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Zhou Z, Wang Z, Peng F, Chen S, Yang S, Li Z, Xu Y, Qin H, Wang J, Lu Q, Xu R. The association between obstructive sleep apnea and nocturnal enuresis in children: current advances and research trends. World J Urol 2025; 43:158. [PMID: 40064684 DOI: 10.1007/s00345-025-05541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 02/28/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) represent two clinically prevalent pediatric disorders that frequently present as comorbidities. OSA, characterized by recurrent upper airway collapse during sleep, and NE, defined as involuntary voiding during sleep, collectively contribute to psychosocial distress in children. Emerging evidence suggests that OSA in children can cause NE through multiple mechanisms, though the pathophysiological interplay involving altered arousal thresholds and hormonal dysregulation remains incompletely elucidated. Herein, we summarized the relationship between OSA and NE and identified mainstream research directions and recent hotspots in the relationship between OSA and NA in children and informed further research. MATERIALS AND METHODS This review searched for original publications on the relationship between OSA and NE in children in the Web of Science Core Collection from 1981 to 2025. Research trends, countries, institutions, journals, authors, highly cited publications, and keywords were analyzed using bibliometrics. Co-citation networks were mapped using VOSviewer, and research hotspots and trends were analyzed using CiteSpace. RESULTS A total of 147 publications were included. The number of publications and related research interest in the relationship between OSA and NE in children has increased globally year after year. Sleep monitoring and multidisciplinary collaboration may be the next hotspot in this field. The occurrence of NE shows a positive correlation with the prevalence of OSA, and children with NE frequently exhibit comorbid sleep-disordered breathing. Adenotonsillectomy has been demonstrated to have therapeutic efficacy as a primary intervention for children with concurrent OSA and NE. CONCLUSIONS The co-morbid association between NE and OSA may have significant adverse effects on the psychophysical health of children. Adenotonsillectomy shows potential for treating children with co-morbid OSA and NE. However, systematic multidisciplinary clinical evaluation remains critical in this patient population. Furthermore, this review will help researchers to identify the mainstream research directions and latest hotspots in the field of the relationship between OSA and NE.
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Affiliation(s)
- Zhaokai Zhou
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Zhan Wang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
- Pediatric Urodynamic Center, Department of Urology, Henan Joint International Pediatric Urodynamic Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Fu Peng
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
- Department of Pharmacology, Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Shuang Chen
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shuai Yang
- Pediatric Urodynamic Center, Department of Urology, Henan Joint International Pediatric Urodynamic Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhengrui Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yudi Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hongzhuo Qin
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jiaojiao Wang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China.
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Wang Z, Zhang P, Shi R, Yang S, Liu K, Zhou Z, Li Q. Relationship Between Obstructive Sleep Apnea and Enuresis in Children: Current Perspectives and Beyond. Nat Sci Sleep 2025; 17:211-222. [PMID: 39926476 PMCID: PMC11804225 DOI: 10.2147/nss.s489710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 01/17/2025] [Indexed: 02/11/2025] Open
Abstract
Background Nocturnal enuresis (NE) and obstructive sleep apnea (OSA) are common diseases in children, which often cause various social and psychological problems. The coexistence of both seriously affects the physical and mental health of children. However, whether OSA can directly lead to NE and the specific pathogenesis is still unclear. Moreover, the benefits of surgical and non-surgical treatments for OSA on NE symptoms remain controversial. This review summarizes the relationship between NE and OSA and how to treat them, aiming to provide a reference for the clinical treatment of OSA and NE in children. Methods All pertinent original publications to this point from PubMed database have been collected, including investigations on the connection between OSA and NE as well as studies on the mechanism and therapeutic strategy of NE in children with OSA. Results There is a bidirectional relationship between OSA and NE in children. NE increases with the incidence of OSA, and children with NE often have sleep-disordered respiratory disease. Children with OSA may be susceptible to NE due to aberrant humoral factors secretion, sleep-wake disorder, bladder dysfunction, obesity, and psychosomatic factors. It has been suggested that adenotonsillectomy (AT) may be the best treatment option for children suffering from OSA with NE. The benefits of positive airway pressure (PAP) therapy in children with NE remain to be further studied. Conclusion NE and OSA comorbidity seriously affect the physical and mental health of children. AT can benefit children with OSA and NE. A comprehensive multidisciplinary evaluation of children with NE and OSA is needed, and the mechanism and treatment of NE in children with OSA need to be further explored.
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Affiliation(s)
- Zhan Wang
- Pediatric Urodynamic Center, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, 450052, People’s Republic of China
| | - Pengpeng Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People’s Republic of China
| | - Run Shi
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Shuai Yang
- Pediatric Urodynamic Center, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, 450052, People’s Republic of China
| | - Kui Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, People’s Republic of China
| | - Zhaokai Zhou
- Pediatric Urodynamic Center, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, 450052, People’s Republic of China
| | - Qi Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
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Ribeiro A, Bastos Netto JM, Figueiredo AAD, Cândido TC, Guércio WB, Zica BO. Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery. INTERNATIONAL BRAZ J UROL 2022; 48:937-943. [DOI: 10.1590/s1677-5538.ibju.2022.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, Brasil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Brasil
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Choi S, Casey L, Albersheim S, Van Oerle R, Irvine MA, Piper HG. Urine sodium to urine creatinine ratio as a marker of total body sodium in infants with intestinal failure. J Pediatr Surg 2022; 57:937-940. [PMID: 35078592 DOI: 10.1016/j.jpedsurg.2021.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Urine sodium (UNa) is a measure of total body sodium in infants with intestinal failure (IF) but can be misleading as it does not reflect volume status. Urine sodium to urine creatinine ratio (UNa:UCr) may offer a more accurate measure, but is not routinely used. This study compares UNa:UCr to UNa as a maker of sodium status in infants with IF. METHODS A retrospective review of infants with IF, from a single center, from 2018 to 2020 was conducted (REB H20-00,816). IF etiology, intestinal anatomy, nutritional intake, urine electrolytes and anthropometrics were collected. Linear mixed effects models adjusting for repeated measures were used to associate UNa and UNa:UCr with weight gain and sodium intake. RESULTS Twenty-two infants with a median gestational age of 31 weeks were included. IF etiology included gastroschisis (41%), necrotizing enterocolitis (23%), and intestinal perforation (14%). Infants had an average of 3 paired UNa and UNa:UCr measures for a total of 74 paired measurements. UNa:UCr more strongly correlated with sodium intake compared to UNa (R = 0.25, p = 0.032 vs. R = 0.10, p = 0.38). Overall, neither UNa (p = 0.21) nor UNa:UCr (p = 0.16) were significantly correlated with weight gain. However, for infants receiving ≤50% nutrition enterally, weight gain correlated with UNa (p = 0.01) and UNa:UCr (p = 0.01). UNa:UCr >35 predicted adequate growth regardless of enteral intake (92% sensitivity, 59% specificity). CONCLUSION UNa:UCr is a measure of total body sodium that correlates with sodium intake in infants with IF. Our study indicates UNa:UCr >35 is associated with adequate growth and can be used to guide further validation studies.
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Affiliation(s)
- Seungwon Choi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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UZUN ÇİÇEK A, BORA A, ALTUNTAŞ E. Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT UPDATES 2020. [DOI: 10.32448/entupdates.729178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bascom A, McMaster MA, Alexander RT, MacLean JE. Nocturnal enuresis in children is associated with differences in autonomic control. Sleep 2020; 42:5208915. [PMID: 30481322 PMCID: PMC6424076 DOI: 10.1093/sleep/zsy239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/06/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022] Open
Abstract
Study Objectives To assess the relationship between urine osmolality, cardiovascular parameters, and nocturnal enuresis in a population of children undergoing polysomnographic assessment. Methods This prospective observational study included consecutive children aged 5–17 years presenting for overnight polysomnography. Children were evaluated using continuous ambulatory blood pressure monitoring to assess heart rate and blood pressure. Urine samples were collected throughout the night to determine urine sodium excretion and osmolality. Comparisons of results were made between children with and without a history of nocturnal enuresis. Results A total of 61 children were included for analysis; 13 had a history of nocturnal enuresis. Children with nocturnal enuresis had greater disruption in respiratory parameters including higher apnea–hypopnea index (mean difference 12.2 ± 8.8 events/h, p < 0.05), attributable to more central respiratory events (mean difference 5.4 ± 4.9, p < 0.05), and higher variability in both oxygen and carbon dioxide parameters compared to those without nocturnal enuresis. Sleep parameters, urine osmolality, and blood pressure did not differ between groups. Children with nocturnal enuresis showed an increase, rather than a decrease, in heart rate across the night (+5.4 ± 19.1 vs. −6.0 ± 14.8 beats/min, p < 0.05). Conclusions Children with a history of nocturnal enuresis have greater respiratory abnormalities, no differences in urine osmolality or blood pressure, and loss of normal heart rate decrease across the night. This pattern suggests that autonomic control, rather than renal or hemodynamic abnormalities, may contribute to the pathophysiology of nocturnal enuresis.
