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Desmopressin improves sleep and psychological functioning in patients with monosymptomatic nocturnal enuresis

By C. Van Herzeele, K. Dhondt, A. Raes, A. Groen, S. Roels, P. Hoebeke and J. Vande Walle

Neurourology and Urodynamics, Volume 33, Issue 6, August 2014, Pages 849-850

Editor’s comments

This study adds value to the fact that the sleep quality is impaired in children who sleep in a wet bed. Kushnir et al have already shown in their study that bedwetting children who are sleeping in a wet bed have impaired sleep quality and children who are wearing a diaper have a normal quality sleep compared to non-bedwetting children [1]. This study confirms the fact that children who sleep “dry” do sleep better.

Reference:

[1]  Kushnir J, Cohen-Zrubavel V, Kushnir B. Night diapers use and sleep in children with enuresis. Sleep Med 2013;14:1013–6. doi:10.1016/j.sleep.2013.02.018.

Abstract

Hypothesis/aims of study
A comorbidity and a possible causality between nocturnal enuresis, sleep disorders and attention deficit-hyperactivity disorder (ADHD) has been suggested (Yeung, Baeyens, Dhondt). This prospective study in children with monosymptomatic nocturnal enuresis (MNE) aims to evaluate the influence of desmopressin melt on sleep and psychological functioning of the child.

Study design, materials and methods
Thirty patients (23 boys) aged 6-16 years (mean 10.43y, SD (+/-3.08)) with MNE based on nocturnal polyuria (NP), in this study defined as nocturnal diuresis (greater-than or equal to)100% bladder volume for age, are included. Patients are tested before the start of desmopressin melt and 6 months later. It is a multi-informant multi-method study, using overnight standardized video-polysomnographic study (PSG), questionnaires, clinical interviews and neuropsychological testing.

Results
According to the ICCS definition, 10 patients were full responders, 2 patients were responders, 11 patients were partial responders and 6 patients were non-responders to desmopressin melt. The esponsestatus was unknown in 2 patients due to missing values. 87% (26 of 30) patients have a disrupted sleep at the first PSG. They experienced greater than 5 periodic limb movements per sleep hour (PLMS-index). 60% (18 of 30) patients have a disrupted sleep at the second PSG. All except 3 patients had a decrease in PLMS-index. The amelioration of the nocturnal enuresis coincides with a significant reduction of the PLMSindex (p < 0.0001) and cortical arousals (p = .0071) 6 months later. Moreover, psychological functioning was improved. After 6 months of desmopressin, children experienced significant less attention problems, less internalizing and externalizing problems, a higher quality of life, higher executive functioning and a higher auditive memory.

Interpretation of results
Children experienced less PLMS, less cortical arousals and an improved psychological functioning after 6 months of desmopressin therapy in children with MNE based on NP.

Concluding message
Desmopressin melt not only improves enuresis but also sleep and psychological functioning in children with MNE based on NP.

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