Obstructive sleep apnea and nocturnal enuresis in the pediatric population: a systematic review and meta-analysis

BACKGROUND: The relationship between nocturnal enuresis (NE) and obstructive sleep apnea (OSA) among the pediatrics population is considered complex. We aimed to assess the prevalence of NE in patients with OSA and the potential relationship between the two. METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane up to October 2024 using terms related to OSA and NE. Eligible studies were observational, published in English, involved participants under 18, and examined the OSA–NE association. RESULTS: The total number of participants included was 11,612 from 15 articles. Twelve studies reported the prevalence of enuresis among children with OSA, with a pooled prevalence of 40% (95% CI: 30%–51%). In studies using polysomnography, prevalence was 43% (95% CI: 32%–53%). Eight studies assessed the association between OSA and enuresis, showing a significant relationship (OR = 2.30; 95% CI: 1.37–3.84), which remained consistent in the polysomnography subgroup (OR = 2.62; 95% CI: 1.53–4.48). Enuretic patients had higher AHI (WMD = 3.37; 95% CI: 0.61–6.14) and BMI (WMD = 0.90; 95% CI: 0.74–1.06), but no significant differences were found in total sleep time or REM sleep. CONCLUSION: This systematic review reveals a significant association between OSA and enuresis in children, with a high prevalence of enuresis among those with OSA. The findings highlight the importance of screening for sleep-disordered breathing in children with persistent enuresis. Further research is needed to establish causality and evaluate the impact of OSA treatment on enuresis resolution.