Enuretic children are described as difficult to arouse from sleep. We studied auditory sleep arousal thresholds in enuretic boys and report on the clinical implications of these findings. Fifteen enuretic and 18 control subjects (7-12-year-old males) were studied in a sleep laboratory for four consecutive nights using standard polysomnographic recording techniques. Sleep was undisturbed for the initial two nights and waking thresholds were measured on the following two nights. Enuretic children wet most frequently in the first two-thirds of the night. Arousal attempts were successful 39.7% of the time in controls and only 9.3% of the time in enuretics. In conclusion, enuretic males were more difficult to arouse than age-matched controls. The elevated arousal thresholds may be due to delayed maturation. Treatment programmes that rely on awakening should be aware of these features.
Developmental variations in auditory arousal thresholds during sleep were investigated in four groups of normal male subjects--children, preadolescents, adolescents, and young adults. Arousal thresholds were determined during NREM and REM sleep for tones presented via earphone insert on a single night following two adaptation nights of undisturbed sleep. Age-related relationships were observed for both awakening frequency and stimulus intensity required to effect awakening, with awakenings occurring more frequently in response to lower stimulus intensities with increasing age. Although stimulus intensities required for awakening were high and statistically equivalent across sleep stages in nonadults, higher intensity stimuli were required in Stage 4 relative to Stage 2 and REM sleep in adults. These results confirm previous observations of marked resistance to awakening during sleep in preadolescent children and suggest that processes underlying awakening from sleep undergo systematic modification during ontogenetic development.
Auditory arousal thresholds were determined throughout sleep (4-night protocol) in prepubertal nonmedicated and medicated hyperkinetic and normal control male children. The most striking result was the general inability to arouse children of all groups to behavioral response even at intensities up to 123 dB sound pressure level. Of total awakening attempts, 52.5% resulted in non-arousal, 13% resulted in partial, nonsustained physiological arousal responses, and 34.3% were associated with complete awakenings. A significant increase in proportion of awakenings and decrease in the frequency of nonarousals occurred across the night. The groups did not differ with respect to the number of arousal responses. Although nonmedicated hyperkinetic children tended to have lower arousal thresholds relative to children in both comparison groups, the only significant group difference was a lower threshold response in nonmedicated, relative to medicated, hyperkinetic subjects during stage 2 sleep. Arousal thresholds in hyperkinetic children receiving stimulant medication approximated those of normal control children. The enhanced sensitivity of nonmedicated hyperkinetic subjects to auditory stimuli during sleep is interpreted as indicating that processes responsible for elevating arousal threshold at this time are less effective in these children.
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