Zaffanello Marco, Piacentini Giorgio, Lippi Giuseppe, Fanos Vassilios, Gasperi Emma, Nosetti Luana
Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy.
Section of Clinical Biochemistry, University of Verona, Italy.
Swiss Med Wkly. 2017 Feb 3;147:w14400. doi: 10.4414/smw.2017.14400. eCollection 2017.
Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or family practitioner; if there is any doubt, the children may be referred to a paediatric urologist. Obstructive sleep-disordered breathing is a complex, multifactorial disorder. Adenotonsillar hypertrophy is considered an important factor associated with obstructive sleep apnoea syndrome. Enuresis and obstructive sleep-disordered breathing are both frequent problems of sleep in childhood. We conducted an electronic search in Medline, Scopus and the ISI Web of Science to look for published material and identify a putative link between nocturnal enuresis and obstructive sleep-disordered breathing. A total number of 98 documents were found, but 24 of these had to be excluded after an attentive reading of the title, abstract or full text because the information therein was not suitable for the aims of our search. Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. We found 17 studies regarding the urological outcome of treatment for obstructive sleep-disordered breathing in children with enuresis. Although a vast amount of information is now available regarding the relationship between nocturnal enuresis and obstructive sleep-disordered breathing, many of the published studies were uncontrolled, retrospective or prospective cohort studies (grade C recommendation). Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasised. Consequently, symptoms such as snoring, sleep apnoeas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.
原发性遗尿症通常由儿科初级医生或家庭医生进行诊断和治疗；如有任何疑问，可将患儿转诊至小儿泌尿科医生处。阻塞性睡眠呼吸障碍是一种复杂的多因素疾病。腺样体扁桃体肥大被认为是与阻塞性睡眠呼吸暂停综合征相关的一个重要因素。遗尿症和阻塞性睡眠呼吸障碍都是儿童睡眠中常见的问题。我们在医学期刊数据库（Medline）、Scopus数据库和科学引文索引（ISI）科学网进行了电子检索，以查找已发表的资料，并确定夜间遗尿症与阻塞性睡眠呼吸障碍之间的潜在联系。共找到98篇文献，但在仔细阅读标题、摘要或全文后，其中24篇因所含信息不符合我们的检索目的而被排除。研究发现，患有阻塞性睡眠呼吸暂停综合征的儿童也经常患有夜间遗尿症。这两种疾病都存在潜在的睡眠障碍，其特征是唤醒反应改变和睡眠片段化。遗尿事件的病理生理学似乎与夜间阻塞性事件有关，导致腹内压升高和全身血压改变，进而通过改变抗利尿激素、心房钠尿肽和脑钠尿肽的水平诱导利钠和多尿。我们找到了17项关于遗尿儿童阻塞性睡眠呼吸障碍治疗的泌尿学结果的研究。尽管现在有大量关于夜间遗尿症与阻塞性睡眠呼吸障碍之间关系的信息，但许多已发表的研究都是非对照、回顾性或前瞻性队列研究（C级推荐）。阻塞性睡眠呼吸障碍经药物或手术治疗后遗尿症的缓解情况已得到强调。因此，对于所有遗尿儿童都应询问是否存在打鼾、睡眠呼吸暂停和睡眠不安等症状。确诊的阻塞性睡眠呼吸障碍应及时治疗；随后，遗尿症持续存在则需要按照标准方案进行治疗。
