Sleep-Related Breathing Disorders and Lower Urinary Tract Dysfunction in Children and Adolescents: A Scoping Review

Abstract

Aims: Sleep disordered breathing (SDB), lower urinary tract dysfunction (LUTD), and enuresis (NE) are common in children and adolescents and have serious consequences, especially on social and emotional development. Even though much is known about the association between SDB and NE among adults, the number of articles in children and adolescents is limited. Therefore, the aim of the present scoping review was to map out the current knowledge about SDB and LUTD in children and adolescents.

Methods: Four electronic databases (i.e., Embase, PsychInfo, Pubmed, Web of Science) were searched in accordance with the Johanna Briggs Institute (JBI) manual for Evidence Synthesis¹ and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).² The Quality Assessment Tool for Quantitative Studies (QATQS) was used to evaluate the methodological quality of the included studies.^63,64 All articles in this scoping review met the following inclusion criteria: (a) the sample included children/adolescents between the ages of 5 and 18; (b) there was a presence of both LUTD and (a clinical manifestation of) SDB, (c) the article was published in English and/or Dutch; (d) the article was available in full text. The following exclusion criteria were used: (a) studies with solely one of the two main concepts (e.g., LUTD or SRBD); (b) studies with a third variable, other than treatment-oriented variables; (c) articles published in a language other than English or Dutch; (d) meta-analyses and reviews.

Results: The search resulted in the inclusion of 17 articles related to SDB and LUTD in children and adolescents. Even though all included articles found a clear association between SDB and NE in children, very limited information was found on SDB and other LUTS and/or how the association impacts children and adolescents with developmental delays (DD's). In addition, limited and/or conflicting results were found related to SDB, NE and other variables (e.g., family history of NE, obstructive sleep apnea (OSA) severity, gender, preoperative ADH/BNP levels, obesity and ADHD). An adenotonsillectomy (T&A) had a significant beneficial therapeutic effect on NE in children and adolescents with SDB.

Conclusions: This scoping review found a clear association between SDB/OSA and NE, as the arousability and urine production at night are impacted. T&A could be considered as a treatment option for children and adolescents who do not respond to standard NE treatment. However, more research is needed to determine mechanisms involved in responders and non-responders and to examine the possible association between SDB in children and adolescents with other LUTS and/or developmental delays. The need for a multidisciplinary approach and future research is highlighted to provide children and adolescents with comorbid disorders adequate care based on the understanding of underlying conditions and mechanisms involved.

Keywords: adolescents; children; developmental delays—scoping review; enuresis; lower urinary tract dysfunction‐incontinence; obstructive sleep apnea; sleep‐related beathing disorders.

Figure 1

PRISMA flow chart showing the study selection [45]. ^a Even though NE can only be diagnosed at the age of 5 or older according to the ICCS criteria, Basha et al., included younger children as the study focused on the surgical treatment of OSA. This is why they were able to include children from the age of two and up and later examined the effects of NE.