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Published in: Lung 1/2020

01-02-2020 | Sleep Apnea | SLEEP

Obstructive Sleep Apnea in School-Aged Children Presented with Nocturnal Enuresis

Authors: Hanaa Shafiek, Melania Evangelisti, Nashwa Hassan Abd-elwahab, Mario Barreto, Maria Pia Villa, Mahmoud Ibrahim Mahmoud

Published in: Lung | Issue 1/2020

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Abstract

Objectives

We aimed to detect obstructive sleep apnea (OSA) among school-age children presented with nocturnal enuresis (NE) and to identify the possible risk factors for OSA in them.

Methods

Sixty-six children aged > 5–16 years presented with NE were enrolled in the study. Children with urinary tract anatomical abnormalities or infection, intellectual disabilities, genetic syndromes, psychological issues, and diabetes mellitus were excluded. They were clinically examined, scored using sleep clinical record score (SCR), and subjected for full-night polysomnogram (PSG). Children with obstructive apnea/hypopnea index (AHI) ≥ 2 episodes/hour (h) were considered as OSA.

Results

Fifty-four children (81.8% of the recruited children) aged 8.3 ± 2.8 years agreed to undergo PSG as 68.5% had OSA with median obstructive AHI of 6.1 (3.7–13.2) episodes/h, median oxygen saturation of 97% and nadir of 88%. Thirty-three percent were obese with significantly higher AHI [7.0 (3.7–12.4) vs. 2.4 (1.3–6.1) episodes/h; p = 0.023]. SCR score correlated significantly with AHI (r2 = 0.462, p = 0.001) with 91% sensitivity in detecting OSA ≥ 5 episodes/h. Nasal obstruction, adenoid/adult facial phenotype, and arched palate were associated with OSA (p < 0.05).

