Sleep Parameters and Motor Activity in Children With Nocturnal Enuresis and Daytime Urinary Incontinence.

INTRODUCTION

Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) are common in childhood. They are associated with sleep disorders, which, in turn, can affect physical activity. The aim of the present study was to investigate sleep quality and motor activity in children with NE and DUI by using actigraphy as an objective assessment method.

METHODS

Thirty-four children with NE or DUI, aged 5-13 years, and 33 controls were included in the study. Of the patients, 16 (47.1%) children had isolated NE and 18 (52.9%) DUI (isolated or combined with NE). Sleep quality and motor activity were measured by a wrist-worn actigraph for 4 days and 4 nights. Further assessment included a physical examination, a 48 h bladder diary, standardized questionnaires on incontinence and behavioral symptoms (CBCL), a structured psychiatric interview, and an intelligence test.

RESULTS

Children with incontinence had significantly shorter wake times after sleep onset (WASO), as well as a lower number of awakenings per night than controls. There were no differences in sleep quality parameters between children with NE and DUI. During the day, motor activity did not differ between patients and controls nor between children with NE and DUI. Patients had a significantly higher rate of CBCL total and externalizing problem scores. 44.1% of patients and 30.3% of controls had psychiatric disorders. In the patient group, there was a significant positive correlation between externalizing symptoms and sleep efficiency. Children with incontinence had significantly higher voiding frequency, a lower minimal voided volume, and a lower maximal voided volume. Sleep efficiency and voiding frequency were negatively correlated in the patient group.

CONCLUSION

In conclusion, children urinary incontinence (DUI, not only NE) show differences in sleep parameters, but not major differences in daytime activity. Sleep disturbances are heterogeneous and require more detailed studies, taking psychiatric comorbidity into consideration. Actigraphy is a valid tool to study children in a naturalistic setting over the day and night. In clinical practice, sleep disturbances need to be taken into consideration in the assessment and treatment of children with NE and DUI.

TRIAL REGISTRATION: DRKS00015110.