Research Article
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Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances

Year 2020, Volume: 10 Issue: 2, 311 - 320, 25.08.2020
https://doi.org/10.32448/entupdates.729178

Abstract

Objective: Adenoid hypertrophy and nocturnal enuresis, comorbidities that are quite prevalent among children, are both associated with sleep problems. However, limited research has specifically focused on sleep domains and their parameters. In the present study we thus aimed to investigate the impact of adenoid hypertrophy and nocturnal enuresis on sleep, both when the two disorders coexist and when they do not coexist.

Methods: We investigated 178 children (mean age: 7.24±1.02 years, range=6-9 years), 50 (28.1%) of whom had only adenoid hypertrophy, 39 (21.9%) of whom had only nocturnal enuresis, 35 (19.7%) of whom had coexistence of adenoid hypertrophy and nocturnal enuresis, and 54 (30.3%) of whom were healthy-control children. Psychiatric disorders were diagnosed by a semi-structured diagnosis interview and the diagnosis of adenoid hypertrophy was confirmed by flexible fiberoptic nasopharyngoscopy. Sleep habits and disturbances were assessed via the Children’s Sleep Habits Questionnaire and Modified Epworth Sleepiness Scale.

Results: Our results showed that the comorbid condition was the most severe form in terms of both adenoid hypertrophy and enuresis. Regarding sleep difficulties, the "Sleep-Disordered Breathing", "Night Wakings", "Sleep Onset Delay" and "Sleep Duration" parameters were closely associated with adenoid hypertrophy and its severity, while "Bedtime Resistance", "Parasomnias" and "Sleep Anxiety" domains of sleep were strongly related to nocturnal enuresis.

Conclusion: Otorhinolaryngologists, child psychiatrists and pediatricians should be aware of the relationship between enuresis and adenoid hypertrophy, that both diseases are associated with impaired sleep patterns, and that children affected by the comorbidity of the two disorders experience more sleep disturbances.

Supporting Institution

There are no funders to report for this submission.

Project Number

none

Thanks

The authors would like to thank all the children and their families who participated in this study.

