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Joinson C, Grzeda MT, Heron J, von Gontard A. Sleep duration, sleep problems and developmental trajectories of urinary incontinence: a prospective cohort study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02471-1. [PMID: 38831062 DOI: 10.1007/s00787-024-02471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/18/2024] [Indexed: 06/05/2024]
Abstract
To examine if preschool sleep duration and sleep problems are associated with urinary incontinence (UI) at primary school-age. We used multinomial logistic regression to examine the association of child sleep duration/problems (3½ years) with UI trajectories (4-9 years) in 8751 (4507 boys, 4244 girls) from the Avon Longitudinal Study of Parents and Children. We adjusted for sex, socioeconomic indicators, mothers' emotional/practical/financial support, developmental delay, stressful life events, temperament, and emotional/behaviour problems. Preschool children who slept more than 8½ hours per night had a decreased probability of UI at school-age. There was a 33% reduction in odds of daytime wetting per additional hour of sleep (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.52-0.86). Sleep problems were associated with increased odds of UI e.g., getting up after being put to bed was associated with daytime wetting (OR = 2.20, 95% CI 1.43-3.39); breathing problems whilst sleeping were associated with delayed bladder control (OR = 1.68, 95% CI 1.12-2.52), and night-time waking was associated with persistent (day and night) wetting (OR = 1.53, 95% CI 1.16-2.00). Waking during the night and waking up early in the morning were associated with reduced odds of bedwetting at school-age (OR = 0.76, 95% CI 0.61-0.96 and OR = 0.80, 95% CI 0.64-0.99 respectively). Preschool children who sleep for longer have a lower likelihood of UI at school-age, whilst those with sleep problems are more likely to experience daytime wetting and combined (day and night) wetting, but not bedwetting alone. Short sleep duration and sleep problems in early childhood could be indicators of future problems attaining and maintaining bladder control.
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Affiliation(s)
- Carol Joinson
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Mariusz T Grzeda
- Galen Research, B1 Chorlton Mill, 3 Cambridge Street, Manchester, M1 5BY, UK
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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2
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Inal B, Ozengin N, Bakar Y, Ankaralı H, Ozturk Y. Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis. J Pediatr Rehabil Med 2023; 16:529-537. [PMID: 36641693 DOI: 10.3233/prm-210105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group. METHODS Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with the Biodex Balance System SD. RESULTS Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p = 0.001), increased upright lumbar lordosis (p = 0.018) and sacral-hip angles (p = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p = 0.001), and decreased mediolateral dynamic balance (p = 0.049). CONCLUSION Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls.
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Affiliation(s)
- Busra Inal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Nuriye Ozengin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Yesim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Handan Ankaralı
- Department of Biostatistics and Medical Informatics, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yusuf Ozturk
- Department of Child and Adolescent Psychiatry, Medical Faculty, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Ribeiro A, Bastos Netto JM, Figueiredo AAD, Cândido TC, Guércio WB, Zica BO. Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery. INTERNATIONAL BRAZ J UROL 2022; 48:937-943. [DOI: 10.1590/s1677-5538.ibju.2022.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, Brasil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Brasil
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Fernandes AER, Roveda JRC, Fernandes CR, Silva DF, de Oliveira Guimarães IC, Lima EM, de Carvalho Mrad FC, de Almeida Vasconcelos MM. Relationship between nocturnal enuresis and sleep in children and adolescents. Pediatr Nephrol 2022; 38:1427-1438. [PMID: 36427087 DOI: 10.1007/s00467-022-05818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nocturnal enuresis (NE) is a multifactorial and complex condition. One less understood factor in its pathophysiology is the enuretic inability to wake up when the bladder is full (impaired arousal). OBJECTIVE We aimed to investigate the relationship between sleep and NE in children and adolescents. METHODS A systematic review was performed following the PRISMA guidelines, and the electronic databases MEDLINE (via PubMed) and SCOPUS were searched until March 2022. Eligibility criteria were studies that recruited patients aged five-17 years with a diagnosis of NE according to the International Child Continence Society (ICCS), Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), or International Classification Criteria of Sleep Disorders-Third edition (ICSD-3) who had their sleep assessed using validated questionnaires and/or polysomnography. The tool used to analyze the risk of bias in the included studies was the risk of bias in non-randomized studies of exposure. RESULTS Of 1582 citations screened, nine were included, giving 1685 participants, 581 with NE. All studies were observational and half had a low risk of bias. Four studies evaluated sleep by questionnaires only; two used questionnaires and polysomnography; two used only polysomnography, and one used sleep logs and actigraphy. Sleep questionnaires showed that children with enuresis had more sleep problems than controls, especially parasomnias, breathing disorders, and daytime sleepiness. Among the polysomnography parameters, the sleep stage architecture and periodic limb movements during sleep had conflicting data between the two studies. LIMITATIONS The studies evaluated sleep through heterogeneous tools. They used different questionnaires; even those considered by polysomnography did not record the same channels. CONCLUSION It seems that enuretic children and adolescents sleep differently from those who are non-enuretic. More studies are needed to clarify the best way to assess sleep and better understand this relationship. The review protocol was registered with PROSPERO, CRD42021266338. There was no funding.
