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Obstructive Sleep Apnea in School-Aged Children Presented with Nocturnal Enuresis

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Abstract

Objectives

We aimed to detect obstructive sleep apnea (OSA) among school-age children presented with nocturnal enuresis (NE) and to identify the possible risk factors for OSA in them.

Methods

Sixty-six children aged > 5–16 years presented with NE were enrolled in the study. Children with urinary tract anatomical abnormalities or infection, intellectual disabilities, genetic syndromes, psychological issues, and diabetes mellitus were excluded. They were clinically examined, scored using sleep clinical record score (SCR), and subjected for full-night polysomnogram (PSG). Children with obstructive apnea/hypopnea index (AHI) ≥ 2 episodes/hour (h) were considered as OSA.

Results

Fifty-four children (81.8% of the recruited children) aged 8.3 ± 2.8 years agreed to undergo PSG as 68.5% had OSA with median obstructive AHI of 6.1 (3.7–13.2) episodes/h, median oxygen saturation of 97% and nadir of 88%. Thirty-three percent were obese with significantly higher AHI [7.0 (3.7–12.4) vs. 2.4 (1.3–6.1) episodes/h; p = 0.023]. SCR score correlated significantly with AHI (r2 = 0.462, p = 0.001) with 91% sensitivity in detecting OSA ≥ 5 episodes/h. Nasal obstruction, adenoid/adult facial phenotype, and arched palate were associated with OSA (p < 0.05).

Conclusion

NE is commonly associated with OSA especially in obese children. Nasal obstruction, abnormal facial phenotype, and high-arched palate were common risk factors.

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Abbreviations

ADHD:

Attention deficit hyperactivity disorder

AHI:

Apnea / hypopnea index

AT:

Adenotonsillectomy

AUC:

Area under the curve

BA:

Bronchial asthma

BMI:

Body mass index

ENT:

Ear, nose and throat examination

IQR:

Interquartile range

NE:

Nocturnal enuresis

ODI:

Oxygen desaturation index

OSA:

Obstructive sleep apnea

pBMI:

Body mass index percentile

PSG:

Polysomnography study

ROC:

Receiver operator characteristic curve

SaO2 :

Arterial oxygen saturation

SBD:

Sleep breathing disorders

SCR:

Sleep clinical record

SD:

Standard deviation

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Correspondence to Hanaa Shafiek.

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Shafiek, H., Evangelisti, M., Abd-elwahab, N.H. et al. Obstructive Sleep Apnea in School-Aged Children Presented with Nocturnal Enuresis. Lung 198, 187–194 (2020). https://doi.org/10.1007/s00408-019-00304-6

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Keywords

  • Sleep clinical record
  • Obesity
  • Obstructive apnea/hypopnea index
  • Facial phenotype