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Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome
Avichai Weissbach1, Alberto Leiberman, Ariel Tarasiuk
1Department of Pediatrics B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Nocturnal enuresis (NE) is common in children with obstructive sleep apnea syndrome (OSAS). Adenotonsillectomy significantly improves enuresis in these children.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Urology
Background:
- Nocturnal enuresis (NE) is a common condition in children.
- Obstructive sleep apnea syndrome (OSAS) is increasingly recognized as a potential contributing factor to NE.
- The therapeutic efficacy of surgical intervention for OSAS on NE requires further investigation.
Purpose of the Study:
- To determine the prevalence of NE in children diagnosed with OSAS.
- To evaluate the impact of adenotonsillectomy (T&A) on NE in children with OSAS.
Main Methods:
- Retrospective review of 161 children (4-18 years) who underwent polysomnography (PSG) between January 2003 and May 2004.
- Standard sleep questionnaire and structured telephone follow-up 9 months post-adenotonsillectomy (T&A).
Main Results:
- 144 children (89%) had OSAS (apnea-hypopnea index >1).
- 42 children (29.2%) with OSAS reported NE; 27 underwent T&A.
- Following T&A, 74.1% of enuretic children had fewer wet nights (37% at 1 month post-op).
- Complete resolution of NE occurred in 41% within 1 month and 11% later.
Conclusions:
- Pediatric OSAS is frequently associated with NE.
- Adenotonsillectomy demonstrates a favorable therapeutic effect on NE in children with OSAS.
Objectives:
To evaluate the prevalence of nocturnal enuresis (NE) in children diagnosed with obstructive sleep apnea syndrome (OSAS) and the effect of tonsillectomy and adenoidectomy on enuresis.
Design, Setting, And Participants:
All children 4-18 years of age who underwent polysomnography (PSG) between January 2003 and May 2004 were included (n=161). The evaluation was based on a retrospective review of a standard sleep questionnaire and a full overnight PSG, followed by an additional structured telephone questionnaire performed 9 months after adenotonsillectomy (T&A) (range 5-14).
Results:
We identified 144 (89%) children with an apnea hypopnea index >1. Of these 144 children, 42 [29.2% (95% CI, 21.8-36.6)] were reported to have enuresis, 27 of these 42 underwent T&A. Among the 27 enuretic children who had undergone adenotonsillectomy, 74.1% had 3 or more wet nights per week before the procedure compared to 37%, 1 month after [n=27 (chi2=3.308, McNemar pv<0.0001)]. Of the 27 children who underwent adenotonsillectomy, any decrease in enuresis severity was reported by 70.4% (95% CI 53.2-87.62), while in 56% of these 27 (95% CI 41.96-70.06) it occurred 1 month postoperatively. In 11/27 children (41%), enuresis totally disappeared within 1 month, while in 3/27 (11%) enuresis disappeared throughout the remaining time of follow-up.
Conclusions:
Obstructive sleep apnea in children is frequently associated with nocturnal enuresis. Adenotonsillectomy has a favorable therapeutic effect on enuresis in children with obstructive sleep apnea presenting this symptom.
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