Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Sleep and Breathing
Published in: Sleep and Breathing 2/2011

01-05-2011 | Original Article

Facial patterns and primary nocturnal enuresis in children

Authors: Marco Carotenuto, Maria Esposito, Antonio Pascotto

Published in: Sleep and Breathing | Issue 2/2011

Login to get access

Abstract

Purpose

Aims of our study are evaluating: (1) the prevalence of dolicofacial pattern among enuretic and control-group children, (2) the prevalence of an abnormal head posture in bedwetters, and (3) the correlation with sleep-related breathing disorders (SRBD) identified by polysomnography (PSG) recording. Nocturnal enuresis is a multifactorial disease, but has been related also to obstructive sleep-disordered breathing in both adults and children. Anatomical factors recognized to predispose to SRBD include adenotonsillar hypertrophy, neuromuscular disorders, craniofacial abnormalities associated with macroglossia, retrognathia or maxillary hypoplasia, and obesity.

Methods

Two hundred seventy enuretic children aged 7–12 years (mean 9.62 ± 2.31) were compared with a control-matched group of 274 children. To screen nocturnal sleep habits, all subjects’ mothers filled out the Sleep Disturbance Scale for Children. Among these scales, only SBD scale was taken into account. Sleep breathing disorders (SBD) scale is composed of three items: sleep breathing difficulties, sleep apnea, and snoring. Cephalic index was calculated for each patient in order to identify facial patterns. An overnight PSG was performed in 28 (15 males, 13 females), randomly chosen, enuretic children and in 38 healthy volunteer controls (18 males, 20 females) matched for age (8.73 ± 0.79 vs. 9.12 ± 1.23; p = 0.147) and sex distribution (chi-square = 0.062; p = 0.803).

Results

Bedwetters show different sleep habits, higher prevalence of dolicofacial pattern, and abnormal head posture more than controls.

