title: Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing?
abstract: OBJECTIVE
  We analyzed the outcome of nocturnal enuresis after adenotonsillectomy in children with sleep disordered breathing. We also evaluated differences in demographic, clinical, laboratory and polysomnography parameters between responders and nonresponders after adenotonsillectomy.
  
  
  METHODS
  We prospectively evaluated children 5 to 18 years old diagnosed with sleep disordered breathing (snoring or obstructive sleep apnea syndrome) on polysomnography and monosymptomatic primary nocturnal enuresis requiring adenotonsillectomy to release upper airway obstruction. Plasma antidiuretic hormone and brain natriuretic peptide were measured preoperatively and 1 month postoperatively.
  
  
  RESULTS
  Sleep studies were done in 46 children and 32 also underwent blood testing preoperatively and postoperatively. Mean ± SD patient age was 8.79 ± 2.41 years and the mean number of wet nights weekly was 6.39 ± 1.26. Polysomnography revealed obstructive sleep apnea syndrome in 71.7% of patients and snoring in 28.3%. After adenotonsillectomy 43.5% of patients became dry. Preoperative polysomnography findings indicated that responders, who were dry, had significantly more arousals and obstructive apnea episodes but fewer awakenings than nonresponders, who were wet. Significant increases in plasma antidiuretic hormone and significant decreases in plasma brain natriuretic peptide were seen in all children with no difference between responders and nonresponders. No difference between the groups was noted in age, gender, race, body mass index, constipation, preoperative number of wet nights weekly or type of sleep disordered breathing.
  
  
  CONCLUSIONS
  Nocturnal enuresis resolved after adenotonsillectomy in almost half of the children with sleep disordered breathing. Those who became dry had more frequent arousal episodes caused by apnea events than those who remained wet.
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Larisa
authors.initials: L
authors.lastname: Kovacevic
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Cortney
authors.initials: C
authors.lastname: Wolfe-Christensen
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Monika
authors.initials: M
authors.lastname: Toton
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Jelena
authors.initials: J
authors.lastname: Mirkovic
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Prasad J
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Department of Pulmonology and Sleep Medicine, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdulhamid
authors.affiliation: Department of Otolaryngology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Madgy
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Lakshmanan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D053206:Nocturnal Enuresis / Q000453:epidemiology* / Q000209:etiology; D014066:Palatine Tonsil / Q000473:pathology*; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000473:pathology; D012913:Snoring / Q000453:epidemiology* / Q000473:pathology; D014068:Tonsillectomy; D014667:Vasopressins / Q000097:blood
chemical_list: D014667:Vasopressins; D020097:Natriuretic Peptide, Brain
keywords: adenoidectomy; bladder; enuresis; sleep apnea syndromes; tonsillectomy