Perfil hormonal de crianças que tem enurese com e sem obstrução de vias aéreas superiores: ensaio clínico comparativo

Abstract

Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence; primary nocturnal enuresis (PNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study is to compare BNP/ADH behavior in primary enuretic children, with and without UAO, before and after treatment (upper airway release surgery and urotherapy, respectively), evaluate improvement of enuresis. Methods: Comparative clinical trial with 39 children presenting PNE with and without UAO, aged 5 to 14 years, recruited voluntarily in a tertiary specialty outpatient clinic. Children were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP prior and after treatment. Children presenting UAO were submitted to surgery (SG) and those without treated with urotherapy (UG). Data were analyzed prior and 90-120 days after surgery /urotherapy. Results: Intergroup analysis showed differences in ADH prior intervention (5.4 ± 3.3 SG vs 3.2 ± 2.4 UG, p=0.03) and dry nights after interventions (22.1 ± 9.6 SG vs 13.9 ± 10 UG, p=0.01). There were no differences between gender and in BNP/ADH prior and after interventions as well as dry nights before interventions considering “improvement criteria” as a group variable. Intragroup analysis showed differences only in dry nights in each group separately (9.8 ± 7.2 ® 22.1 ± 9.6 p < 0.01 SG and 9.3 ± 8.5 ® 13.9 ± 10.0 p = 0.04 UG). Conclusion: There are no differences in BNP/ADH hormones profiles in children with and without upper airway obstruction. Surgical treatment of the upper airway obstruction improves the number of dry nights.