Adenotonsillar upper airway obstruction and nocturnal enuresis in children

ABSTRACT

Adenotonsillar hypertrophy is the most common cause of sleep related upper airway obstruction [UAO] in childhood. Recently there is growing consensus that upper airway obstruction is a causative factor in nocturnal enuresis [NE] in many cases. So the aim of this study was to determine the relationship between nocturnal enuresis and upper airway obstruction caused by chronic adenotonsillar hypertrophy in children. Also to evaluate the effect of surgery on enuretic patients with UAO caused by adenotonsilar hypertrophy. One hundred children suffering from symptoms of upper airway obstruction [UAO] caused by adenotonsillar hypertrophy were included in this study and divided into two groups 24 with enuresis and 76 without enuresis. Patients with organic neurological or urological causes of NE were excluded. During sleep, at the night of the day before the operation, one month and three months after the operation; arterial blood gases were measured using the Blood Gas Analyzer. Follow up was done through parental questionnaire about the degree of improvement of NE before and after surgery at first, third and sixth months after the surgery. Blood gas analysis in patients with and without NE revealed Decrease O2 and increase CO2 saturations that were more in the group with NE. It was found that there were significant statistical improvements in the PaO2 and a significant decrease in the PaCO2 after the operation in both groups that were also more in the group with NE. There were no significant differences between patients with or without NE as regard to O2 saturation, PaO2 and PaCO2 before and after the operation [P>.005]. Parental questionnaire in patients with NE revealed complete cure in 58.6%, 16.7% had partial improvements while no improvements in 25%. So in Conclusion the authors suggest that UAO is probably a more common etiologic factor in NE than previously recognized and appropriate number of cases improved after adenoidectomy and or tonsillectomy