van Galen Maayke, Huskens Bibi, Tak Benodet, von Gontard Alexander, Didden Robert
Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.
SeysCentra, Malden, The Netherlands.
Neurourol Urodyn. 2025 Feb;44(2):464-479. doi: 10.1002/nau.25652. Epub 2025 Jan 6.
Sleep disordered breathing (SDB), lower urinary tract dysfunction (LUTD), and enuresis (NE) are common in children and adolescents and have serious consequences, especially on social and emotional development. Even though much is known about the association between SDB and NE among adults, the number of articles in children and adolescents is limited. Therefore, the aim of the present scoping review was to map out the current knowledge about SDB and LUTD in children and adolescents.
Four electronic databases (i.e., Embase, PsychInfo, Pubmed, Web of Science) were searched in accordance with the Johanna Briggs Institute (JBI) manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). The Quality Assessment Tool for Quantitative Studies (QATQS) was used to evaluate the methodological quality of the included studies. All articles in this scoping review met the following inclusion criteria: (a) the sample included children/adolescents between the ages of 5 and 18; (b) there was a presence of both LUTD and (a clinical manifestation of) SDB, (c) the article was published in English and/or Dutch; (d) the article was available in full text. The following exclusion criteria were used: (a) studies with solely one of the two main concepts (e.g., LUTD or SRBD); (b) studies with a third variable, other than treatment-oriented variables; (c) articles published in a language other than English or Dutch; (d) meta-analyses and reviews.
The search resulted in the inclusion of 17 articles related to SDB and LUTD in children and adolescents. Even though all included articles found a clear association between SDB and NE in children, very limited information was found on SDB and other LUTS and/or how the association impacts children and adolescents with developmental delays (DD's). In addition, limited and/or conflicting results were found related to SDB, NE and other variables (e.g., family history of NE, obstructive sleep apnea (OSA) severity, gender, preoperative ADH/BNP levels, obesity and ADHD). An adenotonsillectomy (T&A) had a significant beneficial therapeutic effect on NE in children and adolescents with SDB.
This scoping review found a clear association between SDB/OSA and NE, as the arousability and urine production at night are impacted. T&A could be considered as a treatment option for children and adolescents who do not respond to standard NE treatment. However, more research is needed to determine mechanisms involved in responders and non-responders and to examine the possible association between SDB in children and adolescents with other LUTS and/or developmental delays. The need for a multidisciplinary approach and future research is highlighted to provide children and adolescents with comorbid disorders adequate care based on the understanding of underlying conditions and mechanisms involved.
睡眠呼吸障碍（SDB）、下尿路功能障碍（LUTD）和遗尿症（NE）在儿童和青少年中很常见，并且会产生严重后果，尤其是对社交和情感发展方面。尽管关于成人中SDB与NE之间的关联已有很多了解，但关于儿童和青少年的相关文章数量有限。因此，本范围综述的目的是梳理有关儿童和青少年SDB与LUTD的现有知识。
根据乔安娜·布里格斯研究所（JBI）证据综合手册以及系统评价和Meta分析扩展版的首选报告项目（PRISMA-ScR）对四个电子数据库（即Embase、PsychInfo、Pubmed、科学网）进行检索。使用定量研究质量评估工具（QATQS）评估纳入研究的方法学质量。本范围综述中的所有文章均符合以下纳入标准：（a）样本包括5至18岁的儿童/青少年；（b）同时存在LUTD和SDB（的临床表现）；（c）文章以英文和/或荷兰语发表；（d）文章可获取全文。使用以下排除标准：（a）仅涉及两个主要概念之一（如LUTD或SRBD）的研究；（b）除了以治疗为导向的变量外还存在第三个变量的研究；（c）以英语或荷兰语以外的语言发表的文章；（d）Meta分析和综述。
检索结果纳入了17篇与儿童和青少年SDB和LUTD相关的文章。尽管所有纳入文章都发现儿童中SDB与NE之间存在明确关联，但关于SDB与其他下尿路症状和/或这种关联如何影响发育迟缓（DD）的儿童和青少年的信息非常有限。此外，发现与SDB、NE和其他变量（如NE家族史、阻塞性睡眠呼吸暂停（OSA）严重程度、性别、术前抗利尿激素/脑钠肽水平、肥胖和注意力缺陷多动障碍（ADHD））相关的结果有限且/或相互矛盾。腺样体扁桃体切除术（T&A）对患有SDB的儿童和青少年的NE有显著的有益治疗效果。
本范围综述发现SDB/OSA与NE之间存在明确关联，因为夜间的唤醒能力和尿液生成会受到影响。对于对标准NE治疗无反应的儿童和青少年，可考虑将T&A作为一种治疗选择。然而，需要更多研究来确定反应者和无反应者所涉及的机制，并研究儿童和青少年SDB与其他下尿路症状和/或发育迟缓之间可能的关联。强调了采用多学科方法和未来研究的必要性，以便在了解潜在状况和所涉及机制的基础上，为患有合并症的儿童和青少年提供充分的护理。