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Affiliation(s)
- Alexandra Bascom
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - R Todd Alexander
- Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joanna E MacLean
- Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Women & Children's Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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The role of sleep in the pathophysiology of nocturnal enuresis. Sleep Med Rev 2020; 49:101228. [DOI: 10.1016/j.smrv.2019.101228] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/09/2019] [Accepted: 10/29/2019] [Indexed: 01/23/2023]
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Zhang A, Li S, Zhang Y, Jiang F, Jin X, Ma J. Nocturnal enuresis in obese children: a nation-wide epidemiological study from China. Sci Rep 2019; 9:8414. [PMID: 31182742 PMCID: PMC6557885 DOI: 10.1038/s41598-019-44532-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/17/2019] [Indexed: 01/20/2023] Open
Abstract
Childhood obesity increases the risk of obstructive sleep apnea syndrome, type 2 diabetes mellitus, cardiovascular abnormalities, and psychological and behavioral disorders. But it is unclear whether obesity is associated with childhood nocturnal enuresis (NE). This study aimed to assess the relationship between childhood obesity and NE in a nationally representative large sample in China. Subjects were enrolled from Urumqi, Chengdu, Xi'an, Hohhot, Wuhan, Canton, Shanghai, and Harbin cities in China in November and December 2005. The survey included 20,987 children aged 5-12 years and they and their caregivers completed questionnaires. Height and weight were measured by school teachers trained in healthcare. According to the WHO child growth standards, obesity was defined as a body mass index >95th percentile of peers with the same age and gender. NE was defined as bed wetting for more than twice a week for 3 consecutive months. Demographic variables were compared among different groups. The prevalence of obesity, asthma, attention-deficit/hyperactivity disorder (ADHD), depressive moods, and snoring were different between the NE and without-NE groups (P < 0.05). The raw odds ratio (OR) for NE and obesity was 1.36 (95%CI = 1.07-1.74; P = 0.013) and the adjusted OR was 1.42 (95%CI = 1.11-1.82; P = 0.005) in the multivariable analysis. When adjusting for co-occurring conditions, the results showed that asthma did not affect the risk of NE (OR = 1.42, 95%CI = 1.11-1.82; P = 0.005), but ADHD (OR = 1.41; 95%CI = 1.10-1.81; P = 0.006) and depressive moods (OR = 1.34; 95%CI = 1.07-1.76; P = 0.012) slightly weakens the association between NE in children and obesity, while snoring weakens the association between obesity and NE and the risk became non-significant (OR = 1.21; 95%CI = 0.94-1.56; P = 0.138). In conclusion, obese children were at a higher risk of incurring NE compared to non-obese children. This association was weaker in children who either snored, had ADHD, or had depressive mood.
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Affiliation(s)
- Anyi Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghui Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingming Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Karakas HB, Mazlumoglu MR, Simsek E. The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children. Eur Arch Otorhinolaryngol 2017; 274:2959-2963. [PMID: 28386646 DOI: 10.1007/s00405-017-4558-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
This study evaluated the necessity of examining the upper airway in children with nocturnal enuresis. 225 children (aged 5-16 years), who were referred from the urology outpatient clinic between May 2015 and May 2016 and who had completed toilet training, were included in this study. Participants were separated into monosymptomatic nocturnal enuresis (MNE) (group 1) and without MNE (group 2) groups. Tonsil hypertrophy, adenoid vegetation, septal deviation, turbinate hypertrophy, allergic rhinitis, upper airway obstruction, and snoring etiology were assessed. In total, 112 children with MNE (group 1) participated in addition to 113 children selected randomly without MNE (group 2). Adenoid score (p = 0.016), septal deviation (p = 0.017), and snoring (p = 0.007) were significantly different between the groups. No differences in tonsil score (p = 0.618), turbinate hypertrophy (p = 0.424), and allergic rhinitis (p = 0.544) were detected between the groups. Possible causes of upper airway obstruction and snoring which is a symptom of obstructive sleep-disordered breathing in the pediatric population, including adenoid hypertrophy and septal deviation, should be considered as possible etiological factors in children with MNE.
