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. 2022 Nov-Dec;48(6):937-943.
doi: 10.1590/S1677-5538.IBJU.2022.0313.

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

André Ribeiro  1 , José Murillo Bastos Netto  2   3 , André Avarese de Figueiredo  2 , Tarssius Capelo Cândido  1 , Wilson Benini Guércio  1 , Bruno O Zica  2
Affiliations

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

André Ribeiro et al. Int Braz J Urol. 2022 Nov-Dec.

Abstract

Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO.

Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery.

Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p˂0.01).

Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Keywords: Natriuretic Peptide, Brain; Nocturnal Enuresis; Urination Disorders.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Cavum X-Ray - adenoid nasopharynx ratio (ANR) – black line is the measure of the adenoid / dotted line is nasopharynx measure; ANR is the result of the division of the measures of the black line by the dotted line.
Figure 2
Figure 2. Choana nasal endoscopic view – Grades I (up to 25% of choana obstruction), II (25% to 50% of choana obstruction), III (50% to 75% of choana obstruction) and IV (more than 75% of choana obstruction) - from left to right and from top to bottom.
Figure 3
Figure 3. Patient recruitment flowchart.
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References

    1. Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D. Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg. 1998;118:69–73. - PubMed
    1. Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr. 1984;105:10–14. - PubMed
    1. Bastos JM, Netto, Rondon AV, de Lima GRM, Zerati M, Filho, Schneider-Monteiro ED, Molina CAF, et al. Brazilian consensus in enuresis-recomendations for clinical practice. Int Braz J Urol. 2019;45:889–900. - PMC - PubMed
    1. Kovacevic L, Wolfe-Christensen C, Lu H, Toton M, Mirkovic J, Thottam PJ, et al. Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing? J Urol. 2014;191(5 Suppl):1592–1596. - PubMed
    1. Kovacevic L, Lu H, Wolfe-Christensen C, Abdulhamid I, Thottam PJ, Lulgjuraj M, et al. Adenotonsillectomy Normalizes Hormones and Urinary Electrolytes in Children With Nocturnal Enuresis and Sleep-Disordered Breathing. Urology. 2015;86:158–161. - PubMed