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 SpO 2 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.