Half of children with sleep apnea who also wet the bed might stop their bed-wetting if their tonsils or adenoids are removed, recent research suggests.

About Sleep Apnea

Obstructive sleep apnea (OSA) is marked by interruptions in breathing while asleep; it is common among children with enlarged tonsils or adenoids. Exactly how sleep apnea results in bedwetting is not fully understood, but hormonal changes may play a role.

The Study

Half of the 417 children in the study who had sleep apnea and were bedwetters stopped wetting the bed after they had their tonsils or adenoids removed. Children in the study were aged five to 18, and were followed for just under one year after their surgery, on average.

Those who did not stop wetting the bed after the surgery were more likely to be born prematurely, be male, be obese or have a family history of bedwetting, the investigators noted. Premature birth was the greatest predictor of continued bedwetting after surgery.

There are many other causes of bedwetting. said Yegappan Lakshmanan, MD, chief of pediatric urology at Children's Hospital of Michigan, in Detroit.

"About five to seven million children are bedwetters, and the causes fall into three main groups-bladder issues, sleep-related problems and the kidneys," he explained. "The children in this study wet the bed due to sleep-related problems."

So why weren't they all cured? "Bedwetting is multifactorial even within these groups, and eventually we should be able to pinpoint the cause for every single child," Dr. Lakshmanan said.

The findings were presented at the annual meeting of the American Urological Association (AUA), in Washington, DC.


"If they haven't seen an ear, nose and throat specialist, see one to see if the child who wets the bed has OSA that can be cured by tonsil or adenoid removal," said Dr. Lakshmanan.

Expert Commentary

"There are several potential causes of bedwetting, and sleep apnea is clearly one of them," said Lane S. Palmer, MD, chief of pediatric urology at the Cohen Children's Medical Center in New Hyde Park, New York.

"There are secondary positive effects of this tonsil- or adenoid-removing surgery, but I don't know that I would jump to have my child's tonsils or adenoids out as a primary treatment for bedwetting," he said. "Children with sleep apnea and bedwetting should see an otolaryngologist first."

This study really underscores the fact that children who have other issues with sleep should be looked at for bedwetting because anything that adversely affects sleep at night can lead to bedwetting, said AUA spokesman Anthony J. Atala, MD, a urologist at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina.

"If a child has bedwetting, pay close attention to their sleep patterns, and observe them while they are asleep and you can see whether they are breathing at a regular pace, and if not, seek additional help," Dr. Atala said.

Children with sleep apnea can be difficult to rouse, which may cause the bedwetting, said Dennis J. Kitsko, DO, an otolaryngologist at the Children's Hospital of Pittsburgh. "But not every child with sleep apnea will wet the bed, and not every bedwetter will have sleep apnea."

Still, "snoring in children is abnormal," said Linda Dahl, MD, an ear, nose and throat specialist at Lenox Hill Hospital in New York City. "Children snore because their tonsils and adenoids are enlarged, and they end up getting other behaviors that go along with sleep apnea, including bedwetting." she explained.

"There are many ancillary benefits that you may not attribute to removing large tonsil and adenoids, such as putting an end to bedwetting," Dr. Dahl added.

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