Abstract

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children.

Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope.

Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173).

Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Keywords: Adenoid Vegetation, Children, Nocturnal Enuresis, Tonsillar Hypertrophy, Upper Airway Obstruction

Copyright and license

How to cite

1.
Kol A, Günizi H, Genç Ş. Upper airway obstruction and nocturnal enuresis in children: Why is it important?. Trends in Pediatrics. 2024;5(2):33-7. https://doi.org/10.59213/TP.2024.118

References

  1. Läckgren G, Hjälmås K, van Gool J, et al. Nocturnal enuresis: a suggestion for a European treatment strategy. Acta Paediatr. 1999;88:679-90. https://doi.org/10.1080/08035259950169396
  2. Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006;176:314-24. https://doi.org/10.1016/S0022-5347(06)00305-3
  3. Akyol I, Ates F, Soydan H, Senkul T, Karademir K, Baykal K. An overlooked issue in children presenting with enuresis: constipation. J Pediatr Urol. 2010;6(Suppl 1):S66. https://doi.org/10.1016/j.jpurol.2010.02.118
  4. Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360:1429-36. https://doi.org/10.1056/NEJMcp0808009
  5. Ryu DS, Lee HW, Kwak KW, Park KH, Baek M. Role of Urodynamic Study in Nocturnal Enuresis: Urodynamic Findings and Treatment Outcome Correlation in Children with Pharmacotherapy-resistant Monosymptomatic Nocturnal Enuresis or Severe Non-monosymptomatic Nocturnal Enuresis. Low Urin Tract Symptoms. 2014;6:88-93. https://doi.org/10.1111/luts.12024
  6. Aydil U, Işeri E, Kizil Y, Bodur S, Ceylan A, Uslu S. Obstructive upper airway problems and primary enuresis nocturna relationship in pediatric patients: reciprocal study. J Otolaryngol Head Neck Surg. 2008;37:235-9.
  7. Hägglöf B, Andrén O, Bergström E, Marklund L, Wendelius M. Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. Eur Urol. 1998;33(Suppl 3):16-9. https://doi.org/10.1159/000052236
  8. Esposito M, Gallai B, Parisi L, et al. Primary nocturnal enuresis as a risk factor for sleep disorders: an observational questionnaire-based multicenter study. Neuropsychiatr Dis Treat. 2013;9:437-43. https://doi.org/10.2147/NDT.S43673
  9. de Sena Oliveira AC, Athanasio BDS, Mrad FCC, et al. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatr Nephrol. 2021;36:3547-59. https://doi.org/10.1007/s00467-021-05083-y
  10. Hashem M, Morteza A, Mohammad K, Ahmad-Ali N. Prevalence of nocturnal enuresis in school aged children: the role of personal and parents related socio-economic and educational factors. Iran J Pediatr. 2013;23:59-64.
  11. Gaonkar N, Takalhar S. Reliability of Nocturnal Enuresis Questionnaire in 6-15 Years Typically Developing School Children. International Journal of Health Sciences and Research. 2016;6:172-7.
  12. Lu X, Zhang J, Xiao S. Correlation between Brodsky Tonsil Scale and Tonsil Volume in Adult Patients. Biomed Res Int. 2018;2018:6434872. https://doi.org/10.1155/2018/6434872
  13. Preece M, Cole T, Fry T. Body mass index standards for children. 1990 data will remain available. BMJ. 1999;319:122. https://doi.org/10.1136/bmj.319.7202.122a
  14. Fitzgerald MP, Thom DH, Wassel-Fyr C, et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol. 2006;175:989-93. https://doi.org/10.1016/S0022-5347(05)00416-7
  15. Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. 1999;53:453-8. https://doi.org/10.1136/jech.53.8.453
