Abnormal circadian blood pressure regulation in children with nocturnal enuresis

Yüce, Özge; Bayrakçı, Umut Selda; Gulleroglu, Kaan; Baskın, Esra

doi:10.3109/0886022x.2016.1164064

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…They looked specifically at enuretic children with nocturnal polyuria, and found that they had more bodily movements – a sign of arousal – than their dry peers . Whether this finding can be extrapolated to other groups of enuretic children remains to be seen, but subjective indicators of poor sleep are accumulating, and recent studies showing higher nocturnal blood pressure in enuretic children than normal controls point in the same direction . In short, the sleep of enuretic children might be “deep” but “poor”.…”

Section: Sleep and Arousalmentioning

confidence: 99%

Pathogenesis of enuresis: Towards a new understanding

Nevéus

2017

Int J of Urology

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Abbreviations & Acronyms ADHD = attention deficit hyperactivity disorder CNS = central nervous system LC = locus coeruleus PAG = periaqueductal gray area PMC = pontine micturition center Abstract: Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be "deep," but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus.

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Section: Sleep and Arousalmentioning

confidence: 99%

Pathogenesis of enuresis: Towards a new understanding

Nevéus

2017

Int J of Urology

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“…Together with markers for oxidative stress, we found a 2.4-fold increase in adrenalin levels during wet nights and the presence of proteins relevant to blood pressure regulation. Kruse et al provided evidence of an increased nocturnal mean arterial pressure in NE children with polyuria and described a positive correlation between average nocturnal mean arterial pressure and nocturnal urine volume [ 38 ], findings that have been confirmed in other studies [ 39 ]. Further in line with this, we found increased levels of uromodulin (also in validation experiments) on wet nights compared to dry nights, which seems relevant since uromodulin is described to be important in sodium handling, blood pressure regulation, and modulation of oxidative stress in the body [ 40 ].…”

Section: Discussionmentioning

confidence: 77%

Differences in the urinary metabolome and proteome between wet and dry nights in children with monosymptomatic nocturnal enuresis and nocturnal polyuria

et al. 2023

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Background Nocturnal enuresis (NE) is a common disease with multiple pathogenic mechanisms. This study aimed to compare levels of metabolites and proteins between wet and dry nights in urine samples from children with monosymptomatic NE (MNE). Methods Ten boys with MNE and nocturnal polyuria (age: 7.6 ± 1.3 years) collected their total nighttime urine production during a wet and a dry night. Untargeted metabolomics and proteomics were performed on the urine samples by liquid chromatography coupled with high-mass accuracy tandem mass spectrometry (LC-MS/MS). Results On wet nights, we found reduced urine osmolality (P = 0.025) and increased excretion of urinary potassium and sodium by a factor of, respectively, 2.1 (P = 0.038) and 1.9 (P = 0.19) compared with dry nights. LC-MS identified 59 metabolites and 84 proteins with significantly different levels between wet and dry nights (fold change (FC) < 0.67 or > 1.5, P < 0.05). Some compounds were validated by different methodologies. During wet nights, levels of compounds related to oxidative stress and blood pressure, including adrenalin, were increased. We found reduced levels of aquaporin-2 on wet nights. The FCs in the 59 metabolites were positively correlated to the FCs in the same metabolites identified in urine samples obtained during the evening preceding wet and dry nights. Conclusions Oxidative stress, which in the literature has been associated with nocturia and disturbances in sleep, might be increased during wet nights in children with MNE. We further found evidence of increased sympathetic activity. The mechanisms related to having wet nights in children with MNE seem complex, and both free water and solute handling appear to be important. Graphical abstract

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“…This lack of difference suggested the presence of white-coat hypertension in the control group. In their study, Yuce O et al (16) , evaluated 28 patients with monosymptomatic enuresis aged between 6-15 years based on 24-hour blood pressure measurements and found higher heart rates in enuretics which they thought to be probably related to increased arterial baroreceptor reflex responses. Normally, increased arterial pressure stimulates arterial baroreceptors in the aortic arch and carotid sinus area which leads to reflex inhibition of sympathetic efferent nerve activity and a decrease in heart rate with increased stimulation of parasympathetic efferent nerve activity.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Children with Primary Monosymptomatic Enuresis in Terms of Ambulatory Blood Pressure Changes

Mertek¹,

Alaygut²,

Soyaltın³

et al. 2021

TERH

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Objective: To evaluate the relationship between blood pressure changes monitored by 24-hour blood pressure measurements and urinary incontinence in children with enuresis. Method: The patients aged 5-18 years who received (patient group), and did not receive (control group) the diagnosis of primary monosymptomatic enuresis, and applied between January 01, 2017 and June 1, 2017, to the outpatient clinics of Izmir Tepecik Training and Research Hospital Department of Pediatric Nephrology and Pediatrics constituted the study group. Demographic data, height, body weight, body mass index, family history of chronic illness, and enuresis, drug use, laboratory test results (blood biochemistry and whole blood count) and ambulatory blood pressure monitoring (ABPM) measurements were compared between groups. Results: Thirty-five (62.5%, Group 1) patients and 21 (37.5%, Group 2) control subjects were included in the study. Demographic properties of the patients were not remarkable. Family history of enuresis was detected in statistically significantly greater number of patients (p=0.001). Any statistically significant difference was not noted when ABPM data of both groups were compared. Conclusion: Discrepancies in the results of various studies concerning the autonomic system changes in enuretic patients, their reflections on blood pressures, and 24-hour blood pressure profiles, in addition to controversial views of the authors about relationship between decreasing urine output and BP depression have necessitated conduction of further studies with larger group of patients.

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Abnormal circadian blood pressure regulation in children with nocturnal enuresis

Abstract: Subtle abnormalities of circadian BP regulation in enuretic children indicated by a selective elevation of nocturnal SBP, DBP, and MAP, and attenuated nocturnal dipping may reflect sympathetic hyper activation and its possible role in pathogenesis of enuresis.

Cited by 12 publications

References 33 publications

Pathogenesis of enuresis: Towards a new understanding

Pathogenesis of enuresis: Towards a new understanding

Differences in the urinary metabolome and proteome between wet and dry nights in children with monosymptomatic nocturnal enuresis and nocturnal polyuria

Assessment of Children with Primary Monosymptomatic Enuresis in Terms of Ambulatory Blood Pressure Changes

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