Sleep apnea as a cause of bedwetting?

I have heard that there is a link between cessation of bedwetting and children who have trouble breathing while they sleep. Is this true and can anything be done to correct the bedwetting?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

While most children with bedwetting have no medical reasons for doing so, there is a small subset of children who begin bedwetting after developing sleep apnea. Sleep apnea is a condition in which there is obstruction of the air getting from the nose and mouth to the lungs. Sleep apnea most often occurs in obese adolescents and adults during sleep, because the muscles of the mouth relax, allowing the walls of the back of the mouth to come together with the tongue effectively blocking air flow. In children, this may occur due to large adenoids. The adenoids are special tissues which lie far back in the nasal passages between the nose and mouth. We normally nose breathe during sleep, so if the adenoids are large enough to cause obstruction, sleep apnea can occur. This can be compounded if the tonsils are also enlarged because they may block air flow as well. There are other less common structural defects of the nose and mouth which can cause sleep apnea, but the adenoids tend to be the biggest culprits.

The symptoms of sleep apnea vary between children. Almost all of these children have significant snoring. As they sleep, you may notice that they seem to stop breathing for more than ten seconds. This is followed by a gasp or partial arousal and then the snoring begins again. During these episodes, the amount of oxygen taken into the body drops significantly. Conversely, the cessation of breathing for less than ten seconds which is not associated with loud snoring or gasping is considered normal.

Children with sleep apnea may exhibit other medical and behavioral problems. Parents may notice their child's sleep is quite restless. Some children with sleep apnea prefer to sleep with the head elevated on pillows. Excessive daytime sleepiness is quite common and school performance may be affected, manifesting itself as poor mental performance and/or hyperactivity. Enuresis or bedwetting, particularly in children who had been dry, is a quite common problem that occurs with sleep apnea. The most serious complication of long-standing sleep apnea is pulmonary hypertension. Pulmonary hypertension is when the blood pressure of the vessels within the lungs becomes significantly elevated. This, in turn, puts a big strain on the heart, which can eventually lead to heart failure.

Open mouth breathing during sleep does not cause bedwetting. However, open mouth breathing and bedwetting are both symptoms of sleep apnea. If sleep apnea is occurring because the adenoids are obstructing air flow, having them removed may very well eliminate all these symptoms. A simple x-ray called a lateral neck film can be done to evaluate the size of the adenoids. On the other hand, if the mouth breathing is caused by reasons not associated with sleep apnea, such as an upper respiratory viral illness, or a deviated nasal septum, it is unlikely that there is a relationship between it and the bedwetting. Because of the potentially serious medical complications and decreased academic performance, parents of children who have symptoms of sleep apnea ought to be brought to the attention of their doctor. Reporting specific behaviors and patterns of breathing during sleep can be quite helpful for diagnosis. Even better would be a recording of the breathing pattern on a tape recorder or video camera.

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