Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e53-e59 (doi:10.1542/peds.2008-2805)

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ARTICLE

Nocturnal Enuresis and Overweight Are Associated With Obstructive Sleep Apnea

Joseph G. Barone, MD^a, Christopher Hanson, PhD^b, Daniel G. DaJusta, MD^a, Kevin Gioia, MD^a, Sandra J. England, PhD^c and Dona Schneider, PhD, MPH^b

^a Department of Surgery, Division of Urology
^c Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey
^b Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey

OBJECTIVE: The objective of this study was to examine the relationship of obstructive sleep apnea (OSA), body weight (BMI percentage [BMI%]), and monosymptomatic nocturnal enuresis (MNE) in children.

METHODS: A case-control study design was used. All children were 5 to 15 years of age; case patients were recruited from a comprehensive sleep disorders center (n = 149), and control subjects were recruited from a general pediatric practice in the same catchment area (n = 139). Case patients were subject to overnight polysomnograms and grouped into apnea severity categories (minimal, mild, moderate, or severe) on the basis of respiratory disturbance index and minimum arterial oxygen saturation levels. Data for all children included age; gender; height; weight; and history of MNE, snoring, diabetes, nasal allergies, and/or enlarged tonsils. BMI% was used to group children into weight categories as suggested by the Centers for Disease Control and Prevention (underweight, normal weight, at risk for overweight, and overweight). Two age groupings were created (5–10 years and 11–15 years). Descriptive statistics provided the prevalence of OSA, weight category, and MNE among case patients and control subjects. Cross-tabulations examined the relationship of severity of OSA with weight categories and MNE, stratified by age and gender. A series of logistic regression models explored the interrelationship of the grouping variables.

RESULTS: A large majority (79.9%) of control subjects were at risk for overweight, and a large majority (80.0%) of children with MNE also had some degree of OSA. Logistic regression demonstrated that both MNE (odds ratio: 5.29) and overweight (odds ratio 4.16) were significantly associated with OSA but not with each other.

CONCLUSIONS: Overweight and MNE are associated with OSA but not with each other. OSA should be considered in overweight children with MNE, especially when they display other symptoms of OSA or fail to respond to standard MNE treatment programs.

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Key Words: BMI% • nocturnal enuresis • childhood obesity • obstructive sleep apnea

Abbreviations: OSA—obstructive sleep apnea • MNE—monosymptomatic nocturnal enuresis • SaO₂—arterial oxygen saturation • RDI—respiratory disturbance index • BMI%—BMI percentage • OR—odds ratio • CI—confidence interval

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Accepted Feb 26, 2009.

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