Recently, we reported a high (23.3%) prevalence of sleep related breathing disorders in patients with MNE [5]. In this report, we share our experience of thirty children with MNE visiting our Pediatric Nephrology clinic. Out of these 30 cases, four had positive sleep related breathing disorder (SRBD) score, and thus underwent detailed polysomnography.

Records of thirty patients registered for MNE between September 2014 to September 2015 were retrieved. As per our protocol, every patient with nocturnal enuresis is screened for the presence of obstructive sleep apnea (OSA) through SRBD questionnaire along with detailed history, clinical and neurological examination. The Pediatric SRBD scale contains a total of 22 items and it is validated screening tool to detect sign and symptoms of OSA. Scores >0.33 are considered positive and suggestive of high risk for a pediatric sleep-related breathing disorder. Four children with monosymptomatic enuresis who had positive (SRBD) score were called upon for overnight polysomnography in the sleep laboratory of the institute. Two of these patients had previously taken desmopressin but were refractory to medical treatment while other two patients were referred to us as they had relapse on discontinuation of desmopressin.

Details of the sleep study such as periodic limb movements (PLMS), apnea-hypopnea index (AHI), EEG, snoring index, and saturation dipping and arousal index was noted. Severity of the disease was classified as primary snoring (AHI <1), mild to moderate OSA (AHI 1-5), and severe OSA (AHI >5). Details of the polysomnographic findings are given in the Table I. Two of the four patients had severe OSA while one each had mild and moderate OSA. PLMS was positive in three out of four cases. Patients with severe OSA underwent adenotonsillectomy and achieved dryness over a period of 4-6 weeks. Other two patients with mild to moderate nocturnal enuresis achieved remission with tapering dose of desmopressin.

TABLE I Clinical and Polysomnography Findings in Enuretic Children with Sleep-Related Breathing Disorder

Findings from this series show that MNE is associated with OSA, and children with MNE should be screened for presence of OSA. A high index of suspicion is required in the MNE patients who are refractory to medical therapy or develop relapses on discontinuation of desmopressin.

Contributors: GC,SJ,ABG: conceptualized the study and wrote initial draft of manuscript; VG,BD: helped in writing and editing the final version of the manuscript. All authors approved the final version of the manuscript.

Funding: None; Competing interest: None stated.

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