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1.
Pediatr Pulmonol ; 54(5): 551-556, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30672145

RESUMO

OBJECTIVES: Although progress has been made in the standardized interpretation of nocturnal oximetry in children with obstructive sleep-disordered breathing (SDB), no evidence exists on oximetry abnormalities in other respiratory disorders. We aimed to compare obstructive lung disease (OLD) and SDB regarding nocturnal oximetry parameters. METHODS: We analyzed oximetry recordings from children with (i) OLD (obliterative bronchiolitis; cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared regarding: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate. RESULTS: Data of 16 subjects with OLD (median age: 7.3 years; Q25, Q75: 5.4, 12), 22 children with SDB (6.3 years; 4, 9) and 22 controls (6.8 years; 5.6, 10.3) were analyzed. Children with OLD or SDB had significantly lower basal SpO2 than controls (91.9% [90.8, 93.4] vs 96.3% [96, 97.4] vs 97.6% [97.1, 97.9]; P < 0.01). No subjects in the SDB or control groups had basal SpO2 < 95%. Children with SDB had significantly higher ODI3 than children with OLD or controls [8.4 episodes/h (6.2, 16.6) vs 4.4 episodes/h (3.6, 6.6) vs 2 episodes/h (1.3, 2.7); P < 0.01]. OLD had the greatest negative effect on basal SpO2 (R2 = 0.62; P < 0.001) and SDB the greatest positive effect on ODI3 (R2 = 0.34; P < 0.001). CONCLUSION: OLD is associated mostly with reduced basal SpO2 , whereas SDB is characterized by elevated ODI3.


Assuntos
Bronquiolite Obliterante/diagnóstico , Fibrose Cística/diagnóstico , Oximetria/métodos , Apneia Obstrutiva do Sono/diagnóstico , Ronco/diagnóstico , Tonsila Faríngea , Adolescente , Bronquiolite Obliterante/metabolismo , Criança , Pré-Escolar , Fibrose Cística/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Hipertrofia , Lactente , Masculino , Tonsila Palatina , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/metabolismo , Apneia Obstrutiva do Sono/metabolismo , Ronco/metabolismo
2.
Eur Respir J ; 50(6)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29217599

RESUMO

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Adenoidectomia , Comitês Consultivos , Pressão Positiva Contínua nas Vias Aéreas , Síndrome de Down/complicações , Europa (Continente) , Humanos , Lactente , Oximetria , Polissonografia , Guias de Prática Clínica como Assunto , Síndrome de Prader-Willi/complicações , Índice de Gravidade de Doença , Ronco/etiologia , Sociedades Médicas , Tonsilectomia
3.
Pediatr Pulmonol ; 52(3): 399-412, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28029756

RESUMO

Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.


Assuntos
Apneia Obstrutiva do Sono/cirurgia , Ronco/terapia , Adenoidectomia , Asma/complicações , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Criança , Transtornos do Comportamento Infantil/etiologia , Disfunção Cognitiva/etiologia , Fadiga/etiologia , Transtornos do Crescimento/etiologia , Frequência Cardíaca/fisiologia , Humanos , Síndrome Metabólica/complicações , Enurese Noturna/etiologia , Otite Média/complicações , Qualidade de Vida , Sons Respiratórios , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/etiologia , Volume Sistólico/fisiologia , Tonsilectomia
4.
Eur Respir J ; 47(1): 69-94, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26541535

RESUMO

This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).


Assuntos
Adenoidectomia/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Apneia Obstrutiva do Sono/terapia , Tonsilectomia/métodos , Adolescente , Criança , Comorbidade , Gerenciamento Clínico , Progressão da Doença , Síndrome de Down/epidemiologia , Humanos , Polissonografia , Síndrome de Prader-Willi/epidemiologia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
5.
JAMA Otolaryngol Head Neck Surg ; 140(10): 944-50, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25211287

