Sleep Architecture Patterns in Enuretic Children with OSA

Objective Nocturnal enuresis (NE) has been described in children with obstructive sleep apnea (OSA) related to adeno‐tonsillar hypertrophy. For those affected adeno‐tonsillectomy has demonstrated to improve both NE and OSA in many patients. Our objective is to determine if preoperative sleep architecture is associated with complete resolution of NE after adeno‐tonsillectomy. Method A prospective study of 18 pediatric patients (1/2011‐2/2012) with primary NE who underwent adeno‐tonsillectomy for OSA was conducted. Both preoperative polysomnograms (PSG) and pre‐ and postoperative reports of NE were recorded. Resolved vs unresolved postoperative nocturnal enuresis (RNE vs UNE) was the outcome evaluated. Data was assessed via chi‐square/ t test analyses. Results Mean child age was 8.28 (SD = 2.3 years). All children reported presurgical primary NE. No RNE vs UNE age/gender differences were identified. Postsurgery, over half of participants reported NE resolution. Significant improvement of NE was identified in children with higher preoperative AHIs (RNE mean = 21.4; UNE mean = 3.6; t = 2.33, P =. 03) and lower preoperative oxygen saturations (RNE lowest % = 78.1; UNE lowest % = 89.6; t = 2.72, P =. 03). All children with prolonged stage 2 sleep reported postsurgical NE resolution, whereas two‐thirds of the children with prolonged delta sleep and all with above normal REM reported persistent postsurgical NE. Conclusion Adeno‐tonsillectomy is a treatment option for OSA with NE. Preliminary data demonstrates that children with high AHIs, significant oxygen desaturations, and abnormally prolonged stage 2 sleep have a high resolution rate of NE postoperatively. There are significant differences in preoperative sleep architecture between UNE and RNE patients with OSA.