title: 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 OSA (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 OSA. There was no interaction between NE and gender regarding the association with moderate-to-severe OSA (P > 0.05). NE was associated significantly with presence of moderate-to-severe OSA 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 OSA and low specificity (34.5%) and high negative predictive value (88.8%) for ruling it out.
  
  
  CONCLUSIONS
  Children with snoring and without NE referred for polysomnography are less likely to have moderate-to-severe OSA compared to those with NE.
authors.affiliation: Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Emmanouel I
authors.initials: EI
authors.lastname: Alexopoulos
authors.affiliation: Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Malakasioti
authors.affiliation: Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Varlami
authors.affiliation: Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Miligkos
authors.affiliation: Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gourgoulianis
authors.affiliation: 1] Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece [2] Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Kaditis
mesh_terms: D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D017286:Polysomnography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors