Nocturnal enuresis in adults with obstructive sleep apnea hypopnea syndrome: A case report and a literature review.

RATIONALE: To delineate the clinical phenotype, putative mechanisms, and treatment outcomes of adult-onset nocturnal enuresis attributable to obstructive sleep apnea-hypopnea syndrome (OSAHS).

PATIENT CONCERNS: Four consecutive obese males (aged 27-40 years) presented with nocturnal enuresis or sleep-disordered breathing; the onset of bed-wetting coincided with worsening symptoms of OSAHS. Two patients also experienced nocturnal seizure convulsions, and one had concomitant fecal incontinence.

DIAGNOSES: Full-night polysomnography revealed extremely severe OSAHS (apnea-hypopnea index 71.2-128.8 events/h) with profound nocturnal hypoxemia (nadir SpO2 27%-48%). Extensive urological, neurological, and metabolic workups disclosed no primary bladder or systemic pathology; bed-wetting was thus deemed secondary to OSAHS.

INTERVENTIONS: All patients were treated with noninvasive positive-pressure ventilation (continuous or bilevel positive airway pressure) and received structured weight-reduction counseling.

OUTCOMES: Noninvasive positive-pressure ventilation produced complete remission or >90% reduction of enuretic episodes in all subjects, accompanied by marked improvement in respiratory symptoms and nocturnal oxygenation.

LESSONS: Adult-onset nocturnal enuresis may signal extremely severe, hypoxemia-predominant OSAHS, particularly in obese men. If no urological pathology is identified, evaluation for sleep-disordered breathing should be initiated. Prompt and effective treatment of OSAHS can significantly improve nocturnal enuresis.