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Respiration during sleep in children with therapy-resistant enuresis

By T. Nevéus, L. Leissner, S. Rudblad, and F. Bazargani.

Acta Paediatrica, International Journal of Paediatrics, Volume 103, Issue 3, March 2014, Pages 300-304

Editor's comments:
Sleep disturbances and respiratory problems are a known association.  Sleep disturbances and nocturnal enuresis are a suspected association.  It seems evident that a study such as this, where (conventional treatment resistant) children with bedwetting were examined for respiration during sleep, is very interesting.  From this study it seems that the children have a higher than expected apnoea hypopnoea index due to a high frequency of hypopnoeas.  It was interesting to note that the “standard” polysomnographic variables were normal.



Although there is a known association between enuresis and snoring or sleep apnoeas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge.

Thirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apnoeas, underwent sleep registrations, including standard electroencephalography (EEG) and electrooculography (EOG) as well as registration of oxygen saturation, respiratory effort and nasal air flow. To assess nasal airway patency, rhinomanometry and acoustic rhinometry were performed before and after nasal decongestion.

The children were found to have a higher than expected apnoea hypopnoea index (AHI), due to a high frequency of hypopnoeas. They were also noted to have a tendency for respiratory arousals. Standard polysomnographic variables were normal.

We provide baseline data of nocturnal respiration in enuretic children. The children were found to have subclinical signs of disordered respiration. This may be one of the explanations for their high arousal thresholds.


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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.