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Affiliation(s)
- Ana Elisa Ribeiro Fernandes
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - José Reinaldo Corrêa Roveda
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Carolina Rodrigues Fernandes
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Diego Ferreira Silva
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Isabela Cristina de Oliveira Guimarães
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Eleonora Moreira Lima
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Flávia Cristina de Carvalho Mrad
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Mônica Maria de Almeida Vasconcelos
- Pediatric Nephrology Unit, Faculty of Medicine - Pediatrics Department, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190. Sala 267, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
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Martenstyn JA, Machaalani R, Caldwell P, Waters KA. Relationship between sleep respiration, architecture and childhood enuresis: Correlates between polysomnography and questionnaire. J Paediatr Child Health 2021; 57:1923-1928. [PMID: 34152048 DOI: 10.1111/jpc.15613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
AIM Nocturnal enuresis (NE) and sleep-disordered breathing (SDB) are common in childhood. While the two disorders are linked, those links are still being clarified. METHODS This study compared sleep profiles and enuresis-related behaviours between children with NE and those without, who were referred to a tertiary sleep unit with suspected SDB, using the combination of polysomnography (PSG) and questionnaire. Continuous numerical data were analysed after adjusting for body mass index z-score. RESULTS The study included 52 Children (39 boys, 13 girls) aged 5-14 years. Twenty-one had enuresis (10 monosymptomatic enuresis (MNE) and 11 non-monosymptomatic enuresis (NMNE)) and 31 did not have enuresis. The majority had comorbidities. On PSG, all children with NE had moderate obstructive sleep apnoea (OSA) compared to the control group which were of mild OSA. Children with NMNE had a higher percentage time in stage-3 non-REM sleep when compared to the non-enuretic and MNE groups (P < 0.05). On the questionnaire, more parents of the NE groups reported that their child was 'difficult to wake in the morning' (P < 0.05). CONCLUSION In this heterogeneous population referred for suspected SDB, children with NE had moderate OSA, yet those with MNE had increased arousals and more often report difficulty waking than children with suspected SDB who do not wet, while children with NMNE exhibit changes in sleep architecture suggesting deeper sleep. These differences may impact treatment choices for children with enuresis.
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Affiliation(s)
- Jordan A Martenstyn
- Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.,Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rita Machaalani
- Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrina Caldwell
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karen A Waters
- Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Bogaert G, Stein R, Undre S, Nijman RJM, Quadackers J, 't Hoen L, Kocvara R, Silay S, Tekgul S, Radmayr C, Dogan HS. Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting. Neurourol Urodyn 2019; 39:489-497. [PMID: 31793066 DOI: 10.1002/nau.24239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/14/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIMS The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist. MATERIAL AND METHODS Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy. Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members. RESULTS The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors. CONCLUSION Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction.
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Affiliation(s)
- Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Shabnam Undre
- Department of Pediatric and Adult Urology, East and North Herts NHS Trust, Stevenage, UK
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Josine Quadackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, First Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Wada H, Kimura M, Tajima T, Shirahama R, Suzuki Y, Suzuki Y, Hayashi T, Maruyama K, Endo M, Sakamoto N, Ikeda A, Gozal D, Tanigawa T. Nocturnal enuresis and sleep disordered breathing in primary school children: Potential implications. Pediatr Pulmonol 2018; 53:1541-1548. [PMID: 30203928 DOI: 10.1002/ppul.24156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/13/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The association between nocturnal enuresis (NE) and sleep disordered breathing (SDB) has been repeatedly reported, but has primarily been focused on clinical cohorts. The purpose of this study, was to assess whether SDB-related symptoms such as snoring and unrefreshing sleep in the morning are associated with NE in a large-scale community school-based survey. METHODS A cross-sectional assessment using a standard questionnaire was conducted on nearly 20 000 primary school children (5-12 years old) in Matsuyama, Japan. Associations between NE and the frequencies of snoring and unrefreshing sleep were evaluated using multivariate logistic and regression analyses. RESULTS Multivariate adjusted odds ratios (95% confidence intervals) for enuresis were 1.21 (1.04 to 1.40) and 1.36 (1.07 to 1.73) in boys who snored 1 or 2 nights per week and ≥3 nights per week, respectively (P for trend <0.0001). Those for enuresis were 1.67 (1.41 to 1.99) and 1.96 (1.63 to 2.36) in boys who showed unrefreshing sleep 1 or 2 nights per week and ≥3 nights per week, respectively (P for trend <0.0001). Significant associations between NE and snoring frequency emerged among children who did not report unrefreshing sleep (P-trend for boys and girls were <0.0001 and <0.01, respectively), while significant associations between NE and frequency of unrefreshing sleep were detected among children who snored ≥1 nights per week (P for trend >0.1). CONCLUSIONS The pathogenic mechanisms linking snoring and unrefreshing sleep to increased risk of NE are unknown. However, snoring, a surrogate reporter of SDB, is associated with increased urine production, while unrefreshing sleep may result from disrupted sleep facilitating increased sleep pressure and elevated arousal thresholds. Thus, both SDB and unrefreshing sleep are potential independent risk factors of NE in school age children.
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Affiliation(s)
- Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Manami Kimura
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Tomokazu Tajima
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Ryutaro Shirahama
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan.,RESM Shin Yokohama Clinic, Yokohama, Kanagawa, Japan
| | - Yohei Suzuki
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yuka Suzuki
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Toshinari Hayashi
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan.,Tokorozawa Sleep and Respiratory Clinic, Tokorozawa, Saitama, Japan
| | - Koutatsu Maruyama
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan.,Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Ehime, Japan
| | - Motoki Endo
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Toho University, Ohta-ku, Tokyo, Japan
| | - Ai Ikeda
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
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