Does maternal asthma contribute to racial/ethnic disparities in obstetrical and neonatal complications?

PURPOSE: To examine whether maternal asthma contributes to racial/ethnic differences in obstetrical and neonatal complications. METHODS: Data on white (n = 110,603), black (n = 50,284), and Hispanic (n = 38,831) singleton deliveries came from the Consortium on Safe Labor. Multilevel logistic regression models, with an interaction term for asthma and race/ethnicity, estimated within-group adjusted odds ratios (aORs) for gestational diabetes, gestational hypertension, pre-eclampsia, placental abruption, premature rupture of membranes, preterm delivery, maternal hemorrhage, neonatal intensive care unit admissions, small for gestational age, apnea, respiratory distress syndrome, transient tachypnea of the newborn, anemia, and hyperbilirubinemia after adjustment for clinical and demographic confounders. Nonasthmatics of the same racial/ethnic group were the reference group. RESULTS: Compared with nonasthmatics, white asthmatics had increased odds of pre-eclampsia (aOR, 1.28; 95% confidence interval [CI], 1.15-1.43) and maternal hemorrhage (aOR, 1.14; 95% CI, 1.04-1.23). White and Hispanic infants were more likely to have neonatal intensive care unit admissions (aOR, 1.19; 95% CI, 1.11-1.28; aOR, 1.16; 95% CI, 1.02-1.32, respectively) and be small for gestational age (aOR, 1.11; 95% CI, 1.02-1.20; aOR, 1.26; 95% CI, 1.10-1.44, respectively), and Hispanic infants were more likely to have apnea (aOR, 1.32; 95% CI, 1.02-1.69). CONCLUSIONS: Maternal asthma did not affect most obstetrical and neonatal complication risks within racial/ethnic groups. Despite their increased risk for both asthma and many complications, our findings for black women were null. Asthma did not contribute to racial/ethnic disparities in complications.

The Epworth Sleepiness Scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth Sleepiness scores of adults in New Zealand.

STUDY OBJECTIVES: To examine possible relationships between excessive sleepiness (Epworth Sleepiness Scale score >10), and age, sex, ethnicity, socioeconomic deprivation, usual sleep, and self-reported symptoms of obstructive sleep apnea. DESIGN: Mail-out survey to a stratified random sample of 10,000 people aged 30 to 60 years, selected from the electoral roll. SETTING: Nationwide survey of adults in New Zealand (71% response rate). PARTICIPANTS: The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each age decade. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Two-page questionnaire. Maori participants had higher mean Epworth Sleepiness Scale scores than non-Maori (7.5 versus 6.0) and were more likely to have an Epworth Sleepiness Scale score of more than 10. Logistic multiple regression modeling identified the following significant independent risk factors for having an Epworth Sleepiness Scale score >10: being Maori, male, older, reporting more or less than 7.5 to 8.0 hours usual sleep, never or rarely getting enough sleep, never or rarely waking refreshed, larger neck circumference, observed apneas, and not drinking alcohol (compared with moderate alcohol consumption). CONCLUSIONS: The relationships between an Epworth Sleepiness Scale score >10 and sleep habits and risk factors for obstructive sleep apnea are as expected. The relationships between an ESS score > 10 and being Maori, a man, older, or more socioeconomically deprived could be related to a higher prevalence of sleep disorders in these groups. However, more research is needed to understand possible differences not only in pathophysiologic processes, but also in the wider societal trends and pressures that may impact differentially on sleep and sleepiness.

Effect of ethnicity on sleep: complexities for epidemiologic research.

STUDY OBJECTIVES: The goal of this study was to examine whether there were ethnic differences in polysomnographically recorded sleep, either in the controlled laboratory environment or in the home setting. DESIGN: Prospective study of ethnic differences in stress physiology and sleep. SETTING: Two sleep recordings were performed on consecutive nights in a hospital-based sleep laboratory, followed 1 to 4 weeks later by a third sleep recording in the subject's home. PARTICIPANTS: 51 employed healthy adult subjects, aged 15 to 50 years. 24 self-identified as black, and 27 as white. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Blacks had less slow wave sleep than did whites in both the sleep laboratory and in the home. Blacks had significantly more slow wave sleep at home compared to the hospital setting, while the reverse was true for whites. This location-by-ethnicity interaction could not be accounted for by depression ratings or social class. CONCLUSIONS: The home setting is generally considered to be more ecologically valid than the controlled hospital-based laboratory setting for the monitoring of sleep. These data suggest that ethnicities may respond differentially to the sleeping environment. This observation may need to be taken into account in future epidemiologic studies of sleep.

Caffeine in apnoeic Asian neonates: a sparse data analysis.

AIMS: To monitor plasma caffeine concentrations and adverse effects and to study the pharmacokinetics of caffeine in neonatal apnoea in the local Asian population after intravenous administration of caffeine. METHODS: Eighteen neonates with apnoea were treated with caffeine citrate at a loading dose of 10 mg caffeine base kg-1 and a maintenance dose of 2.5 mg kg-1 day-1. Blood samples, three after loading and two after the maintenance dose on day 2, 3, 7, 14 and 21 were taken and analysed for caffeine and its main metabolites using solid phase extraction and h.p.l.c. Adverse effects were monitored. Sparse data pharmacokinetic analysis was performed using P-Pharm. RESULTS: Mean caffeine concentrations varied from 10 to 20 mg l-1 throughout treatment (range 3.6-28.4 mg l-1). These concentrations were efficacious; less so in those with lower concentrations. Adverse effects included gastrointestinal disturbances, diuresis and hyperglycaemia. Pharmacokinetic parameter estimates [mean (coefficient of variation%)] were CL=0.00628 (17.5%) l h-1 and V=0.961 (20.3%) l. CL (l h-1)=0.004248 * wt(kg)+0.00154; r=0.8, P<0.01, explained 64% of the variation. V (l)=0.6299 * wt(kg)+0.259; r=0.67, P<0.01, explained 45% of variation. Model-predicted compared with observed plasma concentrations in a separate group of 10 neonates were unbiased and of good precision. CONCLUSIONS: The dosing regimen studied was suitable for our local Asian neonates as it resulted in therapeutic caffeine concentrations for adequate treatment of apnoea. Adverse effects were tolerable. Therefore, to avoid a higher incidence of adverse effects, this regimen should be retained and not increased as proposed by other workers. CL and V were within values of those reported for neonatal apnoea. Sparse data analysis showed that weight alone was adequate as the influential variable for the accurate prediction of individual pharmacokinetic parameters, plasma concentrations and for dosage adjustment if required.