Wang Q W, Zhang W, Zhu Z M, Jia C Y, Wang C Y, Zhang R L, Zhang Y, Wang Q F, Dou J G, Wen Jianguo
Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of Urodynamic Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2022 Oct 18;102(38):2994-3000. doi: 10.3760/cma.j.cn112137-20220122-00169.
To evaluate the bladder function and sleep pattern in the children with primary mono-symptomatic nocturnal enuresis (PMNE) by the polysomnography (PSG) and ambulatory urodynamic monitoring (AUM). From October 2019 to October 2021, forty-three patients with PMNE were selected as PMNE group from the First Affiliated Hospital of Zhengzhou University and further subdivided into the severe PMNE group (enuresis>4 times/week) and the non-severe PMNE group (enuresis times 4 times/week) according to the severity. The conventional urodynamics (CUD), AUM, and PSG examinations and bladder diary were completed in the PMNE group. The control group consisted of 23 children with normal PSG findings and without the lower urinary tract symptoms. The severe PMNE group included 9 males and 14 females, aged(12.1±3.2)years, and nocturnal enuresis number per week is 6.7±1.7. The non-severe PMNE group included 9 males and 11 females, aged(12.0±3.4)years, and nocturnal enuresis number per week is 2.3±1.0. The incidences of nocturnal polyuria and the reduction in maximum bladder capacity in the PMNE group was 34.9% and 11.6%, respectively. The incidence and frequency of detrusor overactivity (DO) in the severe PMNE group were significantly higher than those in the non-severe PMNE group [78.3% vs 45.0%, (5.5±1.8) times/h vs (3.4±1.0) times/h, respectively, all <0.05]. It was found by the PSG that the severe PMNE group had significantly higher cortical arousal index, apnea hypopnea index (AHI), and percentage of N1+N2 phase in total sleep time, compared with the control group[(58.6±9.8)% vs (49.3±9.5)%, (9.4±4.4) times/h vs (3.1±1.5) times/h, (2.7±0.9) times/h vs (0.9±0.7) times/h] (all <0.05). While the sleep efficiency of the severe PMNE group was substantially lower than that of the non-severe PMNE group [(86.4±4.3)% vs (91.0±3.9)%], the cortical arousal index and AHI were significantly greater than those of the non-severe PMNE group[(9.4±4.4) times/h vs (5.7±3.2) times/h, (2.7±0.9) times/h vs (1.9±0.7) times/h] (all <0.05). In the PMNE group, there were positive correlations between cortical arousal index and nocturnal DO frequency or AHI (=0.705, 0.765, =0.001). Children with PMNE have nocturnal bladder dysfunction and abnormal sleep pattern, and there is a certain correlation between them. PSG and AUM are necessary for the evaluation and treatment of children with PMNE.
通过多导睡眠图（PSG）和动态尿动力学监测（AUM）评估原发性单症状性夜间遗尿症（PMNE）患儿的膀胱功能和睡眠模式。2019年10月至2021年10月，从郑州大学第一附属医院选取43例PMNE患儿作为PMNE组，并根据严重程度进一步分为重度PMNE组（遗尿>4次/周）和非重度PMNE组（遗尿≤4次/周）。PMNE组完成了传统尿动力学（CUD）、AUM、PSG检查及膀胱日记。对照组由23例PSG检查结果正常且无下尿路症状的儿童组成。重度PMNE组包括9例男性和14例女性，年龄（12.1±3.2）岁，每周夜间遗尿次数为6.7±1.7次。非重度PMNE组包括9例男性和11例女性，年龄（12.0±3.4）岁，每周夜间遗尿次数为2.3±1.0次。PMNE组夜间多尿发生率和最大膀胱容量减少率分别为34.9%和11.6%。重度PMNE组逼尿肌过度活动（DO）的发生率和频率显著高于非重度PMNE组[分别为78.3%对45.0%，（5.5±1.8）次/小时对（3.4±1.0）次/小时，均P<0.05]。PSG检查发现，与对照组相比，重度PMNE组的皮质觉醒指数、呼吸暂停低通气指数（AHI）及N1+N2期占总睡眠时间的百分比显著更高[（58.6±9.8）%对（49.3±9.5）%，（9.4±4.4）次/小时对（3.1±1.5）次/小时，（2.7±0.9）次/小时对（0.9±0.7）次/小时]（均P<0.05）。虽然重度PMNE组的睡眠效率显著低于非重度PMNE组[（86.4±4.3）%对（91.0±3.9）%]，但其皮质觉醒指数和AHI显著高于非重度PMNE组[（9.4±4.4）次/小时对（5.7±3.2）次/小时，（2.7±0.9）次/小时对（1.9±0.7）次/小时]（均P<0.05）。在PMNE组中，皮质觉醒指数与夜间DO频率或AHI之间存在正相关（r=0.705、0.765，P=0.001）。PMNE患儿存在夜间膀胱功能障碍和睡眠模式异常，且二者之间存在一定相关性。PSG和AUM对于PMNE患儿的评估和治疗是必要的。