  16. Bozlu M, Cayan S, Doruk E, Canpolat B, Akbay E. The epidemiology of nocturnal and diurnal enuresis in childhood and adolescence. Turk J Urol. 2002;28:70-5.
  17. Khazaie H, Eghbali F, Amirian H, Moradi MR, Ghadami MR. Risk Factors of Nocturnal Enuresis in Children with Attention Deficit Hyperactivity Disorder. Shanghai Arch Psychiatry. 2018;30:20-26. https://doi.org/10.11919/j.issn.1002-0829.216088
  18. Chan IHY, Wong KKY. Common urological problems in children: primary nocturnal enuresis. Hong Kong Med J. 2019;25:305-11. https://doi.org/10.12809/hkmj197916
  19. Choudhary B, Patil R, Bhatt GC, et al. Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India. PLoS One. 2016;11:e0155808. https://doi.org/10.1371/journal.pone.0155808
  20. Bakwin H. The genetics of enuresis. In: Kolvin I, MacKeith RC, Meadow SRC, editors. Bladder Control and Enuresis. London: Heineman; 1996:73-7.
  21. von Gontard A, Heron J, Joinson C. Family history of nocturnal enuresis and urinary incontinence: results from a large epidemiological study. J Urol. 2011;185:2303-6. https://doi.org/10.1016/j.juro.2011.02.040
  22. Prince E, Heys M. Nocturnal enuresis: an update on management. Drug Ther Bull. 2020;58:25-9. https://doi.org/10.1136/dtb.2018.000034
  23. Barone JG, Hanson C, DaJusta DG, Gioia K, England SJ, Schneider D. Nocturnal enuresis and overweight are associated with obstructive sleep apnea. Pediatrics. 2009;124:e53-9. https://doi.org/10.1542/peds.2008-2805
  24. Weintraub Y, Singer S, Alexander D, et al. Enuresis-an unattended comorbidity of childhood obesity. Int J Obes (Lond). 2013;37:75-8. https://doi.org/10.1038/ijo.2012.108
  25. Ma Y, Shen Y, Liu X. Association between enuresis and obesity in children with primary monosymptomatic nocturnal enuresis. Int Braz J Urol. 2019;45:790-7. https://doi.org/10.1590/S1677-5538.IBJU.2018.0603
  26. Chang SS, Ng CF, Wong SN; Hong Kong Childhood Enuresis Study Group. Behavioural problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong. Acta Paediatr. 2002;91:475-9. https://doi.org/10.1080/080352502317371742
  27. Görür S, İnandı T, Turhan E, Helli A, Kiper AN. The prevalence and risk factors of enuresis in children aged between 6 and 18 years in Hatay. Turk J Urol. 2008;34:42-50.
  28. Ciftci H, Savas M, Altunkol A, Oncel H, Yeni E, Verit A. The relations between enuresis in childhood and nocturnal polyuria syndrome in adult life. Int Neurourol J. 2012;16:37-40. https://doi.org/10.5213/inj.2012.16.1.37
  29. Alexopoulos EI, Malakasioti G, Varlami V, Miligkos M, Gourgoulianis K, Kaditis AG. Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring. Pediatr Res. 2014;76:555-9. https://doi.org/10.1038/pr.2014.137
  30. Nevéus T. The role of sleep and arousal in nocturnal enuresis. Acta Paediatr. 2003;92:1118-23. https://doi.org/10.1080/08035250310005837
  31. Kaditis AG, Alexopoulos EI, Hatzi F, et al. Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing. Chest. 2006;130:1377-84. https://doi.org/10.1378/chest.130.5.1377
  32. Karakas HB, Mazlumoglu MR, Simsek E. The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children. Eur Arch Otorhinolaryngol. 2017;274:2959-63. https://doi.org/10.1007/s00405-017-4558-z
  33. Abdollohi-Fakhim S, Talebi A, Naghavi-Behzad M, Piri R, Nazari MS. Effects of adenotonsillar hypertrophy corrective surgery on nocturnal enuresis of children. Niger Med J. 2016;57:69-73. https://doi.org/10.4103/0300-1652.180558
  34. Liu J, Zhang X, Zhao Y, Wang Y. The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies. PLoS One. 2020;15:e0228533. https://doi.org/10.1371/journal.pone.0228533