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Enuretic children with obstructive sleep apnea syndrome: Should they see otolaryngology first?

Journal of Pediatric Urology, Volume 9, Issue 2, pages 145 - 150

Abstract

Objectives

To study: (1) the prevalence of diurnal urinary incontinence (DI) and nocturnal enuresis (NE) in children with obstructive sleep apnea syndrome (OSAS) who underwent surgery for their upper airway symptoms, (2) the postoperative rate of enuresis resolution, and (3) factors that may predict lack of improvement post surgery.

Patients and Methods

An observational, pilot study of children 5–18 years of age with OSAS and NE who underwent tonsillectomy and/or adenoidectomy (T&A) between 2008 and 2010 was performed. Study consisted of a phone interview and chart review. Severity of NE and DI, frequency, arousal and sleeping disturbances were assessed pre and post T&A. Factors associated with failure to respond were analyzed using a logistic regression model.

Results

Among the 417 children who underwent T&A, 101 (24%) had NE (61 males, mean age 7.8 ± 2.5 years), and of these 24 had associated DI (6%). Mean postoperative follow-up was 11.7 months. Of the 49 whose NE responded to T&A (49%), 30 resolved within 1 month postoperatively. DI resolved in 4 children (17%). There was a statistically significant difference between responders and non-responders regarding the presence of prematurity, obesity, family history of NE, type of enuresis, enuresis severity, and ability to be easily aroused.

Conclusion

NE was present in about one fourth of children with OSAS undergoing surgery, and resolved in about half. Lower response rate was associated with prematurity, obesity, family history of NE, presence of non-monosymptomatic NE, severe NE preoperatively, and arousal difficulties.

Keywords: Adenotonsillectomy, Enuresis, Obstructive sleep apnea syndrome, Children.

Abbreviations: DI - diurnal urinary incontinence, NE - nocturnal enuresis, OSAS - obstructive sleep apnea syndrome, T&A - adenotonsillectomy, HIC - Human Investigation Committee, ENT - ear–nose–throat, BMI - body mass index, ICCS - International Children's Continence Society, ADHD - attention deficit hyperactivity disorder, STROBE - Strengthening the Reporting of Observational Studies in Epidemiology, Non-MNE - non-monosymptomatic NE, MNE - monosymptomatic NE, PNE - primary nocturnal enuresis, ANP - atrial natriuretic peptide.

Footnotes

a Children's Hospital of Michigan, Pediatric Urology Department, 3901 Beaubien Blvd, Detroit, MI 48201, USA

b Wayne State University, Detroit, MI, USA

c Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

d Children's Hospital of Michigan, Pediatric ENT Department, Michigan State University, Lansing, MI, USA

Corresponding author. Tel.: +1 313 745 5588; fax: +1 313 993 8738.