多导睡眠监测联合动态尿动力评估原发单症状性夜间遗尿症患儿的膀胱功能及睡眠特征

Evaluation of bladder function and sleep patterns in children with primary mono-symptomatic nocturnal enuresis by polysomnography combined with ambulatory urodynamic monitoring

目的通过多导睡眠监测(PSG)联合动态尿动力学检查(AUM)的方法评估原发单症状性夜间遗尿症(PMNE)患儿的膀胱功能及睡眠特征。方法选取2019年10月至2021年10月于郑州大学第一附属医院就诊的PMNE患儿43例,按是否每周尿床夜晚数>4,分为严重PMNE组(>4次/周,23例)和非严重PMNE组(≤4次/周,20例)。记录排尿日记,行常规尿动力(CUD)、AUM和PSG检查。选取经检查无下尿路症状且PSG结果正常的儿童23名为对照组。结果严重PMNE组年龄(12.1±3.2)岁,其中男9例、女14例,每周遗尿频率为(6.7±1.7)次;非严重PMNE组年龄(12.0±3.4)岁,其中男9例、女11例,每周遗尿频率为(2.3±1.0)次。PMNE组夜间多尿发生率为34.9%(15/43),夜间最大膀胱容量降低发生率为11.6%(5/43)。严重PMNE组在AUM中的逼尿肌过度活动(DO)阳性率、DO频率[78.3%比45.0%,(5.5±1.8)次/h比(3.4±1.0)次/h]均显著高于非严重PMNE组(均P<0.05)。PSG结果示,严重PMNE组N1+N2期占总睡眠时间百分比、皮质觉醒指数以及呼吸暂停低通气指数(AHI)均显著高于对照组[(58.6±9.8)%比(49.3±9.5)%,(9.4±4.4)次/h比(3.1±1.5)次/h,(2.7±0.9)次/h比(0.9±0.7)次/h](均P<0.05);同时,严重PMNE组皮质觉醒指数和AHI显著高于非严重PMNE组[(9.4±4.4)次/h比(5.7±3.2)次/h,(2.7±0.9)次/h比(1.9±0.7)次/h],而睡眠效率显著低于非严重PMNE组[(86.4±4.3)%比(91.0±3.9)%](均P<0.05)。PMNE组的夜间DO发生频率、AHI与皮质觉醒指数呈正相关性(r=0.705,0.765,均P<0.001)。结论PMNE患儿存在夜间膀胱功能障碍与睡眠结构紊乱,并且两者之间具有一定关联性,PSG和AUM可为PMNE评估和治疗提供重要依据。

Objective To evaluate the bladder function and sleep pattern in the children with primary mono-symptomatic nocturnal enuresis(PMNE)by the polysomnography(PSG)and ambulatory urodynamic monitoring(AUM).Methods From October 2019 to October 2021,forty-three patients with PMNE were selected as PMNE group from the First Affiliated Hospital of Zhengzhou University and further subdivided into the severe PMNE group(enuresis>4 times/week)and the non-severe PMNE group(enuresis times 4 times/week)according to the severity.The conventional urodynamics(CUD),AUM,and PSG examinations and bladder diary were completed in the PMNE group.The control group consisted of 23 children with normal PSG findings and without the lower urinary tract symptoms.Results The severe PMNE group included 9 males and 14 females,aged(12.1±3.2)years,and nocturnal enuresis number per week is 6.7±1.7.The non-severe PMNE group included 9 males and 11 females,aged(12.0±3.4)years,and nocturnal enuresis number per week is 2.3±1.0.The incidences of nocturnal polyuria and the reduction in maximum bladder capacity in the PMNE group was 34.9%and 11.6%,respectively.The incidence and frequency of detrusor overactivity(DO)in the severe PMNE group were significantly higher than those in the non-severe PMNE group[78.3%vs 45.0%,(5.5±1.8)times/h vs(3.4±1.0)times/h,respectively,all P<0.05].It was found by the PSG that the severe PMNE group had significantly higher cortical arousal index,apnea hypopnea index(AHI),and percentage of N1+N2 phase in total sleep time,compared with the control group[(58.6±9.8)%vs(49.3±9.5)%,(9.4±4.4)times/h vs(3.1±1.5)times/h,(2.7±0.9)times/h vs(0.9±0.7)times/h](all P<0.05).While the sleep efficiency of the severe PMNE group was substantially lower than that of the non-severe PMNE group[(86.4±4.3)%vs(91.0±3.9)%],the cortical arousal index and AHI were significantly greater than those of the non-severe PMNE group[(9.4±4.4)times/h vs(5.7±3.2)times/h,(2.7±0.9)times/h vs(1.9±0.7)times/h](all P<0.05).In the PMNE group,there were positive correlations between cortical arousal index and nocturnal DO frequency or AHI(r=0.705,0.765,P=0.001).Conclusions Children with PMNE have nocturnal bladder dysfunction and abnormal sleep pattern,and there is a certain correlation between them.PSG and AUM are necessary for the evaluation and treatment of children with PMNE.