Psychosomatic comorbid conditions in children with enuresis

Abstract

Enuresis is a considerable medical and socio-psychological problem. The pathophysiology of enuresis remains unknown; none of the existing theories can explain its nature in full. The article reviews the studies devoted to the role of obstructive sleep disturbances in the occurrence of enuresis. The mentioned sleep disturbances in children are associated with other related disorders: pulmonary hypertension, developmental delay, sleepwalking, attention deficit and hyperactivity disorder, obstructive sleep apnea syndrome and enuresis. Numerous studies confirm the correlation of the mentioned syndromes. The obstruction of the upper respiratory tract during sleep is accompanied by an increase in the efforts of the respiratory muscles and negative intrathoracic pressure, which is associated with high atrial natriuretic peptide and low antidiuretic hormone levels. In most cases the surgical removal of respiratory tract obstruction (adenotonsillectomy) leads to significant improvement or complete resolution of enuresis. This category of patients requires a comprehensive interdisciplinary approach to the examination and treatment by the pediatricians, psycho-neurologists and ENT specialists.