Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

Abstract

Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p˂0.01). Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Weak clinical effect of airway clearance on ADH and BNP concentration: mechanism or data collection BIAS

“…The improvement shown for nocturnal enuresis in the study by Ribeiro et al ( 5 ) was clinically very large (d=1.50) compared to the effects of surgery on the concentration of ADH (d=0.38) and BNP (d=0, 32), which are considered small clinical effects, even the comparison before and after BNP being significant from the probabilistic point of view.…”

“…The study by Ribeiro et al ( 5 ), published in this journal in issue 48 ( 6 ), presents interesting results on enuresis. However, we bring an analysis based on clinical effect measurement to complement the probabilistic analysis presented by the authors.…”

Treating asthma in patients with enuresis: repercussions on urinary symptoms

“…The association between enuresis and SDB has already been demonstrated in several studies (6)(7)(8)(9). Various studies have shown resolution of two thirds or more of the cases of enuresis following surgical resolution of SDB through an adenoidectomy, with or without tonsillectomy (6)(7)(8)(9).…”

“…In addition, partial or complete UAO events in SDB, micro-recurrent awakenings caused by obstruction of the upper airways lead to an increased threshold of awakening and stimulation such as bladder filling or contractions of the detrusor muscle become ineffective. ( 9 , 10 ).…”

The effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of monosymptomatic enuresis in children and adolescents: a systematic review

“…The exact etiology of enuresis is not yet fully understood. It is considered multifactorial (1,2,(6)(7)(8)(9)(10)(11). One of the main factors involved in the pathophysiology of enuresis are hereditary factors (1,2,(4)(5)(6).…”