A curious 12-year-old on a long cross-country trip, Carole Marcus found a slim book in her family car’s backseat written by William C. Dement, MD, PhD, a pioneering sleep researcher. Little did she know as she began flicking through its intriguing pages, that one day she would receive a prestigious sleep medicine career award named in his honor.
On June 8, Carole Marcus, MBBCh, received the 2015 William C. Dement Academic Achievement Award at the Annual Meeting of the Associated Professional Sleep Societies held at the Washington State Convention Center. The award recognizes members of the sleep field who have displayed exceptional initiative and progress in the areas of academic research.
“I am extremely honored,” said Dr. Marcus, who since 2003 has directed the Sleep Center at The Children’s Hospital of Philadelphia. “Dr. Dement is the father of sleep medicine and someone I really admire. He has taught me to be open to new ideas. A lot of research is not believing what you see and following the path that your research takes, even if it’s an unexpected turn.”
Dr. Marcus has spent most of her career studying the physiology of pediatric obstructive sleep apnea (OSA) and trying to understand the factors leading to airway collapse in sleep. During OSA, a child stops breathing usually because there is a blockage from enlarged tonsils or adenoids, causing a brief arousal that increases muscle tone, opens the airway, and allows the child to resume breathing.
Through her research, Dr. Marcus has identified that most children have very active upper airway neuromotor reflexes that allow them to compensate when their airways become narrowed during sleep. Children who experience OSA, however, do not appear to have these reflexes. It remains unclear whether they lost them or never developed them.
Recurrent nightly episodes of sleep disruptions caused by OSA have been associated with adverse behavioral, cognitive, quality of life, and health outcomes in children. Dr. Marcus was the first author of a large, multicenter study published in the New England Journal of Medicine in 2013 called the Childhood Adenotonsillectomy Study for Children With OSAS (CHAT). Results of the study showed that study participants who underwent surgery to remove their adenoids and tonsils had notable improvements in behavior, quality of life, and other symptoms compared to those treated with “watchful waiting” and supportive care, but the researchers did not find any improvements in cognition.
When Dr. Marcus was in medical school in South Africa during the early 1980s, not much was known about OSA and especially about how it affected children. She remembers medical students receiving only one lecture on sleep. Fortunately, during her residency in pediatrics at the State University of New York, one of the senior doctors had just written one of the earliest case reports on pediatric OSA. During rounds, he would point out patients, many with Down Syndrome, who had periods of airway obstruction during sleep.
Dr. Marcus recalls one case in particular. She was called to the emergency room to perform her first intubation, which involves the placement of a flexible tube into the windpipe to maintain an open airway. The child had cerebral palsy and could not breathe after receiving sedation. But just as Dr. Marcus was about to begin the procedure, an attending physician asked her to wait a moment.
“He repositioned the child’s jaw and showed that the child had obstructive sleep apnea,” Dr. Marcus said. “And so I didn’t get to do my intubation. But, in fact, once we treated the obstructive sleep apnea, the child changed dramatically. He went from being severely impaired to a happy, smiley, playful child who had moderate function. That really caught my attention.”
Dr. Marcus continues to find practicing sleep medicine extremely gratifying because she often sees how diagnosing sleep problems and then recommending appropriate therapies can make a huge difference in patients’ and families’ lives. She directs a sleep laboratory at The Children’s Hospital of Philadelphia’s main campus and two satellite sites in suburban Philadelphia and New Jersey, with a total of 14 beds. Dr. Marcus and a team of sleep specialists and technologists perform sophisticated sleep studies to help children of all ages — from premature infants to teens — who have a wide range of sleep conditions, including narcolepsy and suspected seizures during sleep.
The sleep field has come a long way since the childhood road trip when she read about Dr. Dement’s homemade sleep lab in his basement, and many of those advancements are due to Dr. Marcus’ enduring pursuit of knowledge in sleep medicine. Dr. Marcus currently is excited about a new study, called Steroids for Pediatric Research in Kids (SPARK), that she is leading at CHOP to look at the effects of nasal steroids on treating OSA as an alternative to surgery.
“Sleep is just so fascinating,” Dr. Marcus said. “We’re in an era where we have the gene for so many diseases, and yet we don’t fully understand why people sleep. Sleep remains one of the big enigmas in medicine. So little research has been done in pediatric sleep, and there is so much to find out.”