The Association of Nocturnal Enuresis and Breathing Disorders in Children with Sleep Disordered Breathing: A Retrospective Review of Pediatric Cases Treated with a Preformed Monoblock Oral Appliance Karen Parker Davidson* Department of Health Sciences, Central Michigan University, Michigan, United States
INTRODUCTION
Nocturnal Enuresis (NE) is one of the most frequent pediatric pathologies. The prevalence of Primary Nocturnal Enuresis (PNE) is around 9% in children between 5 and 10 years of age, with approximately 40% having one or more episodes per week [1]. NE episodes have been shown to affect the quality of life in children and their families with an emotional impact causing anxiety, embarrassment, social isolation and problems with self-esteem [1,2]. The emotional impact of bedwetting can affect relationships with family and friends, schoolwork and in turn affect sleep patterns. Nocturnal Enuresis is defined as an involuntary loss of urine during sleep after the age of 5 years occurring over a continuous six-month period, affecting approximately 15% of children up to the age of 15 [3]. The prevalence of NE dramatically decreases to 5% between 6 and 10 years of age and 1% to 2% between the ages of 10 and15 years [3,4]. Of this population, 80% of NE cases lack subtle daytime symptoms related to a mono symptomatic or single principal symptom, of NE with the bedwetting diagnosis classified as primary or secondary NE [3,4]. The etiology of mono symptomatic enuresis is not clearly understood, but is hypothesized as a sleep disorder with low arousability, high arousal threshold and frequent urination or hyperactivity associations [5-7]. Furthermore, the association of psychological disorders and sleep related breathing disorders are common in nearly 80% of children with NE having concurrent sleep apnea present; hence the strong correlation between NE and sleep apnea [4,5,7,8]. NE can occur in all stages of sleep; however, the sleep patterns or hypnograms, appear to differentiate between children with enuresis versus children without enuresis [6,8]. To further associate NE and Sleep Disorder Breathing (SDB), Polysomnography (PSG) detects an arousability threshold in stage N2 of sleep and stage N3, which is reduced in children with enuresis [6,8]. In the last two decades, there has been an increasing recognition where SDB may be a plausible root cause of NE [1-4]. Medical and surgical interventions are options to address nocturnal enuresis [9]. Medicinal interventions, such as anti-diuretic therapy, have been an option that may help reduce the number of wet nights without changing the sleep pattern [5,10]. It has also been previously found that adenoidectomies and tonsillectomies reduce the nocturnal resistance airflow and may alleviate bedwetting in children with SDB and tonsillar hypertrophy [9].
