A Hidden Cause of Bedwetting

Sleep apnea among children linked to bedwetting but removing tonsils helps

(RxWiki News) If little Johnny or Susie is wetting the bed frequently at night, that doesn't necessarily mean they have a psychological or behavior issue. They might have a serious sleeping disorder.

A recent study that reviews existing literature confirms that the rate of bedwetting among children with sleep apnea is higher than than average but that the rate decreases with treatment from a tonsillectomy.

"Your child's bedwetting may be related to sleep apnea."

Anita Jeyakumar, MD, of the Department of Otorhinolaryngology at Louisiana State University's Health Science Center, led a study that reviewed past research on any possible links between nighttime bedwetting in children and sleep apnea.

Jeyakumar and her colleagues used the medical study databased PubMed and Ovid to review all studies published from 1980 to 2010 involving children who had both a history of bedwetting and some type of sleep-disordered breathing, which usually refers to sleep apnea.

The researchers reviewed 14 studies involving a total of 3,550 children who had sleep apnea. About a third of these kids, or 1,113 total, also had problems wetting the bed.

Bedwetting normally occurs with about 2 to 15 percent of children aged 5 to 15, as an average since bedwetting decreases as children grow older. About 20 percent of 5-year olds wet the bed, about five percent of 10-year olds, and just one to two percent of 15-year olds.

The rate of bedwetting among children with sleep-disordered breathing was therefore much higher.

Because the children ranged in age from 18 months to 19 years old, it was likely developmentally appropriate that some of the children were urinating at night if they were not yet potty-trained, but the studies did not distinguish these kids from the others.

Scientists do not fully understand all the underlying causes of bedwetting, but some of the theories proposed were that children have irregular internal biological clocks, that they have unstable bladders or that bedwetting may be partly hereditary.

One of the primary treatments for sleep-disordered breathing is removing children's tonsils, so Jeyakumar's team also identified seven studies involving 1,360 children who had had their tonsils removed to address their sleep apnea.

The average number of patients in each of these studies was 194 children ranging from 2 years old to 18 years old. Among the total group, 31 percent (426 kids) had nighttime bedwetting issues.

After their tonsillectomies, 587 children had follow-ups and the rate of bedwetting issues for this smaller group was 16 percent (95 kids total).

The authors therefore concluded that a link does exist between sleep apnea and nighttime bedwetting and that giving tonsillectomies for these children statistically cut the rate of bedwetting issues in half.

William Kohler, MD, director of the Florida Sleep Institute and director of Pediatric Sleep Services at Florida Hospital Tampa, said the evidence in this study has borne out in his own practice with children who had bedwetting, also medically known as enuresis.

"I have had many patients that have had enuresis that was corrected when their sleep-disordered breathing was corrected with a tonsillectomy adenoidectomy," Dr. Kohler said. "The enuresis is a known association with obstructive sleep apnea and correcting the sleep apnea will often correct enuresis."

Dr. Kohler said another association not discussed in this paper with sleep apnea is sleep-walking, which will also often go away once the sleep apnea is treated.

There are other treatments for sleep apnea besides tonsillectomies and/or adenoidectomies, and removing a child's tonsils and adenoids does not always resolve sleep-disordered breathing.

One standard treatment for sleep apnea is the use of continuous positive airway pressure, or CPAP, therapy. CPAP machines can cost anywhere from a couple hundred dollars to a thousand dollars, part of which can be covered by a health insurance plan.

One common side effect of CPAP machines is a build-up of gas in the stomach, which can cause some stomach pain and increase a person's flatulence.

A tonsillectomy without insurance costs between $4,000 and $6,500. Side effects of tonsillectomies can include excessive bleeding, pain lasting longer than two or three days and scabs in the mouth that leave a bad taste in the mouth.

The study appeared online May 1 in the journal Laryngoscope. The research was internally funded at LSU, the University of Texas Southwestern Medical Center and Saint Louis University. There are no identified conflicts of interest.

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Review Date: 
May 10, 2012