Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring

Abstract

Background: Conflicting data suggest that prevalence of monosymptomatic primary nocturnal enuresis (NE) increases with increasing severity of obstructive sleep apnea (OSA) in childhood and especially in girls. We hypothesized that NE is associated with increased risk of moderate-to-severe OSA (obstructive apnea-hypopnea index (AHI) >5 episodes/hour) among children with snoring. Methods: Data of children (≥5 y old) with snoring who were referred for polysomnography over 12 y were reviewed. results: Data of 525 children with mean age (±SD) 7.5 (± 2.2) y and median obstructive AHI (10th-90th percentiles) 1.9 (0.4-7.3) episodes/hour were analyzed. Three hundred and fifty-five children (67.6%) had NE and 87 (16.6%) had moderate-to-severe OSA. There was no interaction between NE and gender regarding the association with moderate-to-severe OSA (P > 0.05). NE was associated significantly with presence of moderate-to-severe OSA after adjustment for tonsillar hypertrophy, obesity, gender, and age (adjusted odds ratio = 1.92 (1.08-3.43); P = 0.03). Presence of NE had high sensitivity (78.2%) and low positive predictive value (19.2%) for detecting moderate-to-severe OSA and low specificity (34.5%) and high negative predictive value (88.8%) for ruling it out. conclusion: Children with snoring and without NE referred for polysomnography are less likely to have moderate-tosevere OSA compared to those with NE.

CPAP Treats Enuresis in Adults With Obstructive Sleep Apnea

“…Proposed mechanisms for the association between OSA and enuresis include direct mechanical pressure against the bladder that occurs with breathing against an obstructed airway, as well as indirect influence of hormones, such as natriuretic peptides, which are released in response to hemodynamic changes occurring in OSA. 3,4 Obesity is another important risk factor, with studies demonstrating an association with UI in both men and women, and improvement in UI after weight loss. 15 Obesity is also a strong risk factor for OSA, but likely contributes independently of OSA toward UI and enuresis by increasing intra-abdominal pressure and pressure on the bladder.…”

“…[1][2][3][4] In children, enuresis has a higher prevalence among those who have OSA, correlates with disease severity on polysomnography (PSG), and often resolves with treatment of OSA by adenotonsillectomy. 5,6 The reported prevalence of enuresis in adults varies widely, depending on how enuresis is clinically defined and on the population studied.…”

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…Enuresis and somatic growth delay or growth failure a) Three class IV studies support an association between frequency of nocturnal enuresis and SDB severity [106][107][108]. Resolution or decreased frequency of enuresis after treatment of SDB is indicative of an aetiological relationship between the two conditions as suggested by a systematic review [109].…”

“…Primary nocturnal enuresis among children with snoring referred for polysomnography is a significant predictor of OSAS severity (class IV) [106]. However, neither the AHI nor sophisticated measures of sleep fragmentation, such as respiratory cycle-related electroencephalogram (EEG) changes, are associated with behavioural problems, cognitive deficits or sleepiness, and they do not explain the improvement in neurobehavioral outcomes following adenotonsillectomy (meta-analysis, class III and IV) [92,145,149,150].…”

Urological Manifestations of Obstructive Sleep Apnea Syndrome: A Review of Current Literature

“…Nocturnal enuresis and OSA tend to be common conditions during adolescence, which is accompanied with bedwetting due to OSA severity [66]. Nocturnal enuresis severity increases as severity of OSA increases, especially in female children [67].…”