New study suggests desmopressin melt improves sleep patterns and psychological functioning of bedwetting children
New data has shown that treatment with melt-in-the-mouth desmopressin (MINIRIN® Melt)* improved sleep patterns and psychological functioning (including attention problems and memory) in children with nocturnal enuresis (bedwetting). The negative impact of bedwetting on children’s neuropsychological functioning (e.g. anxiety and social self-esteem problems) was also shown.1,2 The data from a study by researchers at the University Hospital Ghent, Belgium was presented at the 25th annual congress of the European Society for Paediatric Urology (ESPU) in Innsbruck, Austria.
Results were based on a study of 30 bedwetting children aged 6-16 years old who were tested before and after six months of desmopressin treatment. Data showed that an improvement in bedwetting following six months of desmopressin treatment corresponded with a significant reduction in sleep disruption, as demonstrated by fewer periodic limbic movements per sleep hour (PLMS index) (p<0.001) and reduced cortical arousals (p<0.01).1
In addition, bedwetting children showed significant improvements in their psychological functioning after six months of desmopressin treatment. There were significant reductions in parent-reported attention problems (p<0.01), and both internalising (p<0.05) and externalizing (p<0.01) problems. Furthermore, there were significant improvements in quality of life (p<0.01), executive functioning (p<0.01) and auditive memory (p<0.01).1
Further data from the study presented at ESPU identified which psychological problems were present in bedwetting children as well as which of these problems were related to which specific clinical symptoms. In fact, 80% of bedwetting children in the study had at least one psychological, motor or neurological difficulty.2 A positive correlational relationship was shown between the number of wet nights a child experienced and the presence of social problems, and anxiety/depression problems. Conversely, a negative correlational relationship was shown between number of wet nights and social self-esteem.2
Commenting on these findings, Charlotte Van Herzeele, clinical psychologist, Department of Pediatric Nephrology/Urology, University Hospital Ghent, Belgium, said, “We know that bedwetting has a negative impact on the lives of both children and their families. However, these new data suggest that the impact is more profound than previously thought, highlighting the need for parents to seek medical help for their children and explore available treatment options.”Dr Karlien Dhondt, child psychiatrist, Pediatric sleep centre, University Hospital Ghent, Belgium, said, “The age at which children are most likely to suffer from bedwetting is a crucial time in their psychological and neurocognitive development. This study has shown that treating bedwetting can improve a child’s sleep quality and psychological functioning on a number of parameters.”
Up to 16% of children aged 5 years frequently wet the bed.3,4 After allergic disorders, bedwetting is the most common chronic childhood condition.5 Whilst an extremely common disorder, bedwetting can have a significant psychological impact on those affected and an economic burden on their families.6
About the study
These data are based on a multi-method (polysomnography (monitoring of sleep), questionnaires, clinical interviews, neuropsychological testing), multi informant (children, parents and teachers were questioned) study of children aged 6 – 16 years, referred to tertiary care and diagnosed with Monosymptomatic Nocturnal Enuresis (MNE, or, simply bedwetting) associated with nocturnal polyuria (NP). NP was defined as nocturnal diuresis >100% bladder volume for age. Patients were tested using various different measures before the start of treatment with desmopressin melt and then six months later.1,2
MINIRIN® (desmopressin) is a man-made (synthetic) form of vasopressin, a naturally-occurring antidiuretic hormone which controls the balance of water levels in the body.7 Desmopressin works by binding to the antidiuretic (V2) receptors in the kidneys, mimicking the effect of the naturally-occurring antidiuretic hormone. This can prevent excessive amounts of water being filtered out of the blood, reducing the volume of urine produced.8 Studies on bedwetting have shown that long-term treatment with desmopressin is effective, well-tolerated and can aid long-term improvements in nocturnal dryness.9,10
*Desmopressin melt is indicated for the treatment of bedwetting in 82 countries across the world and it is marketed under several names, including MINIRIN® Melt, Desmomelt® and DDAVP® Melt.
1. Van Herzeele, C. 2014. Desmopressin improves sleep pattern and psychological functioning in patients with monosymptomatic nocturnal enuresis. Poster # S13-3. European Society for Paediatric Urology Congress, 7-10 May 2014, Innsbruck, Austria.
2. Van Herzeele, C. 2014. Correlation between clinical symptoms of nocturnal enuresis and neuropsychological functioning. Poster #S13-5. European Society for Paediatric Urology Congress, 7-10 May 2014, Innsbruck, Austria.
3. Fergusson et al. Behav Psychother 1986;78:884-90
4. Yeung CK et al. BJU Int 2006;97:1069-1073
5. Hjälmås K, Nocturnal Enuresis in children, Barnklinikerna, Ostra sjukhuset, Göteborg. Nordisk Medicin [1998, 113(1):13-5, 15]
6. Tryggve Nevéus et al, Enuresis – Background and Treatment Scand J Urol Nephrol Suppl 206: 1-44, 2000
7. Cornu J et al. A Contemporary Assessment of Nocturia: Definition, Epidemiology, Pathophysiology, and Management – a Systematic Review and Meta-analysis. European Urology 2012.
8. Nørgaard JP, Harris AS. A passion for Peptides. Published in 2011 by Ferring Pharmaceuticals. ISBN 978-87-994103-0-9 http://biomed.papers.upol.cz/pdfs/bio/2013/01/15.pdf
9. Lottmann H, Baydala L, Eggert P, Klein BM, Evans J, Norgaard JP. Long-term desmopressin response in primary nocturnal enuresis: open-label, multinational study. Int J Clin Pract 2009;63(1):35-45.
10. Evans J, Malmsten B, Maddocks A, Popli HS, Lottmann H; on behalf of the UK study group. Randomized comparison of long-term desmopressin and alarm treatment for bedwetting. J Pediatr Urol 2011 Feb;7(1):21-9. Epub 2010 Jun 25.