Nocturnal Enuresis, Obstructive Sleep Apnea and Obesity: A Vicious Circle Entrapping Children
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ABSTRACT Objectives : Evaluation of the impact of adenotonsillectonty alone or in association with weight reduction program on nocturnal enuresis (NE) as an associated co-morbidity for obstructive sleep apnea syndrome (OSAS). Patients & Methods : A survey questionnaire about child's sleeping habits as regards snoring and/or enuresis was applied for all parents attending with their children aged 5-10 years to select 150 children with both snoring and enuresis. Collected data included gender, age, weight, height for calculation of body mass index (BMI). The questionnaire included questions to detect anfil wore both NE and OSAS. All children underwent determination of sleep arterial blood oxygen saturation (Sa02%) by pulse oximetery and according the McGill Oximetery Scoring System patients with scores of 2-4 were subjected to adenotonsillectomy, while those scored 1 underwent further investigations. Pulse oximetery and questionnaire of the same items were conducted 6 months later and scores were compared to baseline data. All patients were subjected to weight reduction dieting regimen and scheduled for aerobic exercise for three months for weight reduction. Results : Twenhj-seven children (18%) had score of one and were ruled out as surgical cases, while 123 children (82%) underwent adenotonsillectomy. Mean postoperative (PO) number of desaturation episodes and lowest 5a02% were significantly improved compared to preoperative measures. Post-treatment NE scoring showed significantly higher frequency of low grades with significantly lower mean total score compared to pretreatment measures. Concerning line of treatment, 103 adeiwtonsillectomy patients had dry bed at the end of postoperative months for a success rate of surgical treatment of 83.7%, while only 16 patients received conservatim therapy for other causes than adenotonsillitis had dry bed for a success rate of 59.3% with significant difference in favor of surgical treatment. All patients showed reduction of their body weight with concomitant decrease of BMI at the end of the 6 months follaw-up compared to their pre-treatment BMI. Conclusion : The obtained results supported the afisociation between nocturnal enuresis, OSAS and obesity and allowed the conclusion that adenotonsillectomy can be considered as appropriate procedure for management of such cases and in addition, weight reduction allowed flirt her improvement.