MELATONIN PRODUCTION IS SIMILAR IN CHILDREN WITH MONOSYMPTOMATIC NOCTURNAL ENURESIS OR OTHER FORMS OF ENURESIS/INCONTINENCE AND IN CONTROLS

Melatonin treatment in children with therapy-resistant monosymptomatic nocturnal enuresis

OBJECTIVE

To evaluate the effects of exogenous melatonin on the frequency of wet nights, on the sleep-wake cycle, and on the melatonin profile in children with therapy-resistant MNE.

PATIENTS AND METHