Sleep associated breathing problems in primary nocturnal enuresis: A polysomnographic study

Nocturnal enuresis (NE) is one of the most common pediatric sleep related problems. Lack of arousal and inhibition deficit of micturation reflex have been proposed as the main dysfunction leading to wetting during sleep. Nocturnal enuresis may be a symptom of sleep-disordered breathing.Data regarding sleep patterns in children with enuresis and its relationship to obstructive sleep apnea is controversial. We aimed to study the sleep architecture in children with primary nocturnal enuresis and search for sleep associated breathing problems in those children. This study included 31 children aged 6-18 years with primary monosymptomatic nocturnal enuresis and having no respiratory complains. They were subjected to polysomnographic assessment and compared to age and sex matched controls. Enuretic children had significant prolonged sleep latency (45.56±46.29 Vs 23±25.3 min, P=.01). Stages 1% and 3% were significantly prolonged (9.98± 7.24 and 10.23±4.77 Vs 7.1±5.5 and 5.5±2.9, P=.03 &.001 respectively). REM stage % (12.35±7.67 Vs 22.6±5.2, P=.001), sleep efficiency % (71.8±20.67 Vs 89.3±7.5, P=.01) and arousal index (1.03±2.61 Vs 9.3± 4.8, P=.001) were significantly reduced. Snoring were present in 6 cases (19.35%), 5 cases (16.1%) had sleep disordered breathing and 6 cases (19.35%) had apenia hypopnea index >5. Ten cases (32.2%) had nocturnal arrhythmia. Conclusion: Primary nocturnal enuresis is associated with disturbed sleep architecture. Nocturnal enuresis could be a presenting symptom for hidden sleep disordered breathing. Polysomnography is recommended in children complaining of primary nocturnal enuresis to investigate breathing disorders.