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Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep

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Abstract

Background

There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder.

Methods

In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void.

Results

Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains.

Conclusions

The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.

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Abbreviations

ADHD:

Attention deficit hyperactivity disorder

BRIEF:

Behavior Rating Inventory of Executive Function

CANTAB:

Cambridge Neuropsychological Test Automated Battery

DBDRS:

Disruptive Behavior Disorder Rating Scale

ICCS:

International Children’s Continence Society

MNE:

Monosymptomatic nocturnal enuresis

NMNE:

Non-monosymptomatic nocturnal enuresis

PedsQL:

Pediatric Quality of Life Inventory

PinQ:

Pediatric Incontinence Questionnaire

PLMS:

Periodic limb movements during sleep

QoL:

Quality of life

TEA-Ch:

Test of Everyday Attention for Children

WISC-III-NL:

Flemish version of the Wechsler Intelligence Scale for children, 3rd edn

References

  1. Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S (2012) Practical consensus guidelines for the management of enuresis. Eur J Pediatr 171:971–983

    Article  PubMed  PubMed Central  Google Scholar 

  2. von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185:1432–1436

    Article  Google Scholar 

  3. Dhondt K, Baert E, Van Herzeele C, Raes A, Groen LA, Hoebeke P, Vande Walle J (2014) Sleep fragmentation and increased periodic limb movements are more common in children with nocturnal enuresis. Acta Paediatr 103:e268–e272

    Article  CAS  PubMed  Google Scholar 

  4. Kovacevic L, Jurewicz M, Dabaja A, Thomas R, Diaz M, Madgy DN, Lakshmanan Y (2013) Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first? J Pediatr Urol 9:145–150

    Article  PubMed  Google Scholar 

  5. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, von Gontard A, Wright A, Yang SS, Neveus T (2014) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol 191:1863–1865, e1813

    Article  PubMed  Google Scholar 

  6. Wolfish NM, Pivik RT, Busby KA (1997) Elevated sleep arousal thresholds in enuretic boys: clinical implications. Acta Paediatr 86:381–384

    Article  CAS  PubMed  Google Scholar 

  7. Yeung CK, Diao M, Sreedhar B (2008) Cortical arousal in children with severe enuresis. N Engl J Med 358:2414–2415

    Article  CAS  PubMed  Google Scholar 

  8. Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A (2011) Sleep and sleepiness in children with nocturnal enuresis. Sleep 34:191–194

    PubMed  PubMed Central  Google Scholar 

  9. Imeraj L, Sonuga-Barke E, Antrop I, Roeyers H, Wiersema R, Bal S, Deboutte D (2012) Altered circadian profiles in attention-deficit/hyperactivity disorder: an integrative review and theoretical framework for future studies. Neurosci Biobehav Rev 36:1897–1919

    Article  PubMed  Google Scholar 

  10. Mahler B, Kamperis K, Schroeder M, Frokiaer J, Djurhuus JC, Rittig S (2012) Sleep deprivation induces excess diuresis and natriuresis in healthy children. Am J Physiol Ren Physiol 302:F236–F243

    Article  CAS  Google Scholar 

  11. Glazener CM, Evans JH (2002) Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 3:CD002112

    PubMed  Google Scholar 

  12. Hjalmas K, Hanson E, Hellstrom AL, Kruse S, Sillen U (1998) Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre study. Swedish Enuresis Trial (SWEET) Group. Br J Urol 82:704–709

    Article  CAS  PubMed  Google Scholar 

  13. Bliwise DL, Holm-Larsen T, Goble S, Norgaard JP (2015) Short time to first void is associated with lower whole-night sleep quality in nocturia patients. J Clin Sleep Med 11:53–55

    PubMed  PubMed Central  Google Scholar 

  14. Hjalmas K (1988) Urodynamics in normal infants and children. Scand J Urol Nephrol Suppl 114:20–27

    CAS  PubMed  Google Scholar 

  15. Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, Katz L, Mason TB, Tapia IE (2014) Prevalence of periodic limb movements during sleep in normal children. Sleep 37:1349–1352

    PubMed  PubMed Central  Google Scholar 

  16. Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812

    Article  CAS  PubMed  Google Scholar 

  17. Bower WF, Sit FK, Bluyssen N, Wong EM, Yeung CK (2006) PinQ: a valid, reliable and reproducible quality-of-life measure in children with bladder dysfunction. J Pediatr Urol 2:185–189

    Article  CAS  PubMed  Google Scholar 

  18. Pelham WE Jr, Gnagy EM, Greenslade KE, Milich R (1992) Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 31:210–218

    Article  PubMed  Google Scholar 

  19. Cambridge Cognition Ltd (2006) CANTAB eclipse test administration guide. Manual version 3.0.0. Cambridge Cognition Ltd, Cambridge

  20. Manly T, Roberston IH, Anderson V, Nimmo-Smith I (1999) Manual of the Test of Everyday Attention for Children. Thames Valley Test Company, Bury St Edmunds

    Google Scholar 

  21. Miyake A, Friedman NP (2012) The nature and organization of individual differences in executive functions: four general conclusions. Curr Dir Psychol Sci 21:8–14

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gioia GAI PK, Guy SC, Kenworthy L (2000) Behavior rating inventory of executive function BRIEF. Professional manual. Psychological Assessment Resources, Lutz

  23. Wechsler D (1991) The Wechsler intelligence scale for children—third edition. The Psychological Corporation, San Antonio

    Google Scholar 

  24. Achenbach TM, Rescorla LA (2001) Manual for the ASEBA School-Age Forms & Profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington

    Google Scholar 

  25. Franco I (2007) Overactive bladder in children. Part 1: pathophysiology. J Urol 178:761–768, discussion 768

    Article  PubMed  Google Scholar 

  26. Scholz H, Trenkwalder C, Kohnen R, Riemann D, Kriston L, Hornyak M (2011) Dopamine agonists for restless legs syndrome. Cochrane Database Syst Rev 3:CD006009

    PubMed  Google Scholar 

  27. Faraone SV, Doyle AE, Mick E, Biederman J (2001) Meta-analysis of the association between the 7-repeat allele of the dopamine D(4) receptor gene and attention deficit hyperactivity disorder. Am J Psychiatry 158:1052–1057

    Article  CAS  PubMed  Google Scholar 

  28. Monti JM, Monti D (2007) The involvement of dopamine in the modulation of sleep and waking. Sleep Med Rev 11:113–133

    Article  PubMed  Google Scholar 

  29. Sadeh A, Pergamin L, Bar-Haim Y (2006) Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies. Sleep Med Rev 10:381–398

    Article  PubMed  Google Scholar 

  30. Owens J, Sangal RB, Sutton VK, Bakken R, Allen AJ, Kelsey D (2009) Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder. Sleep Med 10:446–456

    Article  PubMed  Google Scholar 

  31. Stegner H, Artman HG, Leake RD, Fisher DA (1983) Does DDAVP (1-desamino-8-D-arginine-vasopressin) cross the blood-CSF barrier? Neuroendocrinology 37:262–265

    Article  CAS  PubMed  Google Scholar 

  32. Baeyens D, Roeyers H, Naert S, Hoebeke P, Vande Walle J (2007) The impact of maturation of brainstem inhibition on enuresis: a startle eye blink modification study with 2-year followup. J Urol 178:2621–2625

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Charlotte Van Herzeele, Ann Raes, Piet Hoebeke, Luitzen-Albert Groen & Johan Vande Walle

  2. Child Neurology & Metabolism, Pediatric Sleep Center, University Hospital Ghent, Ghent, Belgium

    Karlien Dhondt

  3. Department of Data Analysis, University Ghent, Ghent, Belgium

    Sanne P. Roels

Authors
  1. Charlotte Van Herzeele
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  2. Karlien Dhondt
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  3. Sanne P. Roels
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  4. Ann Raes
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  5. Piet Hoebeke
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  6. Luitzen-Albert Groen
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  7. Johan Vande Walle
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Corresponding author

Correspondence to Charlotte Van Herzeele.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Ethics Board of the Ghent University Hospital (B670201212; Clinical Trials.gov NCT01645475).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial disclosures

The authors have no financial relationships relevant to this article to disclose. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript, except for a linguistic edit of the manuscript which was performed by Caroline Loat, Articuloat.

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

The study was supported by the “Agency for Innovation by Science and Technology in Flanders (IWT)” through the ‘SAFEPEDRUG’ project (IWT/SBO 130033). Desmopressin medication was provided and funded by Ferring N.V., Aalst, Belgium. Ferring N.V. and IWT had no involvement in the design and conduct of the study, in the collection, management, analysis and interpretation of data and in the preparation, review or approval of the manuscript.

Additional information

Trial registration: Clinical Trials.gov NCT01645475

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Van Herzeele, C., Dhondt, K., Roels, S.P. et al. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol 31, 1477–1484 (2016). https://doi.org/10.1007/s00467-016-3351-3

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  • DOI: https://doi.org/10.1007/s00467-016-3351-3

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