*"It doesn't matter if the cat is black or white as long as it catches
mice."*

Deng Hsaio P'ing 1904-1997

This a page for sharing "what works" as seen in the published literature
as well as what is done at sites that care for American Indian/Alaskan
Native children. If you have any suggestions, comments or questions
please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics
at sholve@tcimc.ihs.gov

IHS Child Health Notes

August 2005

# Quote of the month

"*Sleeping is no mean art. For its sake one must stay awake all day*.*"*

Friedrich Nietzsche

**Articles of Interest**

Clinical assessment of pediatric obstructive sleep apnea.\
Pediatrics. 2004 Jul;114(1):33-43.

<http://pediatrics.aappublications.org/cgi/content/full/114/1/33>

-   Obstructive sleep apnea (OSA) is thought to occur in 1-3% of all
    children

-   Tonsillectomy and adenoidectomy (T & A) will cure sleep apnea in 90%
    of children

-   The accuracy of a clinical diagnosis of sleep apnea was thought to
    be poor -- only 30-50% of clinical diagnoses of OSA were confirmed
    on sleep studies

-   The AAP currently recommends that all children considered for T & A
    for OSA should have a sleep study first. However, sleep studies are
    expensive and often difficult to obtain

-   Children with clinical evidence of OSA but negative sleep studies
    who underwent T & A had significant improvement suggesting that
    symptoms of OSA may be a better predictor of need for T & A then
    sleep studies

Excessive Sleepiness in Adolescents and Young Adults: Causes,
Consequences, and Treatment Strategies\
Pediatrics, Jun 2005; 115: 1774 - 1786.

<http://pediatrics.aappublications.org/cgi/content/full/115/6/1774?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=sleep&searchid=1122219026136_3622&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=115&firstpage=1774&journalcode=pediatrics>

-   Adolescents are often excessively sleepy

-   This sleepiness can have a deleterious effect on mood and
    performance

-   The article reviews available scientific knowledge of sleep changes
    in adolescents

-   An algorithm for work up of excessively sleepy adolescents is
    provided

# Editorial Comment

Physicians, in general, don't have much clinical expertise in treating
sleep disorders. These two articles will help.

The first article about OSA reaffirms what is often true in clinical
practice. If the history and physical suggest a disorder, further
testing may not help or may even be deleterious. Children who have clear
histories of OSA do not benefit from sleep studies and such studies may
not be the best measure of disordered breathing. Children with negative
sleep studies but a clinical history of OSA had significant benefit from
T & A. Especially for most of us serving Native children access to a
pediatric sleep lab may be nearly impossible. Direct referral for T & A
may be the best choice when clinically indicated.

Teenagers are sleepy. That doesn't sound like news, especially to anyone
who has adolescent children. However, there is now a surprising bit of
science on this subject. It is not sloth but the anterior hypothalamus
that makes teens want to stay up late and wake up late. Teens need 9-10
hours of sleep per night but rarely get it. The sleep debt has to be
retired which is what leads high school students to sleep until noon on
weekends. There is a lot of interesting science covered in this
technical report from the AAP. There is even a useful algorithm for work
up of sleepy teenagers. .

**Recent literature on American Indian/Alaskan Native Health**

Tuberculosis among American Indians and Alaska Natives in the United
States, 1993-2002.\
Am J Public Health. 2005 May;95(5):873-80.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15855468&query_hl=11>

-   TB rates have declined in the past decade for AI/AN

-   The decline was 40% which was the smallest decrease among US born
    ethnic groups

-   The TB rate for AI/AN continues to be almost 5 times the rate of US
    born whites

-   TB rates continue to decline for AI/AN groups but TB remains a
    disproportionate burden for AI/AN populations

# 

# [Pediatric Locums Service]{.underline} 

The AAP Committee on Native American Child Health has developed a web
site to help IHS and 638 contract sites find pediatric locums. The web
site has on line form you can fill out describing your locums needs and
which will be posted for AAP members.

[www.aap.org/nach](http://www.aap.org/nach)

In addition, the AAP is interested in helping site find pediatricians to
fill permanent vacancies. Contact AAP staff member Sunnah Kim at
847-434-4729

.