This is an meta-analysis on everity-related Association Between Sleep-Disordered Breathing and Nocturnal Enuresis in Children. Nocturnal enuresis (NE) is a prevalent pediatric condition with potential associations with sleep-disordered breathing (SDB)[1]. While prior studies suggest a relationship, the severity-dependent effect and influence of additional factors remain unclear. This study aims to systematically evaluate the correlation between NE and SDB, assess the impact of SDB severity, and explore how other factors such as diagnostic criteria, study design, and geographic region affect this relationship.

This systematic review and meta-analysis (registered in Prospero, CRD42024576610) followed PRISMA 2020 guidelines, systematically searched PubMed, Web of Science, Embase, and Cochrane Library (inception to May 17, 2024) using keywords "Nocturnal Enuresis" and "Sleep Apnea" to include case-control, cohort, or cross-sectional studies (excluding non-English/low-quality reports) evaluating children aged 5–18 years with NE (ICCS/WHO/ICD-10 criteria) and SDB (PSG-defined OSA with AHI ≥1 and snoring assessment), assessing study quality via NOS/AHRQ and analyzing pooled prevalence/ORs using random-effects models with subgroup analysis for severity/diagnostic criteria/region.

In a meta-analysis of 22 studies comprising 40,296 participants, the pooled prevalence of sleep-disordered breathing (SDB) in patients with nocturnal enuresis (NE) was 32.3% (95% CI: 28.3–36.2%), while the prevalence of NE in those with SDB was 24.5% (95% CI: 15.7–33.3%). The analysis revealed a significant positive association between SDB and NE (adjusted OR = 2.45, 95% CI: 1.72–3.50), establishing SDB as an independent risk factor for NE. Notably, a severity-dependent relationship was observed, with mild SDB (e.g., snoring) increasing NE risk by 84% (OR = 1.84, 95% CI: 1.02–3.33) and moderate-to-severe SDB (e.g., obstructive sleep apnea) more than doubling the risk (OR = 2.81, 95% CI: 2.08–3.79). Furthermore, the strength of the NE-SDB association varied according to diagnostic criteria (ICCS-defined NE: OR = 2.50 versus ICD-10: OR = 5.81), study design (cross-sectional: OR = 2.55 versus case-control: OR = 2.27), sample source (hospital-based: 37.7% prevalence versus community-based: 13.6%), and geographic region (strongest in South America with OR = 4.95 and weakest in Europe with OR = 1.49).

The results indicate a robust link between NE and SDB, especially as the severity of SDB increases. This severity-dependent relationship underscores that not all SDB cases carry the same risk—more severe sleep disturbances are likely to have a greater impact on bladder control during sleep.

This study highlights a severity-dependent relationship between SDB and NE and identifies additional factors influencing their association. OSA is a major risk factor for NE, and early screening and intervention for SDB may help reduce NE prevalence. Future studies should focus on whether treating SDB, particularly moderate-to-severe cases, improves NE outcomes and explore regional variations in risk factors and treatment effectiveness.

Su M S, Xu L, Pan W F, et al. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children [J]. World journal of pediatrics : WJP, 2019, 15(2): 109-16.