Severity-related association between sleep-disordered breathing and nocturnal enuresis in children and adolescents and adolescents: a systematic review and meta-analysis.

OBJECTIVE: This study aims to explore the association between nocturnal enuresis (NE) and sleep-disordered breathing (SDB) through a meta-analysis and evaluate the impact of different SDB severity levels on the occurrence of NE. METHODS: This systematic review and meta-analysis followed the PRISMA 2020 guidelines. Studies were collected from PubMed, Web of Science, Embase, and the Cochrane Library, including case-control, cohort, or cross-sectional studies. The search included the keywords, ‘Nocturnal Enuresis’ and ‘Sleep Apnea, Obstructive’, from database inception to 17 May 2024, involving children and adolescents aged 5–18 years with clear diagnoses of NE or SDB. RESULTS: A total of 22 studies (40,296 participants) were included, of which 20 were rated as moderate to high quality. NE patients had a 32.3% (95% CI: 28.3–36.2) SDB prevalence (SWN), while SDB patients had a 24.5% (95% CI: 15.7–33.3) NE prevalence (NWS). The meta-analysis revealed a significant positive NE-SDB association (adjusted OR = 2.85, 95% CI: 2.35–3.45), indicating SDB is an independent NE risk factor. Subgroup analyses showed that both mild SDB (e.g., habitual snoring) and moderate-to-severe SDB (e.g., OSA) were associated with higher NE risk-mild: OR 2.48 (95% CI 1.68–3.67); moderate-to-severe: OR 2.91 (95% CI 2.20–3.86), but the differences between severity strata were not statistically significant (test for subgroup differences P = 0.758). CONCLUSION: There is an independent positive association between NE and SDB, indicating a high prevalence of SDB among children with NE and, conversely, a high prevalence of NE among children with SDB. Both mild and moderate-to-severe SDB are associated with an increased risk of NE; however, no significant risk gradient was observed across different levels of SDB severity.