Skip to main content

Advertisement

SpringerLink
Log in

Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Children with nocturnal enuresis (NE) have been found to have sleep fragmentation and a high incidence of periodic limb movements in sleep (PLMS). This study explored the association of monosymptomatic NE and polyuria in relation to fluid intake, bladder volume, number of wet nights, and number of nights with polyuria to the frequency of PLMS and cortical arousals during sleep.

Materials and methods

Thirty children with monosymptomatic NE and polyuria were enrolled in the study. Enuretic parameters were determined by diaries, forced drinking, uroflow, and ultrasound examination. All subjects participated in one polysomnographic study. The number of cortical arousals and PLMS were compared with those recorded in a former pilot study which included only children with refractory NE.

Results

Of the 30 children who participated in the study, the mean age was 10.43 ± 3.08 (range 6–16) years, and 23 were boys. The PLMS index was positively associated with the arousal index and the awakening index (p < 0.001). No significant association between the sleep and the enuretic parameters was found. Children with refractory NE showed a significantly higher PLMS index (p < 0.001).

Conclusions

We found that PLMS and cortical arousals in sleep were increased in children with monosymptomatic NE and polyuria, without a significant association with the enuretic parameters. These observations suggest the presence of a comorbid mechanism driven by a common, independent pacemaker. We hypothesize the autonomic system, its sympathetic branch, and the dopaminergic system as candidates for this pacemaker.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Butler RJ (2004) Childhood nocturnal enuresis: developing a conceptual framework. Clin Psych Rev 24:909–931

    Article  Google Scholar 

  2. Djurhuus JC, Matthiesen TB, Rittig S (1999) Similarities and dissimilarities between nocturnal enuresis in childhood and nocturia in adults. BJU Int 84:9–12

    Article  PubMed  Google Scholar 

  3. Yeung CK, Sit FK, To LK, Chiu HN, Sihoe JD, Lee E, Wong C (2002) Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int 90:302–307

    Article  CAS  PubMed  Google Scholar 

  4. Dijk DJ, Czeisler CA (1995) Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. J Neurosc 15:3526–3538

    CAS  Google Scholar 

  5. De Guchtenaere A, Vande Walle C, Van Sintjan P, Raes A, Donckerwolcke R, Van Laecke E, Hoebeke P, Vande Walle J (2007) Nocturnal polyuria is related to absent circadian rhythm of glomerular filtration rate. J Urol 178:2626–2629

    Article  PubMed  Google Scholar 

  6. Negoro H, Kanematsu A, Yoshimura K, Ogawa O (2013) Chronobiology of micturition: putative role of the circadian clock. J Urol 190:843–849

    Article  PubMed  Google Scholar 

  7. Rittig S, Schaumburg HL, Siggaard C, Schmidt F, Djurhuus JC (2008) The circadian defect in plasma vasopressin and urine output is related to desmopressin response and enuresis status in children with nocturnal enuresis. J Urol 179:2389–2395

    Article  CAS  PubMed  Google Scholar 

  8. Bader G, Neveus T, Kruse S, Sillèn U (2002) Sleep of primary enuretic children and controls. Sleep 25:579–583

    PubMed  Google Scholar 

  9. Chandra M, Saharia R, Hill V, Shi Q (2004) Prevalence of diurnal voidings symptoms and difficult arousal from sleep in children with nocturnal enuresis. J Urol 172:311–316

    Article  PubMed  Google Scholar 

  10. Neveus T, Stenberg A, Lackgren G, Tuvemo T, Hetta J (1999) Sleep of children with enuresis: a polysomnographic study. Pediatrics 103:1193–1197

    Article  CAS  PubMed  Google Scholar 

  11. Wolfish NM, Pivik RT, Busby KA (1997) Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr 86:381–384

    Article  CAS  PubMed  Google Scholar 

  12. Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A (2011) Sleep and sleepiness in children with nocturnal enuresis. Sleep 34:191–194

    PubMed Central  PubMed  Google Scholar 

  13. Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J (2009) Abnormal sleep architecture and refractory nocturnal enuresis. J Urol 182:1961–1965

    Article  PubMed  Google Scholar 

  14. Yeung CK, Diao M, Sreedhar B (2008) Cortical arousal in children with severe enuresis. N Engl J Med 358:2414–2415

    Article  CAS  PubMed  Google Scholar 

  15. Dhondt K, Baert E, Van Herzeele C, Raes A, Groen LA, Hoebeke P, Vande Walle J (2014) Sleep fragmentation and increased periodic limb movements are more common in children with NE. Acta Paediatr 103:268–272

    Article  Google Scholar 

  16. Mahler B, Kamperis K, Schroeder M, Frǿkǽr J, Djurhuus RC, Rittig S (2012) Sleep deprivation induces excess diuresis and natriuresis in healthy children. Am J Physiol renal Physiol 15:236–243

    Article  Google Scholar 

  17. Austin P, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, Von Gontard A, Wright A, Yang SS, Nevéus T (2014) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international children’s continence society. J Urol. 191:1963–1965