Conclusion

NE is commonly associated with OSA especially in obese children. Nasal obstruction, abnormal facial phenotype, and high-arched palate were common risk factors.
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Literature
1.
go back to reference Marcus CL, Brooks LJ, Draper KA et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):576–584CrossRef Marcus CL, Brooks LJ, Draper KA et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):576–584CrossRef
2.
go back to reference Halbower AC, Degaonkar M, Barker PB et al (2006) Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med 3(8):e301CrossRef Halbower AC, Degaonkar M, Barker PB et al (2006) Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med 3(8):e301CrossRef
3.
go back to reference Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF (2005) Clinical screening of school children for polysomnography to detect sleep-disordered breathing–the Tucson Children's Assessment of Sleep Apnea study (TuCASA). J Clin Sleep Med 1(3):247–254CrossRef Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF (2005) Clinical screening of school children for polysomnography to detect sleep-disordered breathing–the Tucson Children's Assessment of Sleep Apnea study (TuCASA). J Clin Sleep Med 1(3):247–254CrossRef
4.
go back to reference Desta M, Hagglof B, Kebede D, Alem A (2007) Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children. Acta Paediatr 96(4):556–560CrossRef Desta M, Hagglof B, Kebede D, Alem A (2007) Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children. Acta Paediatr 96(4):556–560CrossRef
5.
go back to reference Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR (2009) Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among US children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry 48(1):35–41CrossRef Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR (2009) Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among US children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry 48(1):35–41CrossRef
6.
go back to reference Alexopoulos EI, Malakasioti G, Varlami V, Miligkos M, Gourgoulianis K, Kaditis AG (2014) Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring. Pediatr Res 76(6):555–559CrossRef Alexopoulos EI, Malakasioti G, Varlami V, Miligkos M, Gourgoulianis K, Kaditis AG (2014) Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring. Pediatr Res 76(6):555–559CrossRef
7.
go back to reference Basha S, Bialowas C, Ende K, Szeremeta W (2005) Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 115(6):1101–1103CrossRef Basha S, Bialowas C, Ende K, Szeremeta W (2005) Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 115(6):1101–1103CrossRef
8.
go back to reference Kaditis AG, Alonso Alvarez ML, Boudewyns A et al (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94CrossRef Kaditis AG, Alonso Alvarez ML, Boudewyns A et al (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47(1):69–94CrossRef
9.
go back to reference Villa MP, Paolino MC, Castaldo R et al (2013) Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 41(6):1355–1361CrossRef Villa MP, Paolino MC, Castaldo R et al (2013) Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 41(6):1355–1361CrossRef
10.
go back to reference Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105(1):10–14CrossRef Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105(1):10–14CrossRef
11.
go back to reference Marzocchi GM, Cornoldi C (2000) Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattivita. [A scale to identify behavioural problems in ADHD children.]. Psicologia Clinica dello Sviluppo 43–64. Marzocchi GM, Cornoldi C (2000) Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattivita. [A scale to identify behavioural problems in ADHD children.]. Psicologia Clinica dello Sviluppo 43–64.
12.
go back to reference Hassan AM, Al-Haidar F, Al-Alim F, Al-Hag O (2009) A screening tool for attention deficit hyperactivity disorder in children in Saudi Arabia. Ann Saudi Med 29(4):294–298CrossRef Hassan AM, Al-Haidar F, Al-Alim F, Al-Hag O (2009) A screening tool for attention deficit hyperactivity disorder in children in Saudi Arabia. Ann Saudi Med 29(4):294–298CrossRef
13.
go back to reference Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events; Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619CrossRef Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events; Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619CrossRef
14.
go back to reference El-Mitwalli A, Bediwy AS, Zaher AA, Belal T, Saleh AB (2014) Sleep apnea in children with refractory monosymptomatic nocturnal enuresis. Nat Sci Sleep 6:37–42PubMedPubMedCentral El-Mitwalli A, Bediwy AS, Zaher AA, Belal T, Saleh AB (2014) Sleep apnea in children with refractory monosymptomatic nocturnal enuresis. Nat Sci Sleep 6:37–42PubMedPubMedCentral
15.
go back to reference Su MS, Li AM, So HK, Au CT, Ho C, Wing YK (2011) Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea. J Pediatr 159(2):238–421CrossRef Su MS, Li AM, So HK, Au CT, Ho C, Wing YK (2011) Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea. J Pediatr 159(2):238–421CrossRef
16.
go back to reference Jeyakumar A, Rahman SI, Armbrecht ES, Mitchell R (2012) The association between sleep-disordered breathing and enuresis in children. Laryngoscope 122(8):1873–1877CrossRef Jeyakumar A, Rahman SI, Armbrecht ES, Mitchell R (2012) The association between sleep-disordered breathing and enuresis in children. Laryngoscope 122(8):1873–1877CrossRef
