The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology

Dossche, Lien; Walle, Johan Vande; Herzeele, Charlotte Van

doi:10.1007/s00431-016-2729-3

Cited by 46 publications

(44 citation statements)

References 77 publications

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“…Children with NE were more likely to be sleepy in the morning, and also do not awaken easily. However, even though they did not sleep more deeply than other children without NE, their sleep was more fragmented, as indicated by a high arousal index, with more frequent EEG shifts from stage N3 to N1‐N2, as previously described in some of the children with NE.…”

Section: Discussionsupporting

confidence: 56%

Nocturnal enuresis and sleep disordered breathing in primary school children: Potential implications

Wada

Kimura

Tajima

et al. 2018

Pediatric Pulmonology

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The pathogenic mechanisms linking snoring and unrefreshing sleep to increased risk of NE are unknown. However, snoring, a surrogate reporter of SDB, is associated with increased urine production, while unrefreshing sleep may result from disrupted sleep facilitating increased sleep pressure and elevated arousal thresholds. Thus, both SDB and unrefreshing sleep are potential independent risk factors of NE in school age children.

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Section: Discussionsupporting

confidence: 56%

Nocturnal enuresis and sleep disordered breathing in primary school children: Potential implications

Wada

Kimura

Tajima

et al. 2018

Pediatric Pulmonology

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“…The elegant demonstration by the same researchers that enuresis can be provoked in dry children by fluid overload does not solve the question completely, as in that study nocturia was much easier to provoke than enuresis, and the volumes voided in bed were far lower than an expected full bladder. Nocturnal polyuria without enuresis (but with nocturia) is quite common among normal children There is a subgroup of enuretic children whose nocturnal polyuria represents solute diuresis, that cannot be explained by vasopressin deficiency, and who do not become dry when treated with the vasopressin analog, desmopressin There is the intriguing possibility that the polyuria might be the effect, not the cause, of enuresis.…”

Section: Urine Productionmentioning

confidence: 99%

Pathogenesis of enuresis: Towards a new understanding

Nevéus

2017

Int J of Urology

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Abbreviations & Acronyms ADHD = attention deficit hyperactivity disorder CNS = central nervous system LC = locus coeruleus PAG = periaqueductal gray area PMC = pontine micturition center Abstract: Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus.

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“…International guidelines recommend that the initial step in the assessment of patients seeking help for troublesome nocturia should focus on whether or not NP is present . A more detailed diagnostic work‐up in enuretic children and nocturic adults with NP has clearly shown considerable variations in water and solute excretion, with the identification of three categories: disorders in circadian rhythms of water diuresis, solute diuresis (mainly sodium) or a combination of both mechanisms . It seems logical that treatment of patients with bothersome symptoms as a result of NP requires an individualised adaptation according to the underlying cause.…”

Section: Discussionmentioning

confidence: 99%

“…Nocturnal polyuria (NP), or excessive overnight urine production, is a highly prevalent but often underreported underlying cause of nocturnal enuresis in children, nocturia in adults and nocturnal incontinence in older persons . It is the result of an impaired circadian rhythm of hormones regulating water and solute handling by adjusting renal blood flow and solute reabsorption.…”

Section: Introductionmentioning

confidence: 99%