Evaluation of sleep disorders in patients with monosymptomatic enuresis nocturna

Objectives: The purpose of this study was aimed to investigate the sleep disorders in patients with monosymptomatic enuresis nocturna (MEN) and the relation between sleep disorders and MEN was evaluated. Material and Methods: Fifty patients presenting with enuresis nocturna that were admitted to our outpatient clinic was enrolled. Patients over 5 years old and having bedwetting at least two times during nighttime in a week for 3 months and longer were accepted as diagnosis of enuresis nocturnia. All the patients were evaluated for the secondary causes of enuresis nocturna. Patients with history of urinary tract infections more than two times, signs of overactive bladder, enuresis diurna and urinary system anomaly were excluded from the study. Informations about the patients were taken by questionnaire. Patients' medical and family histories were taken and physical examinations were performed. Supine and plain abdominal x-rays and ultrasonography (USG) of the urinary system were applied. Bladder capacities were calculated with USG. According to anamnesis and examination results; the full night polysomnography test was performed for all the patients with primary monosemptomatic enuresis nocturna (PMEN). Statistical analysis was done by NCSS (Number Crunher Statistical System) 2007 statistical software (Utah, USA) programme. Analysis of results was accepted if p value was at the P < 0.05. Results: Thirty four patients with PMEN were assessed with polysomnography test and sleep disorder was found in 29 (85%) of them at different levels. Most of the patients were male. Respectively, avarage apnea score of patients and wet nights per week were 4.99 (1.5-21.5) and five and over times (5.55). Based on apnea score, the grades of ostructive sleep apnea syndrome were mild (<5) in 20 patients, medium (5-10) in 6 patients and severe (>10) in 3 patients. Statistically significant relation was found between apnea scores and body mass indexes (p=0.047). Apnea scores of obese patients were statistically significantly higher than patients with lean body and overweigh (p=0.042, p=0.048) but there was no statistically significant difference between the normal and overweighted patients (p=0.809). Based on analysis of the USG results of patients with PMEN and OSAS, bladder capacities were sufficient in 27.6% (8) and insufficient in 72.4% (21) patients. There was statistically significant negative relation between bladder capacity and wet night frequency (r=-0.441, p=0.017). A history of frequent upper respiratory tract infection (URTI) was found in 14 (48.2%) patients. There was no statistically significant difference in the apnea scores of patients between with and without history of frequent URTI (p>0.05). Conclusion: Positive family history, obesity and sleep disorders were detected as the main predisposing factors for the enuresis nocturna in our study. Although the secondary causes for diagnosis of PMEN should be excluded, sleep disorders and obesity were considered to be the major predisposing factors in the etiology of enuresis nocturna. Further studies are needed to explore the relation between sleep apnea and PMEN.