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Abnormal circadian blood pressure regulation in children with nocturnal enuresis
Özge Yüce1, Umut Selda Bayrakçi1, Kaan Gülleroğlu1
1a Department of Pediatric Nephrology , University of Başkent , Ankara , Turkey.
Insights
Children with enuresis show abnormal blood pressure regulation, particularly at night. This suggests sympathetic nervous system overactivity may contribute to bedwetting.
Area of Science:
- Pediatric Nephrology
- Autonomic Nervous System Function
- Circadian Rhythms
Background:
- Nocturnal enuresis affects children's quality of life.
- Autonomic nervous system (ANS) dysfunction is implicated in enuresis.
- Ambulatory blood pressure monitoring (ABPM) can assess ANS function.
Purpose of the Study:
- To investigate autonomic nervous system function in enuretic children.
- To assess 24-hour ambulatory blood pressure patterns in children with primary nocturnal enuresis.
- To correlate blood pressure abnormalities with enuresis severity.
Main Methods:
- 24-hour ABPM was performed on 28 children with enuresis (ages 6-15) and 27 controls.
- Hypertension was defined by standard deviation score (SDS) > 1.64.
- Urinalysis, urine electrolytes, culture, ultrasound, and voiding diaries were collected.
Main Results:
- Enuretic children had significantly higher nocturnal systolic and diastolic blood pressure (BP) and BP loads compared to controls.
- A lack of nocturnal BP dipping was more common in enuretic children.
- Elevated nocturnal BP load correlated with increased urinary incontinence frequency.
Conclusions:
- Enuretic children exhibit subtle circadian BP regulation abnormalities, including elevated nocturnal BP and reduced dipping.
- These findings suggest sympathetic hyperactivation may play a role in the pathogenesis of enuresis.
- Nocturnal hypertension in enuretic children is linked to increased incontinence frequency.
Introduction:
To investigate autonomic nervous system function in enuretic children by performing ambulatory blood pressure monitor (ABPM) for 24 h.
Methods:
Twenty-eight children ranging in age from 6 to 15 years with primary nocturnal enuresis and 27 age-matched healthy controls were enrolled and they get 24 h ABPM. Hypertension was defined as standard deviation score (SDS) > 1.64 (i.e., >95th percentile) adjusted for gender and height. Urinalysis, urine electrolyte levels, urinary culture, and urinary system ultrasound were carried out in all children. They have also requested to have a diary about daily fluid intake and urine volume.
Results:
Although the mean 24-h and daytime diastolic blood pressure (BP) did not differ between the groups, systolic BP (SBP) was significantly higher in enuretic children (p < 0.05). The mean night-time SBP, DBP values, SDS and BP loads were found to be significantly higher than those in the controls (p < 0.01). A lack of nocturnal decrease was more prevalent in the enuretic children compared with the control subjects, the difference was statistically significant for DBP but not for SBP. Patients with elevated night-time BP load was found to have higher frequency of urinary incontinence per week as well as per night when compared with enuretic children with normal night-time BP load (r = 0.72, r = 0.69, p < 0.01, respectively).
Conclusion:
Subtle abnormalities of circadian BP regulation in enuretic children indicated by a selective elevation of nocturnal SBP, DBP, and MAP, and attenuated nocturnal dipping may reflect sympathetic hyper activation and its possible role in pathogenesis of enuresis.
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