Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea: A Secondary Analysis of a Randomized Clinical Trial

Abstract

Importance: Children with obstructive sleep apnea (OSA) are at increased risk for nocturnal enuresis (NE). However, randomized clinical trials assessing NE outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting are lacking.

Objective: To assess the outcomes of AT vs watchful waiting in children with nonsevere OSA who experience NE.

Design, setting, and participants: Secondary analysis of data from a multicenter randomized clinical trial conducted at tertiary children's hospitals was performed. Participants included 453 children aged 5.0 to 9.9 years with nonsevere OSA who were randomized to either watchful waiting or AT as part of the multicenter Childhood Adenotonsillectomy Trial. Caregivers completed the Pediatric Sleep Questionnaire, which includes a binary item on bed-wetting, at baseline and 7-month follow-up. The trial was conducted between October 2007 and June 2012. Evaluation in this secondary analysis involving NE occurred from October 2019 to March 2021.

Interventions: Adenotonsillectomy vs watchful waiting in children with NE.

Main outcomes and measures: Prevalence of NE as defined by parental response to the Pediatric Sleep Questionnaire bed-wetting item at baseline and 7-month follow-up.

Results: Of the 453 children enrolled, 393 were included in analysis; of these, 201 were girls (51.1%). Mean (SD) age at baseline was 6.54 (1.40) years. At baseline, the number of children with NE was similar (2.6%; 95% CI, -0.12% to 0.07%) between the AT (59 [30.7%]) and watchful-waiting (67 [33.3%]) groups. The odds of NE in the watchful-waiting group were approximately 2 times higher than the AT group after 7 months (odds ratio, 2.0; 95% CI, 1.3 to 3.1). Following AT, there was a decrease (-11.0%; 95% CI, -16.3% to -5.7%) in the number of children with NE (n = 38). The prevalence of NE did not change significantly (-0.5%; 95% CI, -5.4% to 6.4%) in the watchful-waiting group (n = 66) at follow-up. Although NE was less frequent in girls (adjusted odds ratio, 0.53; 95% CI, 0.33-0.85), other clinical factors, such as age, race and ethnicity, obesity, and apnea-hypopnea index, were not associated with improvement of NE.

Conclusions and relevance: In this secondary analysis of a randomized clinical trial, AT for the treatment of pediatric OSA appears to result in improvement in NE. Further research is needed to assess whether AT is associated with long-term benefits for NE compared with watchful waiting.

Trial registration: ClinicalTrials.gov Identifier: NCT00560859.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Participants Included in the Secondary Analysis of the Childhood Adenotonsillectomy Trial

AHI indicates apnea-hypopnea index; NE, nocturnal enuresis; OAI, obstructive apnea index; and PSQ, Pediatric Sleep Questionnaire.

Figure 2.. Prevalence of Nocturnal Enuresis (NE) in Children With Nonsevere Obstructive Sleep Apnea at Baseline and 7-Month Follow-up

Within-group percentage difference for early adenotonsillectomy (AT) group, −11.0% (95% CI, −16.3% to −5.7%), and within-group percentage difference for the watchful-waiting group, −0.5% (95% CI, −5.4% to 6.4%).