his research found that the presence of obstructive sleep apnea was associated with obesity and markers for metabolic syndrome.

He focused his interests in obesity, sleep apnea and metabolic syndrome, and became board certified in pulmonology, pediatrics and sleep medicine. A few years later, Dr. Nakra was co-director of the Cystic Fibrosis Center and associate director of the pediatric residency program at St. Joseph Children’s Hospital in New Jersey, when he heard about an opportunity at CHOC.

The CHOC Sleep Center had recently doubled in size, becoming one of the largest programs in the state. Dr. Nakra was drawn by the opportunity to grow the program further and to work with CHOC pediatric subspecialties.

“Sleep inherently deserves multidisciplinary treatment with other pediatric subspecialties,” said Dr. Nakra, who is working with CHOC otolaryngologists, plastic surgeons and endocrinologists. “One of the joys of practicing sleep medicine at CHOC is the ability to collaborate on a multidisciplinary platform, pick the brains of the best and brightest in the fields, and work together to help the kids of Orange County.”

Dr. Nakra has quickly become an integral part of that team. At a recent CHOC Grand Rounds presentation, he discussed screening guidelines for obesity, metabolic syndrome and obstructive sleep apnea. The American Academy of Pediatrics recommends during routine office visits for pediatricians to ask families about how the patient sleeps at night and for the presence of multiple nighttime awakenings, difficulty breathing, loud snoring and pauses in breathing. This is especially true for overweight and obese children.

“We’re trying to break the cycle of obstructive sleep apnea and obesity,” he said. “Often, the families do not volunteer this information, but when asked, will confirm symptoms of obstructive sleep apnea. In this case, further evaluation by a sleep physician or referral for an overnight sleep study would be warranted.”

Dr. Nakra advises physicians to ask about sleeping when evaluating other symptoms, such as hyperactivity and behavioral disorders in elementary or middle school-age kids. For teens, improved sleep has been shown to improve academic performance and reduce motor vehicle crashes.

When to Refer

An overnight sleep study is recommended for patients with concerns for:

  • Nighttime snoring
  • Persistent mouth breathing
  • Witnessed pauses in breathing while sleeping at night
  • Frequent nighttime awakenings

Further evaluation in the pediatric sleep clinic is warranted based on the results of the sleep study or prior to the study based on pediatrician or parental concerns.

Dr. Nakra sees patients at CHOC Children’s Hospital; CHOC Children’s Health Center, Mission Viejo; and CHOC Children’s Health Center, Huntington Beach. For more information or to schedule a consultation, call 714-509-8622.

Obesity, Metabolic Syndrome and Obstructive Sleep Apnea in Pediatrics

In this CHOC Children’s grand rounds video, Dr. Neal Nakra, pediatric pulmonologist and medical director of CHOC’s pediatric sleep program, addresses the topic of obstructive sleep apnea (OSA) and obesity in the pediatric population. In addition to discussing the trends in OSA, Dr. Nakra details the relationship between the condition and metabolic syndrome. Data, collected over the past decade, regarding the effects of OSA treatment on components of metabolic syndrome is also highlighted.

After watching this video, viewers should be able to

  • describe the screening process for OSA;
  • determine the possible mechanisms underlying the connection between OSA, obesity and metabolic syndrome; and
  • describe the possible effects of OSA treatment on obesity and metabolic syndrome.

For more information on upcoming clinical events at CHOC, visit www.choc.org/cme.