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

Abstract

Importance\nChildren 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.\n\n\nObjective\nTo assess the outcomes of AT vs watchful waiting in children with nonsevere OSA who experience NE.\n\n\nDesign, Setting, and Participants\nSecondary 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.\n\n\nInterventions\nAdenotonsillectomy vs watchful waiting in children with NE.\n\n\nMain Outcomes and Measures\nPrevalence of NE as defined by parental response to the Pediatric Sleep Questionnaire bed-wetting item at baseline and 7-month follow-up.\n\n\nResults\nOf 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\u2009=\u200938). The prevalence of NE did not change significantly (-0.5%; 95% CI, -5.4% to 6.4%) in the watchful-waiting group (n\u2009=\u200966) 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.\n\n\nConclusions and Relevance\nIn 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.\n\n\nTrial Registration\nClinicalTrials.gov Identifier: NCT00560859.