Half of children with sleep apnoea who also wet the bed might stop their bed wetting if their tonsils or adenoids are removed, new research suggests.
Obstructive sleep apnoea (OSA) is marked by interruptions in breathing while asleep; it is common among children with enlarged tonsils or adenoids. Exactly how sleep apnoea results in bed wetting is not fully understood, but hormonal changes may play a role.
However, half of the 417 children in this latest study who had sleep apnoea and were bed wetters stopped wetting the bed after they had their tonsils or adenoids removed. Children in the study were aged five to 18, and were followed for just under one year after their surgery, on average.
Those who did not stop wetting the bed after the surgery were more likely to be born prematurely, be male, be obese or have a family history of bed wetting, the investigators noted. Premature birth was the greatest predictor of continued bed wetting after surgery.
"If they haven't seen an ear, nose and throat specialist, see one to see if the child who wets the bed has OSA that can be cured by tonsil or adenoid removal," said study author Dr Yegappan Lakshmanan, chief of paediatric urology at Children's Hospital of Michigan, in Detroit.
Reasons for bed wetting
The findings were to be presented at the annual meeting of the American Urological Association (AUA), in Washington, DC. Research presented at medical meetings should be viewed as preliminary until it has been published in a peer-reviewed medical journal.
There are many other causes of bed wetting, Lakshmanan said. "About 5 to 7 million children are bed wetters, and the causes fall into three main groups: bladder issues, sleep-related problems and the kidneys," he explained. "The children in this study wet the bed due to sleep-related problems."
So why weren't they all cured? "Bed wetting is multifactorial even within these groups, and eventually we should be able to pinpoint the cause for every single child," Lakshmanan said.
"There are several potential causes of bed wetting, and sleep apnea is clearly one of them," said Dr. Lane S. Palmer, chief of paediatric urology at the Cohen Children's Medical Center in New Hyde Park, NY.
"There are secondary positive effects of this tonsil- or adenoid-removing surgery, but I don't know that I would jump to have my child's tonsils or adenoids out as a primary treatment for bed wetting," he said. "Children with sleep apnea and bed wetting should see an otolaryngologist first."
Children who cannot sleep
"This study really underscores the fact that children who have other issues with sleep should be looked at for bed wetting because anything that depresses sleep at night can lead to bed wetting," said AUA spokesman Dr Anthony Atala, a urologist at Wake Forest University in Winston-Salem, N.C.
"If a child has bed wetting, pay close attention to their sleep patterns, and observe them while they are asleep and you can see whether they are breathing at a regular pace, and if not, seek additional help," Atala said.
Children with sleep apnoea can be difficult to rouse, which may cause the bed wetting, said Dr Dennis Kitsko, an otolaryngologist at the Children's Hospital of Pittsburgh. "But not every child with sleep apnea will wet the bed, and not every bed wetter will have sleep apnoea."
Still, "snoring in children is abnormal", said Dr Linda Dahl, an ear, nose and throat doctor at Lenox Hill Hospital in New York City. "Children snore because their tonsils and adenoids are enlarged, and they end up getting other behaviours that go along with sleep apnea, including bed wetting," she explained.
"There are many ancillary benefits that you may not attribute to removing large tonsil and adenoids, such as putting an end to bed wetting," Dahl added.