Conclusions

Our preliminary study support further investigation of usage of the cephalic index as a predictor of SRBD.
Literature
1.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
2.
Hjalmas K, Arnold T, Bower W, Caione P, Chiozza LM, von Gontard A, Han SW, Husman DA, Kawauchi A, LAckgren G, Lottmann H, Mark S, Rittig S, Robson L, Walle JV, Yeung CK (2004) Nocturnal enuresis: an international evidence based management strategy. J Urol 171(6 Pt 2):2545–2561PubMedCrossRef
3.
Steers WD, Suratt PM (1997) Sleep apnoea as a cause of daytime and nocturnal enuresis. Lancet 349:1604PubMedCrossRef
4.
Kramer NR, Bonitati AE, Millman RP (1998) Enuresis and obstructive sleep apnea in adults. Chest 114:634–637PubMedCrossRef
5.
Stone J, Malone PSG, Atwill D, McGrigor V, Hill CM (2008) Symptoms of sleep-disordered breathing in children with nocturnal enuresis. J Pediatr Urol 4:197–e202PubMedCrossRef
6.
7.
Weider DJ, Sateia MJ, West RP (1991) Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg 105:427–432PubMed
8.
Gislason T, Benediktsdottir B (1995) Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. Chest 107:963–966PubMedCrossRef
9.
Teculescu DB, Caillier I, Perrin P, Rebstock E, Rauch A (1992) Snoring in French preschool children. Pediatr Pulmonol 13(4):239–244PubMedCrossRef
10.
Ali NJ, Pitson D, Stradling JR (1994) Natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child 71:74–76PubMedCrossRef
11.
Brunetti L, Rana S, Lospalluti ML (2001) Prevalence of obstructive sleep apnea syndrome in a cohort of 1207 children of southern Italy. Chest 120:1930–1935PubMedCrossRef
12.
Alexopoulos EI, Kaditis AG, Kostadima E (2005) Resolution of nocturnal enuresis in snoring children after treatment with nasal budesonide. Urology 66:194e.14–194e.16CrossRef
13.
American Academy of Pediatrics (2002) Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 109:704–712CrossRef
14.
Alexopoulos EI, Kostadima E, Pagonari I, Zintzaras E, Gourgoulianis K, Kaditis AG (2006) Association between primary nocturnal enuresis and habitual snoring in children. Urology 68 (2)
15.
Nelson S, Hans M (1997) Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 111:154–162PubMedCrossRef
16.
Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, Giannotti F (1996) The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res 5(4):251–261PubMedCrossRef
17.
Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ (2003) Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21:253–259PubMedCrossRef
18.
Skinner MA, Choudhury MS, Homan SD, Cowan JO, Wilkins GT, Taylor DR (2005) Accuracy of monitoring for sleep-related breathing disorders in the coronary care unit. Chest 127:66–71PubMedCrossRef
19.
American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153:866–878
20.
Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, Von Pechmann WS, Keens TG, Ward SL (1992) Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 146(5 Pt 1):1235–1239PubMed
21.
American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689
22.
Wong TK, Galster P, Lau TS, Lutz JM, Marcus CL (2004) Reliability of scoring arousals in normal children and children with obstructive sleep apnea syndrome. Sleep 27:1139–1145PubMed
23.
Posnick JC, Farkas LG (1994) The application of anthropometric surface measurements in craniomaxillofacial surgery. In: Farkas LG (ed) “Anthropometry of the head and face”, 2nd edn. Raven Press, New York, pp 125–137
24.
Williams PL, Warwick R, Dyson M, Bannister LH (1989) “Gray’s Anatomy”, 37th edn. Churchill Livingstone, Edinburgh
25.
26.
Guilleminault C, Li KK, Khramstov A, Pelayo R, Martnez S (2004) Sleep disordered breathing: surgical outcomes in prepubertal children. Laryngoscope 14(1):132–137CrossRef
27.
Zonato AI, Martinho FL, Bittencourt LR, de Oliveira Campones Brasil O, Gregorio LC, Tufik S (2005) Head and neck physical examination: comparison between non-apneic and obstructive sleep apnea patients. Laryngoscope 115(6):1030–1034PubMedCrossRef
28.
Elsherif I, Kareemullah C (1999) Tonsil and adenoid surgery for upper airway obstruction in children. Ear Nose Throat J 78:617–620PubMed
29.
Finkelstein Y, Wexler D, Berger G, Nachmany A, Shapiro-Feinberg M, Ophir D (2000) Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 126(5):593–600PubMed
30.
Miyao E, Miyao M, Ohta T, Okawa M, Inafuku S, Nakayama M, Goto S (2000) Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms. Psychiatry Clin Neurosci 54(6):659–664PubMedCrossRef
31.
Carotenuto M, Bruni O, Santoro N, Del Giudice EM, Perrone L, Pascotto A (2006) Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: a questionnaire-based study. Sleep Med 7(4):357–361PubMedCrossRef
32.
Guilleminault C, Pelayo R, Leger D, Clerk A, Bocian RCZ (1996) Recognition of sleep-disordered breathing in children. Pediatrics 98:871–882PubMed
33.
Sousa JBR, Anselmo-Lima WT, Valera FCP, Gallego AJ (2005) Matsumoto MAN. Cephalometric assessment of mandibular growth. J Pediatr Otorhinolaryngol 69:311–317CrossRef
34.
Oulis CJ, Vadiakas GP, Ekonomides J, Dratsa J (1994) The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits. J Clin Pediatr Dent 18:197–201PubMed
35.
Kerr WJS, Orth D, McWilliam JS, Linder-Aronson S (1989) Mandibular form and position related to changed mode of breathing—a five-year longitudinal study. Angle Orthod 59:91–96PubMed
36.
Cheng MC, Enlow DH, Papsidero M, Broadbent BH Jr, Oyen O, Sabat M (1988) Developmental effects of impaired breathing in the face of growing child. Angle Orthod 58:309–320PubMed
37.
Kushida CA, Efron B, Guilleminault C (1997) A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 127(8 Pt 1):581–587PubMed
38.
Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R (2002) Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 165:123–127PubMed
39.
Guilleminault C, Eldridge FL, Simmons FB, Dement WC (1976) Sleep apnea in eight children. J Pediatr 58:23–30
40.
Weider DJ, Sateia MJ, West RP (1991) Nocturnal enuresis in children with upper airway obstruction. J Otolaryngol Head Neck Surg 105:427–432
41.
Nowak KC, Weider DJ (1998) Pediatric nocturnal enuresis secondary to airway obstruction from cleft palate repair. Clin Pediatr 37:653–657CrossRef
42.
Ng DK, Chau KW, Kwok KL (2001) Nocturnal enuresis and obstructive sleep apnea in two children. Singapore Med J 42:590–591PubMed
43.
Basha S, Bialowas C, Ende K, Szeremeta W (2005) Effectiveness of adenotonsillectomy in nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope 115:1101–1103PubMedCrossRef
44.
Kikuchi M, Higurashi N, Miyazaki S, Itasaka Y, Chiba S, Nezu H (2002) Facial pattern categories of sleep breathing-disordered children using Ricketts analysis. Psychiatry Clin Neurosci 56(3):329–330PubMedCrossRef
45.
Warren DW, Lehman MD, Hinton VA (1984) Analysis of simulated upper airway breathing. Am J Orthod 86:197–206PubMedCrossRef
46.
Linder-Aronson S (1970) Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhinomanometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol 265(Suppl):1S–132S
47.
Behlfelt K, Linder-Aronson S, McWilliam J, Neander P, Laage-Hellmann J (1990) Cranio-facial morphology in children with and without enlarged tonsils. Eur J Orthod 12:233–243PubMed
48.
Tecco S, Festa F, Tete S, Longhi V, D’Attilio M (2005) Changes in head posture after rapid maxillary in mouth-breathing girls: a controlled study. Angle Orthod 75:171–176PubMed
49.
Berry RB, Kouchi KG, Der DE, Dickel MJ, Light RW (1996) Sleep apnea impairs the arousal response to airway occlusion. Chest 109:1490–1496PubMedCrossRef
50.
51.
Xu Z, Cheuk DK, Lee SL (2006) Clinical evaluation in predicting childhood obstructive sleep apnea. Chest 130(6):1765–1771PubMedCrossRef
52.
Gulati A, Chate RAC, Howes TQ (2010) Can a single cephalometric measurement predict obstructive sleep apnea severity? J Clin Sleep Med 6(1):64–68PubMed
Metadata
Title
Facial patterns and primary nocturnal enuresis in children
Authors
Marco Carotenuto
Maria Esposito
Antonio Pascotto
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
Sleep and Breathing / Issue 2/2011
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-010-0388-6

Other articles of this Issue 2/2011

Sleep and Breathing 2/2011 Go to the issue

Original Article

The efficacy of oral appliances in the treatment of severe obstructive sleep apnea

Conference Abstracts

20th Anniversary Meeting of the American Academy of Dental Sleep Medicine, Minneapolis, Minnesota, USA, 10–12 June 2011

Original Article

Use of flow–volume curves to predict oral appliance treatment outcome in obstructive sleep apnea: a prospective validation study

Editorial

Dental sleep medicine in education, practice and research

Original Article

Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study

CE

American Academy of Dental Sleep Medicine continuing education offerings
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits