Adenotonsillectomy in kids for Sleep Apnea may improve bedwetting: JAMA study

Children with obstructive sleep apnea (OSA) are at increased risk for nocturnal enuresis (NE). However, randomized clinical trials assessing nocturnal enuresis (NE) outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting are lacking.

A group of researchers from Virginia, U.S.A conducted a study to assess the outcomes of adenotonsillectomy (AT) vs watchful waiting in children with non-severe Obstructive Sleep Apnea (OSA) who experience Nocturnal Enuresis (NE).

Secondary analysis of data from a multicenter randomized clinical trial conducted at tertiary children's hospitals was performed. Participants included 453 children aged 5.0 to 9.9 years with nonsevere OSA who were randomized to either watchful waiting or adenotonsillectomy (AT) as part of the multicenter Childhood Adenotonsillectomy Trial. Caregivers completed the Pediatric Sleep Questionnaire, which includes a binary item on bed-wetting, at baseline and 7-month follow-up. The trial was conducted between October 2007 and June 2012. Evaluation in this secondary analysis involving Nocturnal Enuresis (NE) occurred from October 2019 to March 2021.

The results of the study are as follows:

· Of the 453 children enrolled, 393 were included in the analysis; of these, 201 were girls (51.1%). The mean (SD) age at baseline was 6.54 (1.40) years.

· At baseline, the number of children with Nocturnal Enuresis (NE) was similar between the adenotonsillectomy (AT) and watchful-waiting groups.

· The odds of Nocturnal Enuresis (NE) in the watchful-waiting group were approximately 2 times higher than the adenotonsillectomy (AT) group after 7 months

· Following adenotonsillectomy (AT), there was a decrease in the number of children with Nocturnal Enuresis (NE) (n = 38).

· The prevalence of Nocturnal Enuresis (NE) did not change in the watchful-waiting group (n = 66) at follow-up.

· Although Nocturnal Enuresis (NE) was less frequent in girls, other clinical factors, such as age, race and ethnicity, obesity, and apnea-hypopnea index, were not associated with improvement of Nocturnal Enuresis (NE).

Thus, the researchers concluded that in this secondary analysis of a randomized clinical trial, adenotonsillectomy (AT) for the treatment of pediatric Obstructive Sleep Apnea (OSA) appears to result in improvement in Nocturnal Enuresis (NE). Further research is needed to assess whether adenotonsillectomy (AT) is associated with long-term benefits for Nocturnal Enuresis (NE) compared with watchful waiting.

Reference:

Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children with Obstructive Sleep Apnea: A Secondary Analysis of a Randomized Clinical Trial by Snow A et. al published in the JAMA Otolaryngology-Head & Neck Surgery.

doi:10.1001/jamaoto.2021.2303