Sleep Disordered Breathing and Nocturnal Enuresis

Saturday, October 2, 2010: 4:06 PM
Yerba Buena Salon 9 (San Francisco Marriott Marquis)
Alexandra Bascom, Bsc.1, Todd Penney, B.Eng1, Trina Uwiera, MD, M.Ed., FRCSC1, Manisha Witmans, MD, FRCSC2 and Peter D. Metcalfe, MD, MSc, FRCSC1, (1)Surgery, University of Alberta, Edmonton, AB, Canada, (2)Pediatrics, University of Alberta, Edmonton, AB, Canada

Purpose: We wish to determine the prevalence of obstructive sleep apnea (OSA) in children with nocturnal enuresis (NE). Recently, OSA has been implicated as a contributor to NE. Several retrospective reviews have demonstrated that up to 46% of children with OSA have NE, and that 67-84% of children who underwent adenotonsillectomy for OSA showed a decrease in enuresis. Therefore we wish to determine the prevalence of OSA in children presenting with NE and compare patients with monosymptomatic NE (MNE) to diurnal NE (DNE). We hypothesize that NE is associated with significant sleep disturbances and this may have important health and quality of life ramifications. Furthermore, we believe that patients with MNE are more likely to have abnormal sleep patterns than those with DNE Methods: This study was approved by the Health Research Ethics Board and involves prospective data collection. Children with NE that present to the pediatric urology clinic will be given three surveys: 1) The OSA-18 to assess specific quality of life parameters in children with sleep disordered breathing; 2) The Modified Pediatric Sleep Questionnaire (PSQ-22) evaluates sleep disordered breathing (SDB), and related behavioral disturbances; and 3) The Dysfunctional Voiding and Incontinence Scoring System (DVISS) to quantify the effect of dysfunctional elimination. Data was collected by a research team and statistics performed with student t-test and Fishers exact test. Results: Forty-two children were enrolled (males and females). Thirty-one (74%) children presented with a positive DVISS score. The mean baseline OSA-18 score was 49.5 out of a maximum of 126, indicating mildly impaired quality of life, with respect to sleep apnea symptoms. 26(62%) patients scored positively on the PSQ-22, indicating a high likelihood of sleep-related breathing disorder in all patients presenting with NE. Mean OSA-18 scores did not differ between those patients with a positive and negative DVISS. However, patients were significantly more likely to have SDB if they were neither incontinent during the day nor had a positive DVISS (p<0.001). Conclusion: Our data demonstrates that individuals with NE have a high likelihood of sleep disturbances. This risk is further magnified in those patients with normal daytime voiding. Therefore, bedwetting may be an indicator of SDB and all children with NE should be screened for OSA. This data has significant implications, as it should alert practitioners to the potential for significant comorbidities. This may result in a more aggressive approach to treatment of NE. Further research will determine of resolution of NE results in improved sleep scores, or if treatment of OSA improves resolution of NE.