Most epidemiological surveys target children, with relatively few surveys of adolescents. Research on the psychological and sleep aspects of PNE in adolescents is rare[1]. we investigated the prevalence, related factors,and psychosocalimpact of noctumal enuresis (PNE) in adolescents aged 12 to 18 years by an epidemiological survey.

From September 2020 to December 2022, a stratified, cluster random sampling method was used to conduct an epidemiological survey of 6408 junior and senior high school students in a certain area of Henan Province. The survey contents included: basic information, whether there is frequent urination, urgency of urination, urinary incontinence, recurrent urinary tract infection (RUTI), enuresis questionnaire, self-esteem scale (SES) Pittsburgh sleep quality index (PSQI), etc. The inclusion criteria for PNE are those who begin enuresis in early childhood and have involuntary urination more than once a month at night after being older than 5 years of age[2]; The exclusion criteria were obvious organic disease, physical disability, incomplete questionnaire filling, age less than 12 years or older than 18 years. To analyze whether the prevalence of PNE in adolescents is related to factors such as gender, residence, body mass index (BMI), frequency of urination, urgency of urination, urinary incontinence, RUTI, and family history of enuresis. In addition, the psychological problems of adolescent PNE patients were analyzed.

The overall prevalence of PNE among adolescents aged 12 to 18 years was 2.98% (191/6408), with prevalence rates of 4.67%, 4.09%, 3.67%, 2.97%, 2.27%, 1.65%, and 1.37% for each age. The prevalence gradually decreased with age. The prevalence was 3.70% in males and 2.26% in females, with a significant difference (P<0.05). The prevalence of BMI ≥ 25kg/m2 was 5.43%, and the prevalence of BMI<25kg/m2 was 2.72%, with a significant difference (P<0.001). The patients with frequent urination accounted for 9.13%, while those without frequent urination accounted for 2.72%, with a significant difference (P<0.001). There was a significant difference between 5.20% with urgency and 2.51% without urgency (P<0.001). There was a significant difference between 14.47% with urinary incontinence and 2.70% without urinary incontinence (P<0.001). The patients with RUTI accounted for 8.59%, while those without RUTI accounted for 2.75%, with a significant difference (P<0.001). There was a significant difference between 9.46% with a family history of enuresis and 2.52% without a family history of enuresis (P<0.001). The prevalence rate was 2.96% in urban areas and 2.99% in rural areas, with no significant difference (P=0.948). (Table1)Multivariate logistic regression analysis of statistically significant factors in Chi-square analysis showed that male, overweight, urgency to urinate, frequency of urination, urinary incontinence, RUTI, and family history of enuresis (OR=1.677, 1.842, 1.676, 1.919, 3.493, 2.535, 3.005, P<0.05). The scores of the self-esteem scale in PNE patients were lower than those in non PNE groups [28(25,32) vs 29(27,33),z=-3.097, P<0.05]; Compared with the non PNE group, the Pittsburgh sleep index in the PNE group was higher than that in the non PNE group [5(3,7) vs 4(2,6), z=-5.456, P<0.05]. (Table 2)

The prevalence of PNE among adolescents aged 12 to 18 gradually decreases with age. In this survey, there is no statistically significant difference in the prevalence of PNE between urban and rural areas, indicating that with the development of China's economy, the gap between urban and rural awareness of PNE and health awareness is gradually narrowing, and the difference in their place of residence does not affect the prevalence of PNE among adolescents. In this survey, chi-square analysis and multivariate logistic regression analysis of risk factors related to juvenile PNE showed that any one of male, overweight, frequent urination, urgency, urinary incontinence, and RUTI could increase the risk of adolescents PNE, indicating that the decline in urination control ability increased the chance of PNE. In this survey, the prevalence of PNE in adolescents with a positive family history of enuresis is significantly higher than that in adolescents with a negative family history of enuresis, with statistical differences, indicating that PNE has a genetic predisposition and the genetic mechanism needs further research. The scores of the self-esteem scale and the Pittsburgh Sleep Index of PNE patients were lower than those of the non PNE group, with a statistically significant difference, indicating that PNE has a negative impact on the psychological well-being of adolescents and threatens their physical and mental health.

The prevalence of PNE among adolescents is high, and gradually decreases with age. Male, overweight, frequent urination, urgency, urinary incontinence, RUTI, and family history of enuresis are risk factors for PNE. PNE has adverse effects on self-esteem and sleep quality in adolescents.

Alhifthy EH, Habib L, Abu Al-Makarem A, et al. Prevalence of Nocturnal Enuresis among Saudi Children Population. Cureus. 2020;12(1):e6662.
Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020;16(1):10-19.