Bedwetting and Obstructive Sleep Apnea

Nocturnal enuresis (bedwetting) affects approximately 5 million school-aged children. A child must be at least five-years old before this diagnosis can be made. A child with nocturnal enuresis should be examined by a physician to rule out an organic etiology, such as a urinary tract infection. Often no specific organic cause is found. However, pediatricians frequently neglect to ask their enuretic patients about symptoms of obstructive sleep apnea, a common cause of nocturnal enuresis.

Nocturnal enuresis is present in approximately 1/3 of children with obstructive sleep apnea. Besides enuresis, other symptoms of pediatric sleep apnea include snoring, sleepiness, hyperactivity, poor school performance, and behavior problems. In a recent study of children with both nocturnal enuresis and obstructive sleep apnea, Basha and colleagues found that treatment of obstructive sleep apnea by adenotonsillectomy often cured enuresis. In their study, postoperatively 61.4% of children were free of enuresis, 22.8% had a decrease in enuresis, and 15.8% had no change in enuresis.

How does obstructive sleep apnea (OSA) cause enuresis? Proposed factors include: 1) decreased arousal response, 2) impaired urodynamics, and 3) altered secretion of hormones that regulate fluid balance.

Decreased Arousal Response – OSA may promote enuresis by decreasing the arousal response from sleep.
Impaired Urodynamics – Increased intra-abdominal pressure during obstructive respiratory events increases bladder pressure.
Altered Secretion of Hormones – OSA can affect the secretion of atrial natriuretic peptide and antidiuretic hormone.

Nocturnal enuresis is a common childhood condition. Nocturnal enuresis is frequently due to OSA, and in these cases it usually resolves or improves with treatment of OSA.

References

1. Sheldon SH. “Sleep-Related Enuresis”. In Principals and Practice of Pediatric Sleep Medicine.

2. Basha S, et al. Effectiveness of Adenotonsillectomy in the Resolution of Nocturnal Enuresis Secondary to Obstructive Sleep Apnea. Laryngoscope, 115:1101-03, 2005.

3. Brooks LJ and Topol HI. Enuresis in Children with Sleep Apnea. J Pediatr 2003, 142:515-8.