Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA; Department of Pediatric Urology, Cook Children's Medical Center, Fort Worth, TX, USA.
Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA.
J Pediatr Urol. 2019 Dec;15(6):643.e1-643.e5. doi: 10.1016/j.jpurol.2019.08.014. Epub 2019 Aug 24.
INTRODUCTION/BACKGROUND: Health-related quality of life (HRQOL) is a relatively new concept in pediatrics, but it has shown to be extremely important in terms of clinical care, treatment planning, and compliance with medical and behavioral recommendations. Two groups of children who are at risk for impairments in HRQOL are those who have bed-wetting and those who snore or have sleep apnea.
The present study sought to determine whether the combination of monosymptomatic nocturnal enuresis (MNE) and sleep-disordered breathing (SDB) results in diminished HRQOL in a pediatric sample.
A retrospective chart review was conducted in an outpatient pediatric urology clinic and in an outpatient pulmonology clinic. Parents of the patients completed the Pediatric Sleep Questionnaire (PSQ) to assess the presence of SDB and snoring, and HRQOL was assessed using the Obstructive Sleep Apnea Syndrome-18-item (OSAS-18) scale, both validated measures, as part of the child's clinical workup.
One hundred fifty-two (85 males and 67 females ) patients were included and were categorized into any of the following four groups: (1) MNE only, (2) SDB only, (3) MNE + SDB, or (4) healthy control. Patients in the SDB-only group had significantly more severe SDB than those in the other groups. As such, severity of SDB was controlled for in analyses. Results revealed that the four groups significantly differed on all subscales of the OSAS-18, which are Sleep Disturbance, Physical Symptoms, Emotional Symptoms, Daytime Functioning, and Caregiver Concerns. Post hoc analyses revealed the MNE + SDB group had more impairments on each subscale. Analysis of the total impairments revealed that children with only one condition (MNE or SDB) reported similar levels of impairments in HRQOL and patients with MNE + SBD reported significantly higher levels of impairments, as it appears that these comorbid conditions have an additive effect on HRQOL.
Children with comorbid MNE and SDB are at significantly higher risk for reporting impairments in their HRQOL than children who have only one of these conditions. While it is already known that children with MNE are at risk for emotional, behavioral, and social difficulties and children with SDB are at risk for neurobehavioral difficulties, it is possible that children with both conditions are at risk for a multitude of negative consequences.
These data emphasize the importance of urologist screening for SDB and pulmonologist screening for MNE as part of their routine clinical practice.
简介/背景：健康相关生活质量（HRQOL）是儿科学中的一个新概念，但它在临床护理、治疗计划以及对医疗和行为建议的依从性方面都非常重要。有两组儿童存在 HRQOL 受损的风险，一组是遗尿症儿童，另一组是打鼾或患有睡眠呼吸暂停的儿童。
本研究旨在确定单纯性夜间遗尿症（MNE）和睡眠呼吸障碍（SDB）合并是否会导致儿科样本中 HRQOL 下降。
对门诊小儿泌尿科诊所和门诊肺病科诊所进行回顾性图表审查。患者的父母完成了儿科睡眠问卷（PSQ）以评估 SDB 和打鼾的存在，作为患儿临床检查的一部分，使用经过验证的阻塞性睡眠呼吸暂停综合征-18 项（OSAS-18）量表评估 HRQOL。
共纳入 152 名（85 名男性和 67 名女性）患者，并分为以下四组之一：（1）仅 MNE，（2）仅 SDB，（3）MNE+SDB，或（4）健康对照组。SDB 组的患者 SDB 严重程度明显高于其他组。因此，在分析中控制了 SDB 的严重程度。结果显示，OSAS-18 的所有子量表，包括睡眠障碍、身体症状、情绪症状、日间功能和照顾者关注，四个组在所有子量表上均有显著差异。事后分析显示，MNE+SDB 组在每个子量表上的损伤都更大。对总损伤的分析表明，仅有一种疾病（MNE 或 SDB）的儿童报告其 HRQOL 损伤程度相似，而 MNE+SBD 的患者报告其损伤程度显著更高，因为似乎这些合并病症对 HRQOL 有累加效应。
患有 MNE 和 SDB 合并症的儿童报告其 HRQOL 受损的风险明显高于仅有一种这些病症的儿童。虽然已经知道 MNE 儿童存在情绪、行为和社交困难的风险，而 SDB 儿童存在神经行为困难的风险，但患有两种疾病的儿童可能存在多种负面后果的风险。
这些数据强调了泌尿科医生筛查 SDB 和肺病科医生筛查 MNE 的重要性，这是他们常规临床实践的一部分。
