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Relationship between sleep respiration, architecture and childhood enuresis: Correlates between polysomnography and
Jordan A Martenstyn1,2, Rita Machaalani2,3, Patrina Caldwell3,4
1Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Children with nocturnal enuresis (NE) and suspected sleep-disordered breathing (SDB) show moderate obstructive sleep apnoea (OSA). Differences in sleep architecture and waking difficulties suggest tailored treatments for enuresis are needed.
Area of Science:
- Pediatric Sleep Medicine
- Urology
- Respiratory Medicine
Background:
- Nocturnal enuresis (NE) and sleep-disordered breathing (SDB) are common childhood conditions with potential links.
- Understanding the relationship between NE and SDB is crucial for effective management.
Purpose of the Study:
- To compare sleep profiles and enuresis-related behaviors in children with and without NE referred for suspected SDB.
- To clarify the specific links between NE subtypes and SDB characteristics.
Main Methods:
- Polysomnography (PSG) and questionnaires were used to assess 52 children (aged 5-14) with suspected SDB.
- Sleep architecture, enuresis status, and waking difficulties were analyzed, adjusting for BMI z-score.
Main Results:
- Children with NE exhibited moderate obstructive sleep apnoea (OSA), while the control group had mild OSA.
- Non-monosymptomatic enuresis (NMNE) was associated with increased stage-3 non-REM sleep.
- Parents of children with NE reported more difficulty waking their child.
Conclusions:
- Children with NE and suspected SDB present with moderate OSA.
- Distinct sleep architecture changes and waking difficulties in NE subtypes (MNE, NMNE) may influence treatment strategies.
- These findings highlight the importance of considering SDB in children with NE and vice versa.
Aim:
Nocturnal enuresis (NE) and sleep-disordered breathing (SDB) are common in childhood. While the two disorders are linked, those links are still being clarified.
Methods:
This study compared sleep profiles and enuresis-related behaviours between children with NE and those without, who were referred to a tertiary sleep unit with suspected SDB, using the combination of polysomnography (PSG) and questionnaire. Continuous numerical data were analysed after adjusting for body mass index z-score.
Results:
The study included 52 Children (39 boys, 13 girls) aged 5-14 years. Twenty-one had enuresis (10 monosymptomatic enuresis (MNE) and 11 non-monosymptomatic enuresis (NMNE)) and 31 did not have enuresis. The majority had comorbidities. On PSG, all children with NE had moderate obstructive sleep apnoea (OSA) compared to the control group which were of mild OSA. Children with NMNE had a higher percentage time in stage-3 non-REM sleep when compared to the non-enuretic and MNE groups (P < 0.05). On the questionnaire, more parents of the NE groups reported that their child was 'difficult to wake in the morning' (P < 0.05).
Conclusion:
In this heterogeneous population referred for suspected SDB, children with NE had moderate OSA, yet those with MNE had increased arousals and more often report difficulty waking than children with suspected SDB who do not wet, while children with NMNE exhibit changes in sleep architecture suggesting deeper sleep. These differences may impact treatment choices for children with enuresis.
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