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Affiliation(s)
| | | | - Eda Simsek
- Clinic of Ear, Nose and Throat, Erzurum Region Education and Research Hospital, Erzurum, Turkey.
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Kamperis K, Hagstroem S, Faerch M, Mahler B, Rittig S, Djurhuus JC. Combination treatment of nocturnal enuresis with desmopressin and indomethacin. Pediatr Nephrol 2017; 32:627-633. [PMID: 27787700 DOI: 10.1007/s00467-016-3536-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the effect of combining indomethacin and desmopressin in treating children with monosymptomatic nocturnal enuresis (MNE) and desmopressin-resistant nocturnal polyuria. METHODS Twenty-three children with MNE, nocturnal polyuria, and partial or no response to desmopressin were recruited from incontinence clinics of our tertiary referral center. We used a randomized single-arm crossover placebo-controlled study design consisting of two 3-week treatment periods with a combination of desmopressin (0.4 mg) and indomethacin (50 mg) or desmopressin and placebo at bedtime. Home recordings at baseline and for the final 2 weeks of each treatment period were performed and included nocturnal urine output measurements. The number of dry nights achieved and reduction in the nocturnal urine output were the main effect parameters. Student's t test and Pearson's correlation coefficient were used for statistical analysis. RESULTS The addition of indomethacin to desmopressin significantly reduced nocturnal urine output (from 324 ± 14 ml to 258 ± 13 ml, p < 0.001). This did not lead to more dry nights in all children, and we found no statistically significant reduction in enuresis frequency (from 68 % ± 0.1 to 56 % ± 0.1, p = 0.24). CONCLUSIONS Addition of indomethacin to desmopressin can further reduce nocturnal urine output in children with MNE and desmopressin-resistant nocturnal polyuria. The combination treatment does not, however, improve outcome in terms of frequency of nights with enuresis. The dissociation of antidiuretic and antienuretic effect may reflect nocturnal bladder reservoir dysfunction in children who present with normal daytime bladder function.
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Affiliation(s)
- Konstantinos Kamperis
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Soren Hagstroem
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Mia Faerch
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Mahler
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Soren Rittig
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens C Djurhuus
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Tan HL, Alonso Alvarez ML, Tsaoussoglou M, Weber S, Kaditis AG. When and why to treat the child who snores? Pediatr Pulmonol 2017; 52:399-412. [PMID: 28029756 DOI: 10.1002/ppul.23658] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022]
Abstract
Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui-Leng Tan
- Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Silke Weber
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Kim SC. Management of patients with refractory nocturnal enuresis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.10.800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seong Cheol Kim
- Department of Urology, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea
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Zaffanello M. Enuresis and sleep disordered breathing: An old and new link. World J Clin Urol 2016; 5:90-92. [DOI: 10.5410/wjcu.v5.i3.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/30/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
The causes of nocturnal enuresis (NE) are likely multifactorial. It has been related to several (urological-nephrological-hormonal) reasons but clear and univocal pathogenesis remains mostly undetermined. Sleep disordered breathing (SDB) is a syndrome of upper airway dysfunction that occurs during sleep and is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility. Adenotonsillar hypertrophy is the main cause of SDB in children. To date, several studies have associated childhood NE with coexistent SDB. Adenotonsillectomy was successful for both SDB and NE in about half of patients. Unfortunately, practical consensus guidelines for the management of primary NE do not mention, or marginally concern, SDB in these children, particularly in those who have treatment resistance and comorbidities. The concerns regard the concomitant presence of two relatively frequent sleep disorders, raising the question whether they are really coincidental problems of childhood.
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