critically appraising topics, studies of all designs (systematic reviews,
randomized controlled trials, case-controlled studies, case series,
etc.) will be encountered. If “grade A” evidence is not available, less
ideal levels of evidence can still be applicable and relevant, perhaps
with a “lower grades” of recommendation.
enuresis occurs in 15-20% 5 year olds, and its occurrence steadily (15%/year)
decreases with increasing age; this spontaneous resolution of enuresis
complicates all studies that attempt to follow it longitudinally.
true prevalence of obstructive sleep apnea in children is also difficult
to identify; the lowest estimate is 2.9%.2
an association between airway obstruction and nocturnal enuresis could
exist for several reasons. Obstructive sleep apnea interrupts sleep
and may limit normal arousal and self alerting mechanisms. Hormonal
change (obstructive sleep apnea and lower levels of ADH) and increased
intra-abdominal pressure have also been suggested as possible factors.
D, Sateia M, and West R. Nocturnal enuresis in children with upper airway
obstruction. Otolaryngology—Head and Neck Surgery, 1991; 105:427-432.
R, Elkins T, Keech D, Wauquier A, and Hubbard D. Accuracy of clinical
evaluation in pediatric obstructive sleep apnea. Otolaryngology—Head
and Neck Surgery, 1998; 118:69-73.