References

  • 1. Zaffanello M, Piacentini G, Lippi G, Fanos V, Gasperi E, Nosetti L. Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association? Swiss Med Wkly 2017;147:14400.
  • 2. Burg CJ, Friedman NR. Diagnosis and treatment of sleep apnea in adolescents. Adolesc Med State Art Rev 2010;21:457-79.
  • 3. Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2016;47:69-94.
  • 4. Elimination Disorders. In: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013. p. 355-7.
  • 5. Austin PF, Bauer SB, Bower W, et al. 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. Neurourol Urodyn 2016;35:471-81.
  • 6. Neshat A, Miranzadeh-Mahabadi S, Miranzadeh-Mahabadi H, Kelishadi R. The association between adenoid hypertrophy and enuresis in children, J Compr Ped 2016;7:32771.
  • 7. Karakas HB, Mazlumoglu MR, Simsek E. The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children. Eur Arch Otorhinolaryngol 2017;274:2959-63.
  • 8. Balaban M, Aktas A, Sevinc C, Yucetas U. The relationship of enuresis nocturna and adenoid hypertrophy. Arch Ital Urol Androl 2016;88:111-4.
  • 9. Satti SA, Medani SA, A. Elabyad M. Primary nocturnal enuresis in children presenting to the outpatient Department of Khartoum ENT Teaching Hospital with adenotonsillar hypertrophy, Khartoum, Sudan. Basic Res J Med Clin Sci 2015;4:15-9.
  • 10. Kaya KS, Türk B, Erol ZN, Akova P, Coşkun BU. Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients. Int J Pediatr Otorhinolaryngol 2018;105:36-9.
  • 11. Walter LM, Biggs SN, Nisbet LC, et al. Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing. Pediatr Res 2015;78:560-6.
  • 12. Kovacevic L, Lu H, Wolfe-Christensen C, et al. Adenotonsillectomy Normalizes Hormones and Urinary Electrolytes in Children With Nocturnal Enuresis and Sleep-Disordered Breathing. Urology 2015;86:158-61.
  • 13. Esposito M, Gallai B, Parisi L, et al. Primary nocturnal enuresis as a risk factor for sleep disorders: an observational questionnaire-based multicenter study. Neuropsychiatr Dis Treat 2013;9:437-43.
  • 14. Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J. Abnormal sleep architecture and refractory nocturnal enuresis. J Urol 2009;182:1961-5.
  • 15. Dhondt K, Van Herzeele C, Roels SP, et al. Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol 2015;30:1157-62.
  • 16. Nevéus T. Enuretic sleep: deep, disturbed or just wet? Pediatr Nephrol 2008;23:1201-2.
  • 17. Wolfish NM, Pivik RT, Busby KA. Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr 1997;86:381-4.
  • 18. Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A. Sleep and sleepiness in children with nocturnal enuresis. Sleep 2011;34:191-4.
  • 19. Bader G, Nevéus T, Kruse S, Sillén U. Sleep of primary enuretic children and controls. Sleep 2002;25:579-83.
  • 20. Gozmen S, Keskin S, Akil I. Enuresis nocturna and sleep quality. Pediatr Nephrol 2008;23:1293-6.
  • 21. Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med 2008;358:2414-5.
  • 22. Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36:980-8.
  • 23. Ünal F, Öktem F, Çetin Çuhadaroğlu F, et al. [Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. [Article in Turkish] Turk Psikiyatri Derg 2019;30:42-50.
  • 24. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol 2003;67:1303-9.
  • 25. Owens JA, Spirito A, McGuinn M, Nobile C. Sleep habits and sleep disturbance in elementary school-aged children. J Dev Behav Pediatr 2000;21:27-36.
  • 26. Perdahlı Fiş N, Arman A, Ay P, Topuzoglu A, Güler AS, Imren SG, et al. The validity and the reliability of Turkish Version of Children’s Sleep Habits Questionnaire. Anadolu Psikiyatri Derg 2010;11:151-60.
  • 27. Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004;114:768-75.
  • 28. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.
  • 29. Soylu Özler G, Özler S. Coexistence of Upper Airway Obstruction and Primary and Secondary Enuresis Nocturna in Children and the Effect of Surgical Treatment for the Resolution of Enuresis Nocturna. Adv Med 2014;2014:656431.
  • 30. Kovacevic L, Jurewicz M, Dabaja A, et al. Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first? J Pediatr Urol 2013;9:145-50.
  • 31. Taziki MH, Tajri HR, Borghei A, Khorashadizadeh H. Factors associated with enuresis in adenotonsillar hypertrophy and the effect of surgery on it. J Guilan Unive Med Sci 2011;20:62-7. 32. Schechter MS; Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:69.
  • 33. Wolfish NM. Sleep/Arousal and enuresis subtypes. J Urol 2001;166:2444-7.
  • 34. Goldstein NA, Pugazhendhi V, Rao SM, et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004;114:33-43.
  • 35. Montgomery-Downs HE, O'Brien LM, Gulliver TE, Gozal D. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics 2006;117:741-53.
  • 36. O'Callaghan FV, Al Mamun A, O'Callaghan M, et al. The link between sleep problems in infancy and early childhood and attention problems at 5 and 14 years: Evidence from a birth cohort study. Early Hum Dev 2010;86:419-24.
  • 37. Spruyt K. A review of developmental consequences of poor sleep in childhood. Sleep Med 2019;60:3-12.
Year 2020, Volume: 10 Issue: 2, 311 - 320, 25.08.2020
https://doi.org/10.32448/entupdates.729178

Abstract

Project Number

none

References

  • 1. Zaffanello M, Piacentini G, Lippi G, Fanos V, Gasperi E, Nosetti L. Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association? Swiss Med Wkly 2017;147:14400.
  • 2. Burg CJ, Friedman NR. Diagnosis and treatment of sleep apnea in adolescents. Adolesc Med State Art Rev 2010;21:457-79.
  • 3. Kaditis AG, Alonso Alvarez ML, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2016;47:69-94.
  • 4. Elimination Disorders. In: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013. p. 355-7.
  • 5. Austin PF, Bauer SB, Bower W, et al. 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. Neurourol Urodyn 2016;35:471-81.
  • 6. Neshat A, Miranzadeh-Mahabadi S, Miranzadeh-Mahabadi H, Kelishadi R. The association between adenoid hypertrophy and enuresis in children, J Compr Ped 2016;7:32771.
  • 7. Karakas HB, Mazlumoglu MR, Simsek E. The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children. Eur Arch Otorhinolaryngol 2017;274:2959-63.
  • 8. Balaban M, Aktas A, Sevinc C, Yucetas U. The relationship of enuresis nocturna and adenoid hypertrophy. Arch Ital Urol Androl 2016;88:111-4.
  • 9. Satti SA, Medani SA, A. Elabyad M. Primary nocturnal enuresis in children presenting to the outpatient Department of Khartoum ENT Teaching Hospital with adenotonsillar hypertrophy, Khartoum, Sudan. Basic Res J Med Clin Sci 2015;4:15-9.
  • 10. Kaya KS, Türk B, Erol ZN, Akova P, Coşkun BU. Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients. Int J Pediatr Otorhinolaryngol 2018;105:36-9.
  • 11. Walter LM, Biggs SN, Nisbet LC, et al. Augmented cardiovascular responses to episodes of repetitive compared with isolated respiratory events in preschool children with sleep-disordered breathing. Pediatr Res 2015;78:560-6.
  • 12. Kovacevic L, Lu H, Wolfe-Christensen C, et al. Adenotonsillectomy Normalizes Hormones and Urinary Electrolytes in Children With Nocturnal Enuresis and Sleep-Disordered Breathing. Urology 2015;86:158-61.
  • 13. Esposito M, Gallai B, Parisi L, et al. Primary nocturnal enuresis as a risk factor for sleep disorders: an observational questionnaire-based multicenter study. Neuropsychiatr Dis Treat 2013;9:437-43.
  • 14. Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J. Abnormal sleep architecture and refractory nocturnal enuresis. J Urol 2009;182:1961-5.
  • 15. Dhondt K, Van Herzeele C, Roels SP, et al. Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol 2015;30:1157-62.
  • 16. Nevéus T. Enuretic sleep: deep, disturbed or just wet? Pediatr Nephrol 2008;23:1201-2.
  • 17. Wolfish NM, Pivik RT, Busby KA. Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr 1997;86:381-4.
  • 18. Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A. Sleep and sleepiness in children with nocturnal enuresis. Sleep 2011;34:191-4.
  • 19. Bader G, Nevéus T, Kruse S, Sillén U. Sleep of primary enuretic children and controls. Sleep 2002;25:579-83.
  • 20. Gozmen S, Keskin S, Akil I. Enuresis nocturna and sleep quality. Pediatr Nephrol 2008;23:1293-6.
  • 21. Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med 2008;358:2414-5.
  • 22. Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36:980-8.
  • 23. Ünal F, Öktem F, Çetin Çuhadaroğlu F, et al. [Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]. [Article in Turkish] Turk Psikiyatri Derg 2019;30:42-50.
  • 24. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol 2003;67:1303-9.
  • 25. Owens JA, Spirito A, McGuinn M, Nobile C. Sleep habits and sleep disturbance in elementary school-aged children. J Dev Behav Pediatr 2000;21:27-36.
  • 26. Perdahlı Fiş N, Arman A, Ay P, Topuzoglu A, Güler AS, Imren SG, et al. The validity and the reliability of Turkish Version of Children’s Sleep Habits Questionnaire. Anadolu Psikiyatri Derg 2010;11:151-60.
  • 27. Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004;114:768-75.
  • 28. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.
  • 29. Soylu Özler G, Özler S. Coexistence of Upper Airway Obstruction and Primary and Secondary Enuresis Nocturna in Children and the Effect of Surgical Treatment for the Resolution of Enuresis Nocturna. Adv Med 2014;2014:656431.
  • 30. Kovacevic L, Jurewicz M, Dabaja A, et al. Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first? J Pediatr Urol 2013;9:145-50.
  • 31. Taziki MH, Tajri HR, Borghei A, Khorashadizadeh H. Factors associated with enuresis in adenotonsillar hypertrophy and the effect of surgery on it. J Guilan Unive Med Sci 2011;20:62-7. 32. Schechter MS; Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:69.
  • 33. Wolfish NM. Sleep/Arousal and enuresis subtypes. J Urol 2001;166:2444-7.
  • 34. Goldstein NA, Pugazhendhi V, Rao SM, et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004;114:33-43.
  • 35. Montgomery-Downs HE, O'Brien LM, Gulliver TE, Gozal D. Polysomnographic characteristics in normal preschool and early school-aged children. Pediatrics 2006;117:741-53.
  • 36. O'Callaghan FV, Al Mamun A, O'Callaghan M, et al. The link between sleep problems in infancy and early childhood and attention problems at 5 and 14 years: Evidence from a birth cohort study. Early Hum Dev 2010;86:419-24.
  • 37. Spruyt K. A review of developmental consequences of poor sleep in childhood. Sleep Med 2019;60:3-12.
There are 36 citations in total.

Details

Primary Language English
Subjects Otorhinolaryngology
Journal Section Articles
Authors

Ayla Uzun Çiçek 0000-0003-2274-3457

Adem Bora 0000-0002-5036-0595

Emine Altuntaş 0000-0003-4503-3730

Project Number none
Publication Date August 25, 2020
Submission Date April 29, 2020
Acceptance Date May 18, 2020
Published in Issue Year 2020 Volume: 10 Issue: 2

Cite

APA Uzun Çiçek, A., Bora, A., & Altuntaş, E. (2020). Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT Updates, 10(2), 311-320. https://doi.org/10.32448/entupdates.729178
AMA Uzun Çiçek A, Bora A, Altuntaş E. Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT Updates. August 2020;10(2):311-320. doi:10.32448/entupdates.729178
Chicago Uzun Çiçek, Ayla, Adem Bora, and Emine Altuntaş. “Adenoid Hypertrophy and Nocturnal Enuresis Are Associated With Sleep Disturbances”. ENT Updates 10, no. 2 (August 2020): 311-20. https://doi.org/10.32448/entupdates.729178.
EndNote Uzun Çiçek A, Bora A, Altuntaş E (August 1, 2020) Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT Updates 10 2 311–320.
IEEE A. Uzun Çiçek, A. Bora, and E. Altuntaş, “Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances”, ENT Updates, vol. 10, no. 2, pp. 311–320, 2020, doi: 10.32448/entupdates.729178.
ISNAD Uzun Çiçek, Ayla et al. “Adenoid Hypertrophy and Nocturnal Enuresis Are Associated With Sleep Disturbances”. ENT Updates 10/2 (August 2020), 311-320. https://doi.org/10.32448/entupdates.729178.
JAMA Uzun Çiçek A, Bora A, Altuntaş E. Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT Updates. 2020;10:311–320.
MLA Uzun Çiçek, Ayla et al. “Adenoid Hypertrophy and Nocturnal Enuresis Are Associated With Sleep Disturbances”. ENT Updates, vol. 10, no. 2, 2020, pp. 311-20, doi:10.32448/entupdates.729178.
Vancouver Uzun Çiçek A, Bora A, Altuntaş E. Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT Updates. 2020;10(2):311-20.