title: Abnormal sleep architecture and refractory nocturnal enuresis.
abstract: OBJECTIVE
  The relation between sleep and nocturnal enuresis has been an area of discussion for many years. Children with enuresis are generally believed to have sleep that is too deep with decreased arousability. We investigated sleep characteristics in children with refractory nocturnal enuresis.
  
  
  METHODS
  Nine girls and 20 boys between 5 and 19 years old (mean +/- SD age 12.1 +/- 2.7) diagnosed with desmopressin dependent (14) and/or resistant (15) nocturnal enuresis and nocturnal polyuria underwent a standardized investigation protocol, including 1 night of polysomnography. Two age groups of 4 boys and 2 girls 5 to 9 years old, and 16 boys and 7 girls 10 to 19 years old were compared to previously defined controls, including 5 boys and 2 girls 5 to 9 years old and 7 boys and 2 girls 10 to 19 years old. Five to 9 and 10 to 19-year-old controls had a mean of 4.2 +/- 1.5 and 3.3 +/- 0.6 periodic limb movements per hour of sleep, respectively. The total number of arousal-awakenings during sleep was 21.6 +/- 8.1 at ages 5 to 9 years and 21.7 +/- 12.8 at ages 10 to 19.
  
  
  RESULTS
  All except 1 patient had greater than 5 periodic limb movements per sleep hour. The younger and older age groups had a mean of 18.6 +/- 5.7 and 18 +/- 7.8 periodic limb movements per sleep hour, respectively. Total arousal-awakenings were also increased at 86.7 +/- 58.1 and 73.8 +/- 34.8, respectively. Statistical differences were calculated with the Mann-Whitney U test in controls vs the study population for periodic limb movements and in the 2 age groups for arousal-awakening (p = 0.003 and <0.001, respectively).
  
  
  CONCLUSIONS
  Preliminary data indicate a high incidence of periodic limb movements in sleep at night in children with refractory nocturnal enuresis and increased cortical arousability, leading to awakening.
authors.affiliation: Pediatric Sleep Centre, Ghent University Hospital, Ghent, Belgium. Karlien.Dhondt@ugent.be
authors.forename: Karlien
authors.initials: K
authors.lastname: Dhondt
authors.forename: Ann
authors.initials: A
authors.lastname: Raes
authors.forename: Piet
authors.initials: P
authors.lastname: Hoebeke
authors.forename: Erik
authors.initials: E
authors.lastname: Van Laecke
authors.forename: Charlotte
authors.initials: C
authors.lastname: Van Herzeele
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
mesh_terms: D000293:Adolescent; D001143:Arousal; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000503:physiopathology*; D010865:Pilot Projects; D012890:Sleep / Q000502:physiology*; D055815:Young Adult