Primary mono-symptom nocturnal enuresis (PMNE) is a common clinical disease. Desmopressin (DDAVP) and enuresis alarm (EA) are first-line treatments suggested by ICCS.  This study aimed to evaluate the role of desmopressin and enuresis alarm in improving the symptoms and sleep quality in children with PMNE through a multicenter prospective, randomized study in mainland China.

A total of 208 children with PMNE were randomly divided into two treatment groups, DDAVP or EA. After 12 weeks, they were divided into treatment improved group and non-improved group. The inclusion criteria for the children were 6-14 years old, and had more than 2 nights of bedwetting per week. The enuresis form and CSHQ questionnaire [1] were used to record enuresis and sleep status of the children at baseline, 4, 8 and 12 weeks of treatment. The higher CSHQ score, the worse sleep quality.

A total of 179 children were finally analyzed (97 boys and 82 girls) with an average age of 8.97 (1.94) years, 119 (66.5%) children had significantly improved enuresis symptoms. Enuresis symptoms improved in 77/118 children in DDAVP group and 42/61 children in EA group(X2=0.2336, P=0.6288). The number of enuresis nights/week in DDAVP group decreased from a median of 4 (3, 4) to 1.5 (1, 3) (P<0.001), and in EA group from 4 (3, 4) to 1 (1, 2) (P<0.001). The total CSHQ score in DDAVP treatment group decreased from 61.21 (3.87) to 53.19 (4.94) (P<0.001), and in the EA treatment group decreased from 61.28 (2.73) to 52.89 (5.31) (P<0.001). There was no significant difference in the improvement of CSHQ total score between the two groups [8.5 (3.75,13) and 10 (4,13), Z=0.982, P=0326]. A statistically significant correlation was observed between CSHQ scores and the reduction in the number of enuresis nights/week in DDAVP group (ρ=0.662, P<0.001). Similarly, the EA group demonstrated a comparable positive association (ρ=0.583, P<0.001). The first uninterrupted sleep time in DDAVP group increased from 111.26 (21.38) to 168.63 (25.29) minutes (P<0.001), and in EA treatment group increased from 120.51 (19.66) to 151.57 (36.71) minutes (P<0.001). The sleep time of children in both groups was prolonged on weekdays and weekends. The total CSHQ scores of the improved group in DDAVP and EA groups at week 12 were significantly lower than those in the non-improved group [DDAVP: 50.84 (4.05) vs 57.59 (3.15), P < 0.001; EA: 49.29 (2.33) vs 59.16 (2.41), P < 0.001], and the first uninterrupted sleep time and sleep time on weekdays and weekends were significantly prolonged.

Both DDAVP and EA treatments significantly reduced enuresis nights/week and improved sleep quality demonstrated that both DDAVP and EA can improve enuresis symptoms and sleep quality in children with PMNE. The mechanism involved in it need to be further investigated.

In addition to significantly improving enuresis symptoms, DDAVP and EA can also improve the sleep quality of children with PMNE, and the improvement of sleep quality is significantly correlated with the improvement of symptoms. This indicated that the quality of sleep might play an important role in the pathology of enuresis.

Tan T X, Wang Y, Cheah C S L, Wang G H. Reliability and construct validity of the Children's Sleep Habits Questionnaire in Chinese kindergartners [J]. Sleep Health, 2018, 4(1): 104-109.