Enuresis Associated with Sleep Disordered Breathing in Children with Sickle Cell Anemia

Abstract

Purpose Enuresis and sleep disordered breathing are common among children with sickle cell anemia. We evaluated whether enuresis is associated with sleep disordered breathing in children with sickle cell anemia. Materials and Methods Baseline data were used from a multicenter prospective cohort study of 221 unselected children with sickle cell anemia. A questionnaire was used to evaluate, by parental report during the previous month, the presence of enuresis and its severity. Overnight polysomnography was used to determine the presence of sleep disordered breathing by the number of obstructive apneas and/or hypopneas per hour of sleep. Logistic and ordinal regression models were used to evaluate the association of sleep disordered breathing and enuresis. Results The mean age of participants was 10.1 years (median 10.0, range 4 to 19). Enuresis occurred in 38.9% of participants and was significantly associated with an obstructive apnea-hypopnea index of 2 or more per hour after adjusting for age and gender (OR 2.19; 95% CI 1.09, 4.40; p = 0.03). Enuresis severity was associated with obstructive apneas and hypopneas with 3% or more desaturation 2 or more times per hour with and without habitual snoring (OR 3.23; 95% CI 1.53, 6.81; p = 0.001 and OR 2.07; 95% CI 1.09, 3.92; p = 0.03, respectively). Conclusions In this unselected group of children with sickle cell anemia, sleep disordered breathing was associated with enuresis. Results of this study support that children with sickle cell anemia who present with enuresis should be evaluated by a pulmonologist for sleep disordered breathing.

Nocturnal Enuresis in Children and Adolescent with Sickle cell Anemia

“…The prevalence rate of NE in children with SCA decreases with increasing age from 29.7% at age 4-8 years to 9% at age 18-20 years ( Figure 1) [6,9,10,12,16,17,19,20]. A similar trend was also observed in enuretic normal children [26][27][28][29][30].…”

“…The effect of gender on the prevalence rate of NE was reported by 12 studies. Boys were reported by 10 studies to have higher prevalence rate than girls [6,[9][10][11][12]15,16,[19][20][21], equal rates in both sexes was reported by one study [13] and one study reported a higher rate in females [17]. These findings are similar to those reported in normal children with NE [28,[30][31][32][33][34][35].…”

“…The presence of enuresis, after adjusting for age and gender, was associated with OAHI ≥ 2 (OR 2.19; 95% CI 1.09, 4.40; p=0.03). After adjusting for age and gender, the association of habitual snoring alone and severe enuresis (≥ 3 wetting per night) among children with SCA was statistically significant (OR 1.83; 95% CI 1.02, 3.29; p=0.043) [20]. The authors suggested that in an enuretic child with SCA and snoring with adenotonsillar hypertrophy a formal sleep test should be performed; if SDB is detected then adenotonsillectomy would be the next line of therapy as recommended by the American academy of pediatrics [85].…”

“…SCA were retrieved after thorough literature search (Table 1A-1C) [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. We categorized these articles in 3 groups according to the criteria used to define NE.…”

“…Group 3 (Table 1c): These are the studies that used different diagnostic criteria, they reported a prevalence rate of 32.2%-68.9% [4,[16][17][18][19][20][21][22][23][24][25].…”