Sleep deprivation induces excess diuresis and natriuresis in healthy children

Abstract

Urine production is reduced at night, allowing undisturbed sleep. This study was undertaken to show the effect of sleep deprivation (SD) on urine production in healthy children. Special focus was on gender and children at an age where enuresis is still prominent. Twenty healthy children (10 girls) underwent two 24-h studies, randomly assigned to either sleep or SD on the first study night. Diet and fluid intake were standardized. Blood samples were drawn every 4 h during daytime and every 2 h at night. Urine was fractionally collected. Blood pressure and heart rate were noninvasively monitored. Blood was analyzed for plasma antidiuretic hormone (AVP), atrial natriuretic peptide (ANP), angiotensin II, aldosterone, and renin. Urine was analyzed for aquaporin-2 and PGE(2). Successful SD was achieved in all participants with a minimum of 4 h 50 min, and full-night SD was obtained in 50% of the participants. During SD, both boys and girls produced markedly larger amounts of urine than during normal sleep (477 ± 145 vs. 291 ± 86 ml, P < 0.01). SD increased urinary excretion of sodium (0.17 ± 0.05 vs. 0.10 ± 0.03 mmol·kg(-1)·h(-1)) whereas solute-free water reabsorption remained unchanged. SD induced a significant fall in nighttime plasma AVP (P < 0.01), renin (P < 0.05), angiotensin II (P < 0.001), and aldosterone (P < 0.05) whereas plasma ANP levels remained uninfluenced (P = 0.807). Nighttime blood pressure and heart rate were significantly higher during SD (mean arterial pressure: 78.5 ± 8.0 vs. 74.7 ± 8.7 mmHg, P < 0.001). SD leads to natriuresis and excess diuresis in healthy children. The underlying mechanism could be a reduced nighttime dip in blood pressure and a decrease in renin-angiotensin-aldosterone system levels during sleep deprivation.

Case report: Desmopressin and somnambulism

“…Even more, children with NE clearly have more daytime sleepiness and suffer from sleep deprivation [3]. Mahler et al demonstrated that sleep deprivation might result in increased nocturnal diuresis volume [4]. During polysomnography, our study group observed increased periodic limb movements (PLMS) and cortical arousals in children with refractory NE [5].…”

Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria

“…Yet in an actigraphic case control study, Cohen-Zrubavel et al also confirmed the association between significantly increased sleep fragmentation and daytime sleepiness in children with monosymptomatic NE [12]. The observations of nocturnal polyuria (NP) in sleep-deprived healthy children [16] led us to design the present study consisting of a homogenous population: children with monosymptomatic NE and NP, with exclusion of refractory patients. The aims of the study were: (1) to investigate PLMS and sleep fragmentation by using standardized polysomnography (PSG); 2) to correlate sleep parameters with enuretic parameters (fluid intake, bladder volume, number of wet nights, number of nights with NP), and (3) to compare the PLMS and cortical arousals with our previously reported results in children with refractory NE [13].…”

Incontinence and psychological problems in children: a common central nervous pathway?

“…The Aarhus group found a substantial increase in diuresis, a higher heart rate, and higher blood pressure with suppressed plasma levels of all sodium-retaining hormones [11].…”