ESPN 50th Annual Meeting

ESPN 2017


 
Improved sleep quality following adenotonsillectomy is associated with enuresis resolution in children with sleep-disordered breathing
LARISA KOVACEVIC 1 HONG LU 1 YEGAPPAN LAKSHMANAN 1

1- CHILDRENS HOSPITAL OF MICHIGAN
 
Introduction:

We have previously reported that adenotonsillectomy (TA) leads to complete resolution of nocturnal enuresis (NE) in about 50% of children with sleep-disordered breathing (SDB), but the mechanism is not entirely clear. In this study we assessed the effect of TA on sleep quality, night time urinary volume (NUV) and secretion of antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) in children with NE and SDB.

Material and methods:

Prospective pilot study of 41 children 5-18 years of age diagnosed with SDB (snoring, N=17, and obstructive sleep apnea syndrome, N=24) on polysomnography, and monosymptomatic primary NE requiring TA for upper airway obstruction release. Arousal score, nocturia, NUV, and plasma levels of ADH and BNP were measured pre and 1 month post-surgery.

Results:

Decrease in arousal score and plasma BNP level, and increase in plasma ADH level were seen in all patients post-surgery. However, mixed ANOVA showed that responders (dry) had significantly more improvement than non-responders (wet) in the quality of sleep (Table). Following TA, nearly all dry children reported nocturia and significant decrease in BNP levels (P=0.017) without significant change in their NUV.

 

Dry (N=20)

Wet (N=21)

P-value

 

Pre-T&A

Post-T&A

Pre-T&A

Post-T&A

Heavy sleeper

Yes (%)

 

 

10 (50%)

 

 

2   (11.8%)

 

 

13 (27.8%)

 

 

16 (88.9%)

 

 

0.020

Snoring

Yes (%)

 

 

20 (100%)

 

 

3   (15.8%)

 

 

20 (100%)

 

 

7   (35.0%)

 

 

0.001

Arousal score

4.92 ± 0.35

 

2.38 ± 0.29

 

4.92 ± 0.34

 

3.57 ± 0.28

0.015

NUV (ml)

279.56 ± 128.83

340.13 ±190.36

385.05 ± 151.56

352.65 ± 161.26

0.072

ADH (pg/ml)

7.28 ± 6.51

8.00 ± 8.48

4.55 ± 6.36

6.59 ± 6.30

0.297

BNP (ng/ml)

26.49 ± 28.83

16.48 ± 30.87

38.89 ± 32.49

28.33 ± 26.11

0.017

Conclusions:

Conclusions: Change in children’s quality of sleep and arousal score was associated with NE resolution post-TA. Improvement in sleep quality appears to be responsible for the effect of TA on NE in children with SDB.