Neurobehavioral, sleep and bladder dysfunction in children with primary nocturnal enuresis

Primary nocturnal enuresis (PNE) is a multifactorial condition associated with disturbances in neurodevelopmental maturation, sleep regulation, and lower urinary tract function. This study aimed to characterize neurobehavioral, sleep-related, neurophysiological, and lower urinary tract comorbidities in children with PNE and to compare these findings with those of age-matched hospital-based controls without nocturnal enuresis.

This retrospective comparative study included 128 children with PNE and 30 age-matched controls without nocturnal enuresis or daytime lower urinary tract symptoms. Medical records were reviewed for demographic characteristics, family history of enuresis, bowel habits, sleep-related upper airway disorders, uroflowmetric parameters, electroencephalographic (EEG) findings, and lower urinary tract symptoms. ADHD symptoms were assessed using the ADHD Rating Scale-IV.

The PNE group comprised 71 boys (55.5%) and 57 girls (44.5%), with a mean age of 8.4 ± 2.1 years. A positive family history of enuresis was identified in 89 children (69.5%). ADHD symptoms were significantly more frequent in children with PNE than in controls (50.0% vs. 20.0%). Sleep-related abnormalities were common, including tonsillar hypertrophy (28.9%), adenoid hypertrophy (25.0%), snoring and mouth breathing (16.4%). Overactive bladder symptoms were identified in 43 children (33.6%). Immature alpha rhythm was observed in 49.2% of children with PNE compared with 23.3% of controls.

Children with PNE exhibited higher rates of ADHD symptoms, sleep-related upper airway abnormalities, lower urinary tract dysfunction, and EEG abnormalities than age-matched controls. These findings are consistent with a multidimensional clinical phenotype involving neurobehavioral, sleep-related, and bladder dysfunction and highlight the importance of comprehensive multidisciplinary assessment in children with PNE.