Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children
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REVIEW ARTICLE
Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children Miao‑Shang Su1 · Li Xu1 · Wen‑Feng Pan1 · Chang‑Chong Li1 Received: 30 June 2018 / Accepted: 9 October 2018 © Children’s Hospital, Zhejiang University School of Medicine 2018
Abstract Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA. Date sources We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE. Results Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation. Conclusions Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched. Keywords Children · Nocturnal enuresis · Obstructive sleep apnea · Pathogenesis · Prevalence
Introduction Nocturnal enuresis (NE) is defined as intermittent incontinence while asleep in a child who is at least 5 years of age [1]. In general, NE is not considered a clinical problem when the number of wet nights is less than one per month [2]. For a diagnosis of NE to be established, a child 5–6 years old should have two or more bed-wetting episodes per month, and a child older than 6 years of age should have one or more bed-wetting episodes per month [3, 4]. Different prevalence rates of NE in the past mainly resulted from different definitions. Most recent studies have used this common definition Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12519-018-0199-6) contains supplementary material, which is available to authorized users. * Chang‑Chong Li [email protected] 1
Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
(Supplementary Appendix 1) [5–15]. A severity of “at least two wet nights per week” has been recommended by the Diagnostic and Statistical Manual of Mental Disorders as the definition of NE [16], but this severity definition has very rarely been used in epidemiological studies (Supplementary Appendix 2) [17–23]. Recent studies have shown a higher prevalence of NE because of less severe criteria i
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