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Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery
André Ribeiro1, José Murillo Bastos2,3, André Avarese de Figueiredo2
1Divisão de Otorrinolaringologia, Departamento de Cirurgia, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil.
Insights
Surgical treatment for pediatric upper airway obstruction (UAO) significantly improved enuresis by increasing brain natriuretic peptide (BNP) levels. This intervention led to a substantial reduction in nighttime wetting for children with primary monosymptomatic nocturnal enuresis (PMNE).
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Pediatric Urology
Background:
- Upper airway obstruction (UAO) affects 27% of children.
- Primary monosymptomatic nocturnal enuresis (PMNE) is linked to UAO in 8-47% of cases.
- The UAO-PMNE pathophysiological link, potentially involving brain natriuretic peptide (BNP) and anti-diuretic hormone (ADH), is not fully understood.
Purpose of the Study:
- To investigate the relationship between UAO and PMNE.
- To evaluate changes in ADH and BNP hormone levels post-UAO surgery.
- To assess the improvement in dry nights following UAO surgical treatment.
Main Methods:
- A longitudinal prospective study of 21 children (5-14 years) with UAO and PMNE.
- Collected 30-day dry night diaries and blood samples for ADH and BNP analysis.
- Evaluated hormone levels and enuresis status before and 90-120 days after UAO surgery.
Main Results:
- BNP levels increased significantly post-surgery (116.5 to 156.2 pg/mL, p<0.01).
- ADH levels showed no significant change (p=0.26).
- The percentage of dry nights dramatically improved from 32.3% to 75.4% (p<0.01), with 85.8% experiencing partial or complete enuresis improvement.
Conclusions:
- Surgical correction of pediatric UAO positively impacts PMNE.
- Increased BNP levels post-surgery correlate with improved enuresis control.
- UAO treatment offers a promising therapeutic avenue for children with PMNE.
Introduction:
Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO.
Methods:
This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery.
Results:
Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p˂0.01).
Conclusion:
Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.
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