RESUMO

IMPORTANCE: Cysteinyl leukotrienes (CysLTs) potentially promote adenotonsillar hypertrophy in children with obstructive sleep apnea (OSA). Previous studies have identified CysLTs and their receptors in tonsillar tissue from children with OSA. OBJECTIVE: To demonstrate expression of the leukotriene biosynthetic enzymes 5-lipoxygenase (5-LO), 5-lipoxygenase activating protein (FLAP), leukotriene A(4) hydrolase (LTA(4)H), and leukotriene C(4) synthase (LTC(4)S) in T and B tonsillar lymphocytes from pediatric patients with OSA. It was hypothesized that children with OSA have greater expression of biosynthetic enzymes for CysLTs (5-LO, FLAP, and LTC(4)S) in their tonsillar tissue than do children with recurrent tonsillitis (RT), who were enrolled as controls. DESIGN, SETTING, AND PARTICIPANTS: This prospective, nonrandomized study was performed at a tertiary care university hospital on 13 children with OSA and adenotonsillar hypertrophy undergoing adenotonsillectomy and 12 children without OSA also undergoing tonsillectomy for RT. Tonsillar tissue from children with OSA or RT was examined for 5-LO, FLAP, LTA(4)H, and LTC(4)S expression under real time-quantitative polymerase chain reaction (RT-qPCR), flow cytometry (FC), and confocal laser scanning microscopy (CM). MAIN OUTCOMES AND MEASURES: Expression of biosynthetic enzymes for CysLTs (5-LO, FLAP, and LTC(4)S) was the main outcome measure. Patients with OSA and control patients with RT were compared for numbers of copies of 5-LO, FLAP, and LTC(4)S messenger RNA (by RT-qPCR) in T or B tonsillar lymphocytes and proportions of CD3(+) or CD19(+) tonsillar lymphocytes that expressed 5-LO, FLAP, and LTC(4)S (by FC). RESULTS: Messenger RNA for all 4 enzymes was detected in T and B lymphocytes from both study groups, and expression of all biosynthetic enzymes was demonstrated in participants with OSA and RT by FC. Patients with OSA differed from controls in the proportions (median [10th-90th percentile]) of LTC(4)S(+) CD3(+) T lymphocytes (23.31% [8.64%-50.07%] vs 10.81% [3.48%-23.32%], respectively) (P = .01) and LTC(4)S(+) CD19(+) B lymphocytes (20.66% [14.62%-65.77%] vs 12.53% [2.87%-36.64%], respectively) (P = .01) detected by FC. Immunoreactivity for the 4 enzymes was detected by CM in B lymphocytes of mantle zones and T lymphocytes of extrafollicular areas. CONCLUSIONS AND RELEVANCE: Leukotriene biosynthetic enzymes are expressed in tonsillar lymphocytes, and the previously reported detection of CysLTs in tonsillar tissue from children with OSA may be attributed to endogenous synthesis. Enhanced expression of LTC(4)S is a potential target for pharmacologic interventions in OSA.


Assuntos
Cisteína/metabolismo , Leucotrienos/metabolismo , Tonsila Palatina/enzimologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/enzimologia , Proteínas Ativadoras de 5-Lipoxigenase/metabolismo , Adenoidectomia , Araquidonato 5-Lipoxigenase/metabolismo , Linfócitos B/enzimologia , Criança , Epóxido Hidrolases/metabolismo , Feminino , Citometria de Fluxo , Glutationa Transferase/metabolismo , Humanos , Hipertrofia , Masculino , Microscopia Confocal , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Polissonografia , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Inquéritos e Questionários , Linfócitos T/enzimologia , Tonsilectomia
6.
Eur Respir J ; 43(1): 145-55, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23598957

RESUMO

In obese males obstructive sleep apnoea (OSA) is associated with inflammation and insulin resistance; however, findings are confounded by adipose tissue, a hormone- and cytokine-secreting organ. Our goal was to examine whether in a relatively nonobese population, OSA is associated with sleepiness and inflammation/insulin resistance, and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (CPAP) use. 77 subjects, 38 middle-aged males and post-menopausal females with OSA and 39 male and female controls, were studied in the sleep laboratory for 4 nights. Measures of sleepiness (objective and subjective), performance, serial 24-h blood samples for interleukin (IL)-6, tumour necrosis factor receptor (TNFR)-1, leptin and adiponectin, and single samples for high-sensitivity C-reactive protein (hsCRP), fasting glucose and insulin levels were obtained. Apnoeic males were significantly sleepier and had significantly higher hsCRP, IL-6, leptin and insulin resistance than controls. Apnoeic females had significantly higher hsCRP; however, objective sleepiness, IL-6, TNFR-1, insulin resistance (Homeostatic Model Assessment index), leptin and adiponectin were similar to controls. CPAP improved subjective sleepiness, but no changes were observed in any of the biomarkers. In conclusion, OSA is associated with sleepiness, inflammation and insulin resistance, even in nonobese males, and this association is stronger in males than in females. Short-term CPAP does not improve the inflammatory/metabolic aberrations in OSA.


