title: Prenatal and perinatal complications: is it the link between race and SES and childhood sleep disordered breathing?
abstract: OBJECTIVE
  Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones.
  
  
  METHODS
  Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort.
  
  
  RESULTS
  Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES.
  
  
  CONCLUSIONS
  These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood.
authors.affiliation: Sleep Research and Treatment Center, Penn State University, College of Medicine, Hershey, PA, USA. scalhoun@psu.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calhoun
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
authors.forename: Susan D
authors.initials: SD
authors.lastname: Mayes
authors.forename: Marina
authors.initials: M
authors.lastname: Tsaoussoglou
authors.forename: Katherine
authors.initials: K
authors.lastname: Sauder
authors.forename: Fauzia
authors.initials: F
authors.lastname: Mahr
authors.forename: Anoop
authors.initials: A
authors.lastname: Karippot
authors.forename: Krista
authors.initials: K
authors.lastname: Wisner
authors.forename: Edward O
authors.initials: EO
authors.lastname: Bixler
mesh_terms: D015984:Causality; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy; D015931:Intensive Care, Neonatal / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D009035:Mothers; D016017:Odds Ratio; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D017286:Polysomnography / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires