Exploratory analysis of electroencephalogram activity preceding nocturnal enuresis episodes using home-based sleep monitoring.

PURPOSE: Sleep-wake mechanisms are implicated in the pathophysiology of nocturnal enuresis; however, evidence-based treatments for arousal dysfunction remain lacking. We previously demonstrated prolonged REM sleep latency on wet nights using home-based EEG. This exploratory study analyzed EEG spectral power immediately before enuresis onset to characterize electrophysiological changes associated with arousal dysfunction.

METHODS

Among 64 children with primary nocturnal enuresis who underwent home-based single-channel portable EEG monitoring, 18 with both a wet and a dry night recorded within 7 days and an alarm-documented time of enuresis were retrospectively analyzed. Absolute spectral power was calculated by fast Fourier transformation for five frequency bands (delta, theta, alpha, sigma, beta) and total power in 30-s epochs. EEG data at 30, 10, and 5 min before enuresis onset on wet nights were compared with the corresponding clock time on dry nights using the Wilcoxon signed-rank exact test.

RESULTS

No significant differences were observed at 30 min before enuresis in any frequency band. Delta-band power was significantly higher on wet nights at 10 min (p = 0.040, Cohen's d = 0.38) and 5 min (p = 0.020, d = 0.43) before onset, as was total power at 5 min (p = 0.027, d = 0.38). No differences were found in other frequency bands at any time point.

CONCLUSIONS

Delta-band power was higher on wet nights at 10 and 5 min before enuresis, with the wet-dry difference widening toward onset, which may reflect transient deepening of sleep. These exploratory findings warrant confirmation in larger studies.