National Sleep Foundation

Chapter 6: Parasomnias

Etiology/Risk Factors

What are the etiology and the risk factors for bedwetting (enuresis)?

Genetic and familial factors contribute to enuresis,1-3 as do psychological stressors4 ADHD,5-6 and other sleep disorders, such as obstructive sleep apnea,7 and medical issues such as urinary tract infections. Enuresis may be the sole manifestation of nocturnal seizures.8 Although anatomic bladder problems have been postulated to cause enuresis, studies have been contradictory.9

Another hypothesis involves the production of arginine vasopressin (an antidiuretic hormone). Physiological production of this hormone follows a circadian pattern (it raises at night), subsequently, urine production is reduced. Studies suggest that children with enuresis are delayed in developing this nocturnal rise. The resulting polyuria overwhelms the ability of the bladder to retain urine.9

References

  1. Hublin C, Kaprio J, Partinen M, Koskenvuo M: Nocturnal enuresis in a nationwide twin cohort. Sleep. 1998;21:579-585.
  2. Ozkan KU, Garipardic M, Toktamis A, Karabiber H, Sahinkanat T. Enuresis prevalence and accompanying factors in schoolchildren: a questionnaire study from southeast Anatolia. Urol Int. 2004;73:149-155.
  3. Koff SA. Enuresis. In: Walsh PC, Retik AB, Vaughan ED et al (eds): Campbell's urology, 7th ed. Philadelphia: WB Saunders, 1998;2055-2068.
  4. Baeyens D, Roeyers H, Vande Walle J, Hoebeke P. Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review. Eur J Pediatr. 2005;164:665-672.
  5. Touchette E, Petit D, Paquet J, et al. Factors associated with fragmented sleep at night across early childhood. Arch Pediatr Adolesc Med. 2005;159:242-249.
  6. Brooks LJ, Topol HI. Enuresis in children with sleep apnea. J Pediatr. 2003;142:515-518.
  7. Mahowald MW, Bornemann MA. NREM Sleep-Arousal Parasomnias. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2005:889-896.
  8. Thiedke CC. Nocturnal enuresis. Am Fam Physician. 2003;67:1499-1506.