Polysomnographic and urodynamic changes in a case of obstructive sleep apnea syndrome with enuresis

Abstract

A 53-year-old female patient with obstructive sleep apnea syndrome was reported. She had complained of enuresis as well as a 15-year history of snoring, but she had no complaint of sleep and awake disturbance. Polysomnographic study showed repeated obstructive apnea and hypopnea with an apnea/hypopnea index of 52.6, and severe oxygen desaturation during sleep. On cystometography during sleep, the changing amplitude of the spike wave corresponds to the changes of respiratory efforts against a closed upper airway. The patient was treated successfully with imipramine and acetazolamide for the obstructive sleep apnea and enuresis. Apnea/ hypopnea index, nocturnal oxygen desaturation, and sleep architecture were improved, and enuresis completely disappeared. Cystometrography during sleep showed that the average amplitude of the spike wave tended to be low. Percentage urinary volume during sleep compared with 24 h volume was significantly reduced. We considered that the enuresis was mainly related to increased intra-abdominal pressure produced by respiratory efforts and enhanced nocturnal urine production.

Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring

“…Several different pathophysiologic mechanisms have been proposed to explain the association between the two conditions. An increase in intra-abdominal pressure caused by intense inspiratory efforts against a closed upper airway has been implicated in the pathogenesis of enuresis (19). In addition, we have previously shown that fractional urinary excretion of sodium increases in parallel with severity of SDB and diastolic blood pressure in children with snoring (20).…”

Investigating the Associations Between Nocturia and Sleep Disorders in Perimenopausal Women

“…Similarly, increased intra-abdominal pressure generated during apneic events may be transmitted to the bladder increasing detrussor pressure on cystometrogram. 20 The relationship between the increased detrussor pressure during an apneic episode and nocturia needs further investigation.…”

The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients

“…Repetitive episodes of hypoxia during apnea and alterations in intrapleural negative pressure will affect the right atrium, resulting in increased atrial natriuretic peptide (ANP) secretion. Increased levels of ANP will result in inhibition of the renin-angiotensin-aldosterone system, eventually causing increased sodium and urine excretion (21)(22)(23). Furthermore, increased sympathetic activity in OSA patients causes increased urine production and hyperactivity of bladder smooth musculature (10).…”