Sleep Architecture Patterns in Enuretic Children with OSA

Abstract

Objective: Nocturnal enuresis (NE) has been described in children with obstructive sleep apnea (OSA) related to adeno-tonsillar hypertrophy. For those affected adeno-tonsillectomy has demonstrated to improve both NE and OSA in many patients. Our objective is to determine if preoperative sleep architecture is associated with complete resolution of NE after adeno-tonsillectomy.

Method: A prospective study of 18 pediatric patients (1/2011-2/2012) with primary NE who underwent adeno-tonsillectomy for OSA was conducted. Both preoperative polysomnograms (PSG) and pre- and postoperative reports of NE were recorded. Resolved vs unresolved postoperative nocturnal enuresis (RNE vs UNE) was the outcome evaluated. Data was assessed via chi-square/t test analyses.

Results: Mean child age was 8.28 (SD = 2.3 years). All children reported presurgical primary NE. No RNE vs UNE age/gender differences were identified. Postsurgery, over half of participants reported NE resolution. Significant improvement of NE was identified in children with higher preoperative AHIs (RNE mean = 21.4; UNE mean = 3.6; t = 2.33, P = .03) and lower preoperative oxygen saturations (RNE lowest % = 78.1; UNE lowest % = 89.6; t = 2.72, P = .03). All children with prolonged stage 2 sleep reported postsurgical NE resolution, whereas two-thirds of the children with prolonged delta sleep and all with above normal REM reported persistent postsurgical NE.

Conclusion: Adeno-tonsillectomy is a treatment option for OSA with NE. Preliminary data demonstrates that children with high AHIs, significant oxygen desaturations, and abnormally prolonged stage 2 sleep have a high resolution rate of NE postoperatively. There are significant differences in preoperative sleep architecture between UNE and RNE patients with OSA.