Assuntos
Inflamação , Resistência à Insulina , Apneia Obstrutiva do Sono/imunologia , Adiponectina/metabolismo , Glicemia/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/imunologia , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Insulina/metabolismo , Interleucina-6/imunologia , Leptina/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores Tipo I de Fatores de Necrose Tumoral/imunologia , Fatores Sexuais , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
7.
Am J Physiol Endocrinol Metab ; 305(7): E890-6, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-23941878

RESUMO

One workweek of mild sleep restriction adversely impacts sleepiness, performance, and proinflammatory cytokines. Many individuals try to overcome these adverse effects by extending their sleep on weekends. To assess whether extended recovery sleep reverses the effects of mild sleep restriction on sleepiness/alertness, inflammation, and stress hormones, 30 healthy young men and women (mean age ± SD, 24.7 ± 3.5 yr; mean body mass index ± SD, 23.6 ± 2.4 kg/m(2)) participated in a sleep laboratory experiment of 13 nights [4 baseline nights (8 h/night), followed by 6 sleep restriction nights (6 h/night) and 3 recovery nights (10 h/night)]. Twenty-four-hour profiles of circulating IL-6 and cortisol, objective and subjective daytime sleepiness (Multiple Sleep Latency Test and Stanford Sleepiness Scale), and performance (Psychomotor Vigilance Task) were assessed on days 4 (baseline), 10 (after 1 wk of sleep restriction), and 13 (after 2 nights of recovery sleep). Serial 24-h IL-6 plasma levels increased significantly during sleep restriction and returned to baseline after recovery sleep. Serial 24-h cortisol levels during restriction did not change compared with baseline, but after recovery they were significantly lower. Subjective and objective sleepiness increased significantly after restriction and returned to baseline after recovery. In contrast, performance deteriorated significantly after restriction and did not improve after recovery. Extended recovery sleep over the weekend reverses the impact of one work week of mild sleep restriction on daytime sleepiness, fatigue, and IL-6 levels, reduces cortisol levels, but does not correct performance deficits. The long-term effects of a repeated sleep restriction/sleep recovery weekly cycle in humans remain unknown.


Assuntos
Hidrocortisona/sangue , Interleucina-6/sangue , Desempenho Psicomotor/fisiologia , Privação do Sono/sangue , Sono/fisiologia , Vigília/fisiologia , Adolescente , Adulto , Nível de Alerta/fisiologia , Atenção/fisiologia , Fadiga/sangue , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Polissonografia , Tempo de Reação/fisiologia , Privação do Sono/fisiopatologia
8.
J Pediatr ; 162(2): 269-74.e4, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22939928

RESUMO

OBJECTIVE: To analyze age-associated changes in linear and cross-sectional area (CSA) measurements of adenoid, tonsils, and pharyngeal lumen. STUDY DESIGN: Measurements were completed in head magnetic resonance imaging examinations performed for diagnostic purposes. Linear and nonlinear regression models were applied to describe the effect of age on the size of soft tissues and upper airway. RESULTS: Magnetic resonance imaging data were analyzed in 149 children without snoring (aged 0-15.9 years) and in 33 children with snoring (aged 1.6-15 years). In the children without snoring, adenoid size increased during the first 7-8 years of life and then decreased gradually [% (adenoid oblique width/mental spine-clivus length) = 11.38 + 1.52 (age) - 0.11 (age)(2), R(2) = 0.22, P < .01; adenoid CSA = 90.75 + 41.93 (age) - 2.47 (age)(2); R(2) = 0.50; P < .01]. Nasopharyngeal airway CSA increased slowly up to age 8 years and rapidly thereafter. Similar patterns were noted for the tonsils and oropharyngeal airway. In contrast, in children with snoring, adenoid and tonsils were large irrespective of age, and nasopharyngeal airway size increased slowly with age. CONCLUSIONS: In children without snoring, growing adenotonsillar tissue narrows the upper airway lumen to variable degrees only during the first 8 years of life. In contrast, in children with snoring, appreciable pharyngeal lymphoid tissue enlargement is present during the preschool years and persists beyond the eighth birthday.


