28 May Nocturnal enuresis in children (bedwetting)
Nocturnal enuresis is commonly referred to as bedwetting, and is defined as inappropriate urine outflow during sleep. This affects approximately 15% of 5 year-old and 5% of 10 year-old children.1 Enuresis can have dramatic psychological and emotional impact on young children and severely affect their quality of life.2 Proposed mechanisms forcausing nocturnal enuresis include maturational delay in bladder response, increased threshold for arousal from sleep i.e. harder to wake form sleep, abnormal bladder dynamics, and impaired release of renin-angiotensin aldosterone system hormones, atrial natriuretic peptide, or antidiuretic hormone. There is an established relationship between obstructive sleep apnea (OSA) and nocturnal enuresis in young children.
Statement of Significance: Nocturnal enuresis and obstructive sleep apnea commonly co-occur in children; understanding the link between these conditions will shed light on their shared pathophysiology and potential for novel treatment strategies. Our results highlight autonomic disruption as a potential contributor to nocturnal enuresis and a plausible link between nocturnal enuresis and obstructive sleep apnea in children. Exploring pathways linked to autonomic function may lead to novel treatments for both nocturnal enuresis and obstructive sleep apnea.
Study Objectives: To assess the relationship between urine osmolality, cardiovascular parameters, and nocturnal enuresis in a population of children undergoing polysomnographic assessment.
Methods: This prospective observational study included consecutive children aged 5–17 years presenting for overnight polysomnography. Children were evaluated using continuous ambulatory blood pressure monitoring to assess heart rate and blood pressure. Urine samples were collected throughout the night to determine urine sodium excretion and osmolality. Comparisons of results were made between children with and without a history of nocturnal enuresis.
Results: A total of 61 children were included for analysis; 13 had a history of nocturnal enuresis. Children with nocturnal enuresis had greater disruption in respiratory parameters including higher apnea-hypopnea index (mean difference 12.2±8.8 events/h, p<0.05), attributable to more central respiratory events (mean difference 5.4±4.9, p<0.05), and higher variability in both oxygen and carbon dioxide parameters compared to those without nocturnal enuresis. Sleep parameters, urine osmolality, and blood pressure did not differ between groups. Children with nocturnal enuresis showed an increase, rather than a decrease, in heart rate across the night (+5.4±19.1 vs. -6.0±14.8 beats/min, p < 0.05).
Conclusions: Children with a history of nocturnal enuresis have greater respiratory abnormalities, no differences in urine osmolality or blood pressure, and loss of normal heart rate decrease across the night. This pattern suggests that autonomic control, rather than renal or hemodynamic abnormalities, may contribute to the pathophysiology of nocturnal enuresis.
Alexandra Bascom, Mary Ann McMaster, R Todd Alexander, Joanna E MacLean; Nocturnal enuresis in children is associated with differences in autonomic control, Sleep, zsy239, https://doi.org/10.1093/sleep/zsy239
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