Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first?

Area of Science:

• Pediatric Sleep Medicine
• Urology
• Otolaryngology

Background:

• Obstructive sleep apnea syndrome (OSAS) is common in children and can be associated with lower urinary tract symptoms.
• Surgery, such as tonsillectomy and/or adenoidectomy (T&A), is a primary treatment for pediatric OSAS.
• The impact of OSAS surgery on enuresis, including diurnal urinary incontinence (DI) and nocturnal enuresis (NE), requires further investigation.

Purpose of the Study:

• To determine the prevalence of DI and NE in children with OSAS undergoing T&A.
• To assess the postoperative resolution rate of enuresis following T&A.
• To identify factors predicting a lack of enuresis improvement after surgery.

Main Methods:

• An observational pilot study included 417 children (5-18 years) with OSAS and NE who underwent T&A.
• Data were collected via phone interviews and chart reviews, assessing enuresis severity, frequency, and sleep disturbances pre- and post-operatively.
• Logistic regression analysis identified factors associated with treatment failure.

Main Results:

• Of 417 children, 101 (24%) had NE, with 24 (6%) also experiencing DI.
• Postoperative NE resolution occurred in 49% of cases, with 17% of DI cases resolving.
• Non-responders were more likely to be premature, obese, have a family history of NE, present with non-monosymptomatic NE, have severe NE, or experience arousal difficulties.

Conclusions:

• Nocturnal enuresis affects approximately one-fourth of children with OSAS undergoing T&A, with about half experiencing resolution.
• Surgical outcomes for NE are less favorable in children with prematurity, obesity, family history of NE, severe NE, or arousal issues.
• These findings highlight specific risk factors that may guide preoperative counseling and postoperative management strategies for enuresis in pediatric OSAS patients.