Assuntos
Tonsila Faríngea/crescimento & desenvolvimento , Tonsila Palatina/crescimento & desenvolvimento , Síndromes da Apneia do Sono/etiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tamanho do Órgão , Síndromes da Apneia do Sono/complicações , Ronco/etiologia , Inquéritos e Questionários
9.
Sleep Med ; 13(7): 879-85, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22647498

RESUMO

OBJECTIVES: Cysteinyl leukotrienes have been implicated in the pathogenesis of adenotonsillar hypertrophy in children with obstructive sleep apnea (OSA). This study aimed to quantify the expression of cysteinyl leukotriene receptors (CysLT(1), CysLT(2)) by tonsillar lymphocyte subpopulations from children with OSA and to make comparisons to lymphocyte subpopulations from control subjects with recurrent tonsillitis (RT). METHODS: Tonsillar tissue from children with OSA or RT was studied for CysLT(1) and CysLT(2) expression by RT-PCR, flow cytometry (FC), and immunofluorescence. RESULTS: Ten children with OSA and 10 control subjects were recruited. In OSA participants, CysLT(1)+ fraction of small-size CD19+ B-lymphocytes was similar to the CysLT(1)+ CD3+ T-lymphocytes fraction (FC: 36.5 [16.5-55.4] vs. 14 [2.8-22.1]) (p>0.05) and higher than the CysLT(1)+ moderate/large-size CD19+ B-lymphocytes fraction (6.6 [1.5-14.4]) (p<0.01). Similar trends were recognized for CysLT(2). CysLT(1) and CysLT(2) immunoreactivity was detected by immunofluorescence in the tonsillar mantle zones (small B-lymphocytes) and the extrafollicular areas (T-lymphocytes). Compared to subjects with RT, children with OSA had significantly higher expression of CysLT(1) in small-size CD19+ B-lymphocytes (FC) and in CD3+ T-lymphocytes (RT-PCR and FC) (p<0.05). CONCLUSIONS: Increased expression of leukotriene receptors by immunologically active tonsillar areas in children with OSA is a potential therapeutic target for pediatric sleep apnea.


Assuntos
Linfócitos B/química , Tonsila Palatina/química , Receptores de Leucotrienos/análise , Apneia Obstrutiva do Sono/complicações , Linfócitos T/química , Estudos de Casos e Controles , Criança , Citometria de Fluxo , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Tonsila Palatina/imunologia , Polissonografia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Apneia Obstrutiva do Sono/imunologia , Tonsilite/imunologia
10.
Nutr Clin Pract ; 26(5): 598-606, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21947643

RESUMO

BACKGROUND: Previous studies demonstrated the beneficial impact of the Mediterranean diet (MedDiet) on metabolic syndrome (MetS). The aim of this study was to retrospectively investigate the association between MedDiet and MetS in a representative sample of the Athenian population in the early 1980s, when MetS had not been established as an entity yet. METHODS: In a cross-sectional epidemiologic survey of cardiovascular disease (CVD), 2,074 randomly selected adults were examined: 900 men and 1,174 women (age, 46.9 ± 14.9 years). MetS was defined according to criteria of the National Cholesterol Education Program-Adult Treatment Panel III. A validated questionnaire concerning nutrition habits was administered, and MedDiet was assessed according to guidelines of the Division of Nutrition/Epidemiology, Athens University Medical School. RESULTS: Overall, 1,023 participants (49.3%) followed MedDiet (47.3% men, 52.0% women, P = .033) with similar rates across age groups (P = .337). MetS was diagnosed in 24.0% of those following MedDiet, compared with 27.9% of those not following it (P = .041). Participants with CVD or diabetes mellitus were less likely to follow MedDiet (43% vs 50%, P = .009). Multivariate analysis revealed that MedDiet is associated with a 20% reduction in MetS (odds ratio = 0.80, 95% confidence interval = 0.65-0.98), after adjustment for age, gender, smoking, light physical activity, serum levels of low-density lipoprotein cholesterol and γ-glutamyl transferase, diabetes mellitus, CVD, family history of hypertension, and/or hyperlipidemia. CONCLUSIONS: Results indicate that adherence to MedDiet may attenuate the prevalence of MetS and, consequently, the increasing burden of diabetes mellitus and CVD, especially in urban populations.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Mediterrânea , Comportamento Alimentar , Síndrome Metabólica/prevenção & controle , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/prevenção & controle , Inquéritos sobre Dietas , Feminino , Grécia/epidemiologia , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Inquéritos e Questionários , População Urbana
11.
J Clin Sleep Med ; 6(3): 264-9, 2010 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-20572420

RESUMO

STUDY OBJECTIVES: 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. CONCLUSION: 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.


Assuntos
Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Grupos Raciais/estatística & dados numéricos , Síndromes da Apneia do Sono/epidemiologia , Causalidade , Criança , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Mães , Razão de Chances , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Pennsylvania/epidemiologia , Polissonografia/métodos , Gravidez , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários
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