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How do we recognize the child with OSAS

Joosten KF, Larramona H, Miano S, Van Waardenburg D, Kaditis AG, Vandenbussche N, Ersu R

Pediatr Pulmonol. 2016 Nov 16. doi: 10.1002/ppul.23639. [Epub ahead of print]

Commentary by Konstantinos Kamperis

Obstructive sleep apnea in children. Should we consider that in children with enuresis ?

Nocturnal enuresis is a complex disorder with not fully understood pathophysiology. There is increasing interest regarding comorbidity factors seen in children with enuresis that indeed may affect the prognosis and treatment of the condition. One of these factors is sleep-disordered breathing (SDB) a condition which not uncommon in children. The relationship between sleep disordered breathing and nocturnal enuresis is established. Clinicians treating bedwetting should be aware of the association and proceed towards the diagnosis if obstructive sleep apnea is suspected. But how can we do that?

The authors of this state of the art review present us with definitions, clinical symptoms, diagnostic considerations and methods of assessment when sleep disordered breathing is suspected.

Symptoms such as habitual snoring, apneas, excessive sweating and mouth breathing should alert the physician especially in children with bedwetting that does not respond to treatment. Adenotonsillar hypertrophy is the most common risk factor for SDB, but craniofacial abnormalities, maxillary or mandibular hypoplasia are to be encountered as well. A major predisposing factor is obesity with up to 60% of obese children suffering from obstructive sleep apneas during sleep. In addition, it seems that children of African American origin are in increased risk for SDB in comparison to Caucasians the differences attributed to the different airway anatomy.

The objective assessment of the condition is based on in-patient polysomnography but a less resource-demanding approach with overnight oximetry together with questionnaires may be of use as a screening tool. Home-based recordings with polysomnography or nocturnal oximetry are gaining increasing interest being more cost effective.

Sleep questionnaires represent an easy screening method that can readily be implemented in the clinics. The use of such screening tools might be justified as part of the clinical assessment of the enuretic child.

Sleep disordered breathing is a comorbidity factor that clinicians treating bedwetting need to look for.


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.