  18. Hjalmas K (1988) Urodynamics in normal infants and children. Scand J Urol Nephrol 114:20–27

    CAS  Google Scholar 

  19. Hollingshead AB (1971) Commentary on “ the indiscriminate state of social class environment. Social Forces 49:563–567

    Article  Google Scholar 

  20. Iber C, Ancoli-Israel SC (2013) The AASM manural for the scoring of sleep and associated events. Rules, terminology and technical specifications. West-Brook Corporate Center, Westchester

    Google Scholar 

  21. Kemlink D, Pretl M, Sonka K, Nevsimalova S (2008) A comparison of polysomnographic and actigraphic evaluation of periodic limb movements in sleep. Neurol Res 30:234–238

    Article  PubMed  Google Scholar 

  22. Jambhekar SK, Com G, Jones E, Jackson R, Castro MM, Knight F, Carroll JL, Griebel ML (2011) Periodic limb movements during sleep in children with narcolepsy. J Clin Sleep Med 7:597–601

    PubMed Central  PubMed  Google Scholar 

  23. Montplaisir J, Michaud M, Denesle R, Gosselin A (2000) Periodic leg movements are not more prevalent in insomnia or hypersomnia but are specifically associated with sleep disorders involving a dopaminergic impairment. Sleep Med 1:163–167

    Article  PubMed  Google Scholar 

  24. Carrier J, Frenette S, Monplaisir J, Paquet J, Drapeau C, Morettini J (2005) Effects of periodic leg movements during sleep in middle-aged subjects without sleep complaints. Mov Dis 20:1127–1132

    Article  Google Scholar 

  25. Pennestri MH, Whittom S, Adam B, Petit D, Carrier J, Montplaisir J (2006) PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution. Sleep 29:1183–1187

    PubMed  Google Scholar 

  26. Sforza E, Nicolas A, Lavigne G, Gosselin A, Petit D, Montplaisir J (1999) EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 52:786–791

    Article  CAS  PubMed  Google Scholar 

  27. Manconi M, Ferri R, Zucconi M, Clemens S, Rundo F, Oldani A, Ferini- Strambi L (2011) Effects of acute dopamine-agonist treatment in restless legs syndrome on heart rate variability during sleep. Sleep Med 12:47–55

    Article  PubMed  Google Scholar 

  28. Clemens S, Rye D, Hochman S (2006) Restless legs syndrome: revisiting the dopamine hypothesis from the spinal cord perspective. Neurology 67:125–130

    Article  PubMed  Google Scholar 

  29. Hussain TF, Lokhandwala M (2003) Renal dopamine receptors and hypertension. Exp Biol Med 228:134–142

    CAS  Google Scholar 

  30. Wing YK, Zhang J, Ho CK, Au CT, Li AM (2010) Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep 33:759–765

    PubMed Central  PubMed  Google Scholar 

  31. Kruse A, Mahler B, Rittig S, Djurhuus JC (2009) Increased nocturnal blood pressure in enuretic children with polyuria. J Urol 182:1954–1960

    Article  PubMed  Google Scholar 

  32. Yoshimura N, Miyazato M, Kitta T, Yoshikawa S (2014) Central nervous targets for the treatment of bladder dysfunction. Neurourol Urodyn 33:59–66

    Article  CAS  PubMed  Google Scholar 

  33. Nakagawa H, Okumura N (2010) Coordinated regulation of circadian rhythms and homeostasis by the suprachiasmatic nucleus. Proc Jpn Acad Ser B Phys Biol Sci 86:391-409

  34. Arai M (2011) Increased plasma arginine vasopressin levels in dopamine agonist-treated Parkinson’s disease patients. Neuro Endocrinol Lett 32:39–43

    CAS  PubMed  Google Scholar 

  35. Picchietti MA, Picchietti DL, England SJ, Walters AS, Couvadelli BV, Lewin DS, Hening W (2009) Children show individual night-to-night variability of periodic limb movements in sleep. Sleep 32:530–535

    PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatrics, Department of Child Neurology and Metabolism, Pediatric Sleep Center, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Karlien Dhondt

  2. Pediatrics, Department of Child Nephrology, Ghent University Hospital, Ghent, Belgium

    Charlotte Van Herzeele, Ann Raes & Johan Vande Walle

  3. Department of Data Analysis, Ghent University, Ghent, Belgium

    Sanne Patrick Roels

  4. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Luitzen-Albert Groen & Piet Hoebeke

Authors
  1. Karlien Dhondt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charlotte Van Herzeele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanne Patrick Roels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann Raes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luitzen-Albert Groen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Piet Hoebeke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johan Vande Walle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karlien Dhondt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhondt, K., Van Herzeele, C., Roels, S.P. et al. Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol 30, 1157–1162 (2015). https://doi.org/10.1007/s00467-015-3044-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-015-3044-3

Keywords

Search

Navigation