title: Sleep architecture parameters that predict postoperative resolution of nocturnal enuresis in children with obstructive sleep apnea.
abstract: OBJECTIVE
  We performed a prospective cohort study in a pediatric tertiary care center to determine whether preoperative sleep architecture is associated with complete resolution of nocturnal enuresis (NE) after adenotonsillectomy.
  
  
  METHODS
  Thirty-seven pediatric patients with primary NE who underwent adenotonsillectomy for obstructive sleep apnea (OSA) were evaluated. Preoperative polysomnograms, as well as preoperative and postoperative reports of NE, were recorded. We performed chi2 analysis, Fisher's exact test (for p values), and t-tests to evaluate the impact of multiple demographic characteristics on sleep architecture, comparing children with resolved NE to those with unresolved NE after adenotonsillectomy.
  
  
  RESULTS
  The patients' mean age was 8.0 years (SD, 2.32 years). All children had presurgical primary NE. No age or gender differences were identified between children with resolved NE and those with unresolved NE. After surgery, more than half of the participants had resolution of NE. A higher percentage of boys had unresolved NE (chi2 = 3.63; p = 0.06). Improvement of NE was identified in children with a higher obstructive apnea-hypopnea index and more desaturation events. Eleven of the 12 children with prolonged stage 2 sleep reported resolution of NE (p = 0.001). Children with an obstructive apnea-hypopnea index of greater than 10 had a significantly greater rate of resolution of NE (p = 0.01). Logistic regression demonstrated that an elevated body mass index and the interaction of severe OSA and prolonged stage 2 sleep predicted resolution of NE. All 10 children with severe OSA and an abnormal total time spent in stage 2 sleep had resolution of NE.
  
  
  CONCLUSIONS
  Adenotonsillectomy is a treatment option for children with OSA and NE. Postoperative resolution of NE was seen in 51.4% of patients who underwent adenotonsillectomy. The children with both severe OSA and prolonged stage 2 sleep were 3.4 times as likely to have postoperative resolution of NE. These results suggest that there are significant differences in preoperative sleep architecture between children whose NE resolves after adenotonsillectomy and those whose NE does not resolve.
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan-Detroit Medical Center, Detroit, MI 48201, USA.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, MI, USA.
authors.forename: Larisa
authors.initials: L
authors.lastname: Kovacevic
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan-Detroit Medical Center, Detroit, MI 48201, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Madgy
authors.affiliation: Pediatric Pulmonary Division, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan-Detroit Medical Center, Detroit, MI 48201, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdulhamid
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017286:Polysomnography; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires