24 hour ambulatory blood pressure monitoring in patients with nocturnal enüresis

Background: Nocturnal enuresis (NE), defined as involuntary voiding during sleep, is observed in 15% of children at age 5. Development of NE is the result of a variety of factors; genetic factors and stressful early life events are the most notable Aim: To demonstrate the effectiveness of the autonomic nervous system dysfunction in patients with enuresis nocturna. Patients and methods: Twenty-eight patients with the diagnosis of enuresis nocturna were included in the study. Patients' mean age was of 7.9 ± 2.2 years and F/M was control group of 27 healthy children was conducted with a similar agesex and body mass index distribution. Serum creatinine and electrolite (Na, K, Ca) levels, thyroid function tests, plazma osmolality, urinalysis, urine electrolyte levels and urine culture as well as renal ultrasonography were performed to all patients. During the study patients were requested to collect their urine for 24 hour and note to document their fluid intake for one day. Ambulatory blood pressure measurements were done to all patients and control subject for 24 hour. Results: Nocturnal systolic, diastolic and mean arterial blood pressures of the patients were found to be significantly higher than the control subjects. Patients's systolic and diastolic blood pressure loads in the night time period were significantly higher than the controls. The percentage of patients with the loss of nocturnal dip in systolic and diastolic blood pressure was also found to be higher than the controls. Furthermore; a positive correlation was seen between elevated nocturnal blood pressure and the frequency of urinary incontinence per week (days/week) as well as the number of urination per night. Interestingly, pulse rate of patients was found to be significantly lower than the controls during the day time measurements. Conclusions: Nocturnal systolic, diastolic and mean arterial blood pressures as well as systolic and diaştolic blood pressure loads were significantly higher in children with enuresis. These subtle abnormalities of circadian blood pressure regulation, loss of nocturnal dip and the observation of decreased nocturnal pulse rate may reflect sympathetic and parasympathic hyperactivity. Thus, we could suggest that an autonomic nervous system dysfunction may play a role in the pathogenesis of enüresis nocturna and it's specifically might have an influence on the regulation of hormonal activities by changing their circadian rhythm.