Nocturnal enuresis is associated with moderate-to-severe obstructive sleep apnea in children with snoring

Abstract

BACKGROUND: Conflicting data suggest that prevalence of monosymptomatic primary nocturnal enuresis (NE) increases with increasing severity of obstructive sleep apnea (OSA) in childhood and especially in girls. We hypothesized that NE is associated with increased risk of moderate-to-severe GSA (obstructive apnea-hypopnea index (AHI) >5 episodes/hour) among children with snoring. METHODS: Data of children (>= 5 y old) with snoring who were referred for polysomnography over 12 y were reviewed. RESULTS: Data of 525 children with mean age (+/- SD) 7.5 (+/- 2.2) y and median obstructive AHI (10th-90th percentiles) 1.9 (0.4-7.3) episodes/hour were analyzed. Three hundred and fifty-five children (67.6%) had NE and 87 (16.6%) had moderate-to-severe GSA. There was no interaction between NE and gender regarding the association with moderate-to-severe GSA (P > 0.05). NE was associated significantly with presence of moderate-to-severe GSA after adjustment for tonsillar hypertrophy, obesity, gender, and age (adjusted odds ratio = 1.92 (1.08-3.43); P = 0.03). Presence of NE had high sensitivity (78.2%) and low positive predictive value (19.2%) for detecting moderate-to-severe GSA and low specificity (34.5%) and high negative predictive value (88.8%) for ruling it out. CONCLUSION: Children with snoring and without NE referred for polysomnography are less likely to have moderate-to-severe GSA compared to those with NE.