Sleep apnea in children with refractory monosymptomatic nocturnal enuresis

Abstract

BackgroundChildren with nocturnal enuresis (NE) are believed to have deep sleep with high arousal threshold. Studies suggest that obstructive sleep apnea–hypopnea syndrome (OSAHS) and NE are common problems during childhood. We sought to assess the prevalence of OSAHS in children with refractory NE and whether its severity is associated with the frequency of bedwetting.MethodsThe study group comprised 43 children with refractory monosymptomatic NE and a control group of 30 children, both aged 6–12 years. All subjects underwent thorough neurological examination, one night of polysomnography only for the patient group, and a lumbosacral plain X-ray to exclude spina bifida.ResultsThe groups were well matched. Two subjects of the control group had mild OSAHS. The mean age of the patients was (9.19±2.4 years), 26 were boys, and 67% showed frequent NE (>3 days bedwetting/week). Patients with NE had significantly higher rates of OSAHS (P<0.0001); three patients had mild, 12 had moderate, and eleven showed severe OSAHS. There was no significant statistical difference among patients having OSAHS in relation to age, sex, or family history of NE. The frequency of bedwetting was statistically significantly higher in patients with severe OSAHS (P=0.003).ConclusionPatients with refractory NE had a significantly higher prevalence of OSAHS with no sex difference. The frequency of bedwetting was higher in patients with severe OSAHS.

Sleep-Disordered Breathing in Children

“…Nocturnal secondary enuresis, defined as nighttime incontinence, which emerges after at least 6 months of continence, is also suggestive of SDB. (12)…”

Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India

“…Our study further confirmed a high prevalence of OSA in patients with MNE (21.9%) as compared to the general pediatric population (8.9%). Moreover, previous studies have also shown a significant higher rates of OSA in patients with refractory nocturnal enuresis[ 23 ]. Thus, the study findings suggests that it is imperative to screen the children with MNE for the presence of symptoms of OSA by appropriate scales, as the patients of MNE with concomitant OSA may require different therapeutic interventions.…”

“…A study by Alexopoulos, et al found that 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). Another study using overnight polysomnography in 43 children with MNE against 30 controls reported, higher prevalence of OSA in children with refractory NE[ 23 ]. Waleed, et al in a hospital based study, diagnosed sleep disordered breathing in 30.4% of enuretic children with a downgrade trend of enuresis and SRBD with increasing age[ 8 ].…”

Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography

“…However, many parents consider it a normal behaviour during sleep in childhood. Further nocturnal symptoms are profuse sweating, which may be related with laboured breathing, and nocturnal secondary enuresis, very pathognomonic for severe OSAS [ 30 ]. Night terror and sleepwalking during slow-wave sleep may occur in children and adolescents with a positive family history of parasomnias [ 31 ].…”