Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing?

Larisa Kovacevic, Cortney Wolfe-Christensen, Hong Lu, Monika Toton, Jelena Mirkovic, Prasad J. Thottam, Ibrahim Abdulhamid, David Madgy, Yegappan Lakshmanan

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Purpose We analyzed the outcome of nocturnal enuresis after adenotonsillectomy in children with sleep disordered breathing. We also evaluated differences in demographic, clinical, laboratory and polysomnography parameters between responders and nonresponders after adenotonsillectomy. Materials and Methods We prospectively evaluated children 5 to 18 years old diagnosed with sleep disordered breathing (snoring or obstructive sleep apnea syndrome) on polysomnography and monosymptomatic primary nocturnal enuresis requiring adenotonsillectomy to release upper airway obstruction. Plasma antidiuretic hormone and brain natriuretic peptide were measured preoperatively and 1 month postoperatively. Results Sleep studies were done in 46 children and 32 also underwent blood testing preoperatively and postoperatively. Mean ± SD patient age was 8.79 ± 2.41 years and the mean number of wet nights weekly was 6.39 ± 1.26. Polysomnography revealed obstructive sleep apnea syndrome in 71.7% of patients and snoring in 28.3%. After adenotonsillectomy 43.5% of patients became dry. Preoperative polysomnography findings indicated that responders, who were dry, had significantly more arousals and obstructive apnea episodes but fewer awakenings than nonresponders, who were wet. Significant increases in plasma antidiuretic hormone and significant decreases in plasma brain natriuretic peptide were seen in all children with no difference between responders and nonresponders. No difference between the groups was noted in age, gender, race, body mass index, constipation, preoperative number of wet nights weekly or type of sleep disordered breathing. Conclusions Nocturnal enuresis resolved after adenotonsillectomy in almost half of the children with sleep disordered breathing. Those who became dry had more frequent arousal episodes caused by apnea events than those who remained wet.

Original languageEnglish
Pages (from-to)1592-1596
Number of pages5
JournalJournal of Urology
Volume191
Issue number5 SUPPL
DOIs
StatePublished - 2014

Keywords

  • adenoidectomy
  • bladder
  • enuresis
  • sleep apnea syndromes
  • tonsillectomy

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