17.
go back to reference Kaditis AG, Alexopoulos EI, Hatzi F, Kostadima E, Kiaffas M, Zakynthinos E, Gourgoulianis K (2006) Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing. Chest 130(5):1377–1384CrossRef Kaditis AG, Alexopoulos EI, Hatzi F, Kostadima E, Kiaffas M, Zakynthinos E, Gourgoulianis K (2006) Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing. Chest 130(5):1377–1384CrossRef
18.
go back to reference Sans Capdevila O, Crabtree VM, Kheirandish-Gozal L, Gozal D (2008) Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study. Pediatrics 121(5):e1208–e1214CrossRef Sans Capdevila O, Crabtree VM, Kheirandish-Gozal L, Gozal D (2008) Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study. Pediatrics 121(5):e1208–e1214CrossRef
19.
go back to reference Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J (2009) Abnormal sleep architecture and refractory nocturnal enuresis. J Urol 182(4 Suppl):1961–1965CrossRef Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J (2009) Abnormal sleep architecture and refractory nocturnal enuresis. J Urol 182(4 Suppl):1961–1965CrossRef
20.
go back to reference Neveus T (2003) The role of sleep and arousal in nocturnal enuresis. Acta Paediatr 92(10):1118–1123CrossRef Neveus T (2003) The role of sleep and arousal in nocturnal enuresis. Acta Paediatr 92(10):1118–1123CrossRef
21.
go back to reference Villa MP, Shafiek H, Evangelisti M, Rabasco J, Cecili M, Montesano M, Barreto M (2016) Sleep clinical record: what differences in school and preschool children? ERJ Open Res 2(1):00049CrossRef Villa MP, Shafiek H, Evangelisti M, Rabasco J, Cecili M, Montesano M, Barreto M (2016) Sleep clinical record: what differences in school and preschool children? ERJ Open Res 2(1):00049CrossRef
22.
go back to reference Barone JG, Hanson C, DaJusta DG, Gioia K, England SJ, Schneider D (2009) Nocturnal enuresis and overweight are associated with obstructive sleep apnea. Pediatrics 124(1):e53–e59CrossRef Barone JG, Hanson C, DaJusta DG, Gioia K, England SJ, Schneider D (2009) Nocturnal enuresis and overweight are associated with obstructive sleep apnea. Pediatrics 124(1):e53–e59CrossRef
23.
go back to reference Weintraub Y, Singer S, Alexander D et al (2013) Enuresis–an unattended comorbidity of childhood obesity. Int J Obes (Lond) 37(1):75–78CrossRef Weintraub Y, Singer S, Alexander D et al (2013) Enuresis–an unattended comorbidity of childhood obesity. Int J Obes (Lond) 37(1):75–78CrossRef
24.
go back to reference Verhulst SL, Schrauwen N, Haentjens D et al (2007) Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child 92(3):205–208CrossRef Verhulst SL, Schrauwen N, Haentjens D et al (2007) Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child 92(3):205–208CrossRef
25.
go back to reference Guven A, Giramonti K, Kogan BA (2007) The effect of obesity on treatment efficacy in children with nocturnal enuresis and voiding dysfunction. J Urol 178(4 Pt 1):1458–1462CrossRef Guven A, Giramonti K, Kogan BA (2007) The effect of obesity on treatment efficacy in children with nocturnal enuresis and voiding dysfunction. J Urol 178(4 Pt 1):1458–1462CrossRef
26.
go back to reference Miller AJ, Vargervik K, Chierici G (1984) Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod 85(5):385–392CrossRef Miller AJ, Vargervik K, Chierici G (1984) Experimentally induced neuromuscular changes during and after nasal airway obstruction. Am J Orthod 85(5):385–392CrossRef
27.
go back to reference Park S, Lee JM, Sim CS et al (2016) Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study. Laryngoscope 126(5):1241–1245CrossRef Park S, Lee JM, Sim CS et al (2016) Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: A prospective study. Laryngoscope 126(5):1241–1245CrossRef
28.
go back to reference Waleed FE, Samia AF, Samar MF (2011) Impact of sleep-disordered breathing and its treatment on children with primary nocturnal enuresis. Swiss Med Wkly 141:w13216PubMed Waleed FE, Samia AF, Samar MF (2011) Impact of sleep-disordered breathing and its treatment on children with primary nocturnal enuresis. Swiss Med Wkly 141:w13216PubMed
29.
go back to reference Villa MP, Brasili L, Ferretti A et al (2015) Oropharyngeal exercises to reduce symptoms of OSA after adenotonsillectomy. Sleep Breath 19(1):281–289CrossRef Villa MP, Brasili L, Ferretti A et al (2015) Oropharyngeal exercises to reduce symptoms of OSA after adenotonsillectomy. Sleep Breath 19(1):281–289CrossRef
30.
go back to reference Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH (2013) Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med 14(6):518–525CrossRef Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH (2013) Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med 14(6):518–525CrossRef
31.
go back to reference Chervin RD, Weatherly RA, Garetz SL et al (2007) Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 133(3):216–222CrossRef Chervin RD, Weatherly RA, Garetz SL et al (2007) Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 133(3):216–222CrossRef
Metadata
Title
Obstructive Sleep Apnea in School-Aged Children Presented with Nocturnal Enuresis
Authors
Hanaa Shafiek
Melania Evangelisti
Nashwa Hassan Abd-elwahab
Mario Barreto
Maria Pia Villa
Mahmoud Ibrahim Mahmoud
Publication date
01-02-2020
Publisher
Springer US
Published in
Lung / Issue 1/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-019-00304-6

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