Sleep Research and Bedwetting

I read with interest an article that was published on-line on 3/10/10 in Acta Pediatrica. "Effects of desmopressin on the sleep of children suffering from enuresis This article presented research on that done in Germany last year. The aim was to evaluate the effect of DDAVP (desmopressin) on the sleep architecture and arousal reactions in children with bedwetting.

The method of the study was a prospective, placebo-controlled, randomized, cross-over study that was performed over a 7-day period of time. Placebo and DDAVP were given for 7 days each after which an unattended home polysomnography was recorded. 20 bedwetting children, aged 6-15 years, were enrolled.

Results: The number of wet nights decreased with DDAVP treatment. Delta power, distribution of sleep stages, number of arousals, arousal index and the effect of arousals on sleep stages did not differ significantly between the two groups. Bed-wetting occurred within each sleep stage and did not follow any particular pattern. In most cases, it was preceded by an arousal reaction, but no awakening occurred.

Conclusion: DDAVP has no effect on the sleep architecture of children with bedwetting. This study concluded that DDAVP did not affect the sleep patterns of children who take it. Since its mechanism of action is to work locally on the kidneys to produce more concentrated urine, the results are exactly what I expected.

The reason that this study was so interesting to me; however, was that these sleep studies indicated that bedwetting occurs during every sleep stage and does not follow a particular pattern. This is exactly what I see clinically in the families that I work with each day.

There are some organizations that talk about bedwetting as a sleep disorder and how bedwetting children stay in the deep sleep phase longer and wet during this phase. This is based on research that was done in Canada in 1968. In the more recent research report that I just read, bedwetting did not occur only in the deep sleep stage but throughout the entire sleep cycle, with no pattern. Families report that the bedwetting alarm goes off at different times each night, anywhere from 30 minutes after bedtime to 30 minutes before wakening in the morning. The child cannot be in deep sleep all of these times. Anyway, it would have been nice to have a larger sample size but this is good information.