title: Maternal sleep-disordered breathing and the risk of delivering small for gestational age infants: a prospective cohort study.
abstract: It is unclear whether objectively measured maternal sleep-disordered breathing (SDB) leads to poor fetal outcomes. In this study, we prospectively assessed whether polysomnography-based diagnosis of SDB in the third trimester is associated with the delivery of small for gestational age (SGA) infants.
  
  
  
  Participants were recruited from a multicentre pregnancy cohort study. Eligible participants were evaluated for SDB based on symptoms (snoring and/or witnessed apnoeas assessed using the Pittsburgh Sleep Quality Index questionnaire) and in-home complete polysomnography in the third trimester. SGA was defined as <10th centile using customised birthweight centiles adjusted for maternal parity, prepregnancy body mass index (BMI), ethnicity, gestational age and infant sex.
  
  
  
  Of the 234 pregnant participants who completed a sleep study, 82% were Caucasian, with mean (SD) age of 31 (4.3) years and a prepregnancy BMI of 23 (4) kg/m(2). The delivery of SGA infants occurred in 27 (12%) of the study participants. The symptoms of SDB had poor overall sensitivity and specificity for diagnosing SDB identified by polysomnography. Symptoms of SDB in the third trimester demonstrated a potential association with delivering an SGA infant, however this did not reach statistical significance (OR 2.36 (95% CI 0.85 to 6.54, p=0.10)). However, the odds of delivering an SGA infant were significantly increased with polysomnography-based diagnosis of maternal SDB (using apnoea-hypopnoea index cut-off of 10, OR 2.65 (95% CI 1.15 to 6.10, p=0.02)).
  
  
  
  Objectively measured SDB in the third trimester is significantly associated with the delivery of SGA infants.
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Pamidi
authors.affiliation: Departement de Pédiatrie, Centre Hospitalier de l'Université Laval, Québec, Québec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marc
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Simoneau
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lavigne
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Allen
authors.initials: A
authors.lastname: Olha
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Departement de Pneumology, Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sériès
authors.affiliation: Hôpital Ste-Justine, Centre de recherche, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Fraser
authors.affiliation: Hôpital Ste-Justine, Centre de recherche, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Audibert
authors.affiliation: Departement de Pédiatrie, Centre Hospitalier de l'Université Laval, Québec, Québec, Canada.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.affiliation: Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Gagnon
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: R John
authors.initials: RJ
authors.lastname: Kimoff
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009864:Ontario; D017286:Polysomnography; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D011792:Quebec; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis; D011795:Surveys and Questionnaires
keywords: Clinical Epidemiology; Sleep apnoea