The role of sleep in the pathophysiology of nocturnal enuresis

Pedersen, Malthe Jessen; Rittig, Søren; Jennum, Poul; Kamperis, Konstantinos

doi:10.1016/j.smrv.2019.101228

Cited by 42 publications

(58 citation statements)

References 63 publications

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“…Several recent reports have shown that sleep disorders are a risk factor for LUTS progression, with these reports discussing the relationship with the circadian clock system 17 . In addition to the decreased functional bladder capacity associated with LUTS and urgency, sleep disorders were a common feature in nocturnal enuresis and nocturia as well as in nocturnal polyuria, which is another major factor 2,5,22 . Nocturnal polyuria is one of the main causes of nocturia in adults and a low dose desmopressin has been recently available for the treatment of the nocturia as well as the high dose one for enuretic children.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, nocturia, which refers to waking to pass urine during the main sleep period, 1 is not common until early adulthood, but the prevalence becomes high among older adults (60% of people over age 60 years) and increases with aging 4 . These two conditions differ in onset, but share common pathological factors such as nocturnal polyuria, polyuria, reduced functional bladder capacity, and sleep problems 2,5–7 …”

Section: Introductionmentioning

confidence: 99%

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Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study

Negoro

Fukunaga

Setoh

et al. 2020

Neurourology and Urodynamics

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Aim: To evaluate the relationship between nocturia and medical history of nocturnal enuresis: two conditions where diurnal urination rhythm is disturbed. Methods: The Nagahama study is a longitudinal population-based health survey involving people aged 30-75 years in Nagahama city, Japan. Our analysis included 5,402 participants who completed enuresis and International Prostate Symptom Score questionnaires. Associations between nocturnal enuresis and nocturia were evaluated cross-sectionally and longitudinally with three models: (1) univariate analysis; (2) adjusted for basic characteristics (e.g., age, sex, body mass index, activity, alcohol, and smoking); and (3) adjusted for basic and clinical variables (e.g., hyperglycemia, hyperlipidemia, hypertension, renal insufficiency, insomnia, obstructive sleep apnea, and mental health). Results: In total, 1,613 participants (29.9%) had a medical history of enuresis. The mean night-time frequency was 0.73 at baseline and 0.85 at the 5-year follow-up. The cross-sectional analysis showed participants with a medical history of enuresis had night-time frequency more often than those without this history (0.84 vs. 0.68, p < .0001). Significant differences were observed in Models 2 (p < .0001) and 3 (p < .0001). The longitudinal analysis showed nocturia progression was significantly related to a history of enuresis, with odds ratios of 1.32 (p < .0001) in Model 1, 1.21 (p < .01) in Model 2, and 1.22 (p < .01) in Model 3. Conclusions: Medical history of enuresis during school age was significantly related to nocturia in adulthood in the cross-sectional analysis, and to

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study

Negoro

Fukunaga

Setoh

et al. 2020

Neurourology and Urodynamics

View full text Add to dashboard Cite

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“…Finally, the multivariate logistic regression analysis, detected the most significant independent factors related to sleep architecture accompanied by nocturnal enuresis, were sleep arousal and snoring index (OR 3.56, 95% CI 2.08-4.25, P ¼ .001, and OR 2.23, 95% CI 1.68-2.53, P ¼ .005, respectively) followed by sleep latency, N1%, and sleep efficiency (OR 1.67, 95% CI 1.83-2.49, P ¼ .02; OR 1.59, 95% CI 1.72-2.33, P ¼ .03; and OR 1.48, 95% CI 1.67-2.29, P ¼ .04, respectively). Similarly, an updated study of Malthe et al 15 concluded that children with nocturnal enuresis experience more cortical arousals; their sleep may be fragmented and of poor quality. This may lead to changes in the autonomic nervous system and hence hemodynamics, resulting in excess urine production as well as bladder overactivity.…”

Section: Factors Related To Sleep Architecture Accompanied By Nocturnmentioning

confidence: 98%

“…Recent researches find variations in sleep microstructure in children with nocturnal enuresis. 15 There are conflicting results from studies assessing sleep using polysomnography in children with nocturnal enuresis as some studies have reported that the polysomnography results of children with nocturnal enuresis were similar to those of control children, whereas other studies have shown significant differences between the 2 groups. 18,19 Few studies evaluated the relationship between sleep architecture and secondary nocturnal enuresis.…”

mentioning

confidence: 99%

“…14 Several studies have assessed the sleep architecture and characteristics in children with mainly the primary nocturnal enuresis. 15 In a trial to investigate the role of sleep characteristics and sleep stages in the primary nocturnal enuresis, the relationships between nocturnal enuresis and sleep disturbances were evaluated. 16 Ma et al 17 observed that children with nocturnal enuresis have more sleep problems like insomnia, impaired sleep duration, frequent arousal, sleep-disordered breathing, and sleepiness in the daytime more than children without nocturnal enuresis.…”

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confidence: 99%

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Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children

et al. 2020

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Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid–induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid–induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate ( P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child’s ability to awaken to the sense of bladder fullness or contractions. Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863

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Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea

Snow

Vazifedan

Baldassari

2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEChildren with obstructive sleep apnea (OSA) are at increased risk for nocturnal enuresis (NE). However, randomized clinical trials assessing NE outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting are lacking.OBJECTIVE To assess the outcomes of AT vs watchful waiting in children with nonsevere OSA who experience NE.DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of data from a multicenter randomized clinical trial conducted at tertiary children's hospitals was performed. Participants included 453 children aged 5.0 to 9.9 years with nonsevere OSA who were randomized to either watchful waiting or AT as part of the multicenter Childhood Adenotonsillectomy Trial. Caregivers completed the Pediatric Sleep Questionnaire, which includes a binary item on bed-wetting, at baseline and 7-month follow-up. The trial was conducted between October 2007 and June 2012. Evaluation in this secondary analysis involving NE occurred from October 2019 to March 2021. INTERVENTIONS Adenotonsillectomy vs watchful waiting in children with NE.MAIN OUTCOMES AND MEASURES Prevalence of NE as defined by parental response to the Pediatric Sleep Questionnaire bed-wetting item at baseline and 7-month follow-up. RESULTSOf the 453 children enrolled, 393 were included in analysis; of these, 201 were girls (51.1%). Mean (SD) age at baseline was 6.54 (1.40) years. At baseline, the number of children with NE was similar (2.6%; 95% CI, −0.12% to 0.07%) between the AT (59 [30.7%]) and watchful-waiting (67 [33.3%]) groups. The odds of NE in the watchful-waiting group were approximately 2 times higher than the AT group after 7 months (odds ratio, 2.0; 95% CI, 1.3 to 3.1). Following AT, there was a decrease (−11.0%; 95% CI, −16.3% to −5.7%) in the number of children with NE (n = 38). The prevalence of NE did not change significantly (−0.5%; 95% CI, −5.4% to 6.4%) in the watchful-waiting group (n = 66) at follow-up. Although NE was less frequent in girls (adjusted odds ratio, 0.53; 95% CI, 0.33-0.85), other clinical factors, such as age, race and ethnicity, obesity, and apnea-hypopnea index, were not associated with improvement of NE. CONCLUSIONS AND RELEVANCEIn this secondary analysis of a randomized clinical trial, AT for the treatment of pediatric OSA appears to result in improvement in NE. Further research is needed to assess whether AT is associated with long-term benefits for NE compared with watchful waiting.

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The role of sleep in the pathophysiology of nocturnal enuresis

Cited by 42 publications

References 63 publications

Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study

Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study

Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children

Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea

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