Presentations

Abstract

Introduction: Adenotonsillar hypertrophy is the most common cause of sleep-disordered breathing (SDB) in children, treated primarily with adenotonsillectomy (T&A). Many children with SDB experience nocturnal enuresis (NE), thought to be due to increased release of atrial natriuretic peptide that occurs with disordered breathing. A bedwetting alarm is a standard treatment for children with NE. There is a lack of data comparing T&A to bedwetting alarms for the treatment of NE in children with SDB. Our objective is to compare the efficacy of T&A vs bedwetting alarm in NE outcomes in children with SDB.

Methods: Children aged 5-17 years presenting with SDB and NE >3 nights per week and deemed to be T&A candidates were considered for enrollment in the study. Patients with chronic constipation and daytime wetting were excluded. Eligible patients and their caregivers chose either the bedwetting alarm arm or the T&A arm following baseline assessment. After 4 months, patients could cross over to the alternate intervention. Primary outcomes were frequency of bedwetting (as assessed by a diary), and standardized quality of life assessments including the PinQ and OSA-18 questionnaires. Outcomes were recorded at baseline, 4-month, and 7-month follow-up.

Results: There are currently 56 participants enrolled with a mean age of 8 years. In total, 49.1% of patients were female. The mean baseline PinQ score was 48.01 with an SD of 15.37, while the mean baseline OSA-18 score was 57.86 with an SD of 16.71. Fifteen patients (10 alarm arm and 5 T&A arm) completed the 4-month follow-up assessment. Average PinQ scores for the alarm cohort decreased by 0.875 points from 44.5 at baseline to 43.63 at four months and average PinQ scores for the T&A cohort decreased by 1.67 points from 46.7 at baseline to 45 at four months. All alarm subjects reported continued bedwetting, though four noted decreased frequency. Two T&A subjects experienced resolution of their NE and three noted no changes in their bedwetting.

Conclusion: Data collection is ongoing in our prospective study assessing NE outcomes in children with SDB managed with bedwetting alarm vs T&A. At the conclusion of our study, we aim to determine whether a bedwetting alarm or T&A is an optimal treatment option for children presenting with NE in the setting of SDB.