Sleep and sleepiness in children with nocturnal enuresis

Abstract

Study Objectives: To assess if sleep patterns and sleepiness are compromised in children with nocturnal enuresis (NE), in comparison with normal control subjects, and to evaluate the role of enuresis-related events during sleep. Design: Assessment of natural sleep patterns at home in a sample of children referred to enuresis clinics and controls. Setting: Children's homes. Participants: Thirty-two children (19 boys and 13 girls aged 5.1 to 9.1 years) who suffer from primary NE and 94 healthy control subjects (49 boys and 45 girls aged 5 to 8.58 years). Interventions: N/A. Measurements and Results: Sleep measures were derived from 3 to 5 nights of actigraphy and daily logs. Additional information on events related to enuresis and daytime sleepiness was collected using daily reports. Children with NE slept significantly worse than did the control subjects. Their compromised sleep patterns were reflected in a higher number of actigraphic nighttime awakenings, the reduced percentages of motionless sleep, the higher number of reported nighttime awakening, and the increased sleep latency. Children with NE also reported higher levels of sleepiness in the morning and in the evening. Conclusions: Compared with the sleep of control subjects, the natural sleep of children with NE is significantly more fragmented, and the children with NE experience higher levels of daytime sleepiness. This phenomenology is associated with bedwetting episodes and attempts to keep the child dry during the night. These findings may suggest that children with NE suffer from sleep fragmentation, which may explain their higher arousal threshold. These findings have clinical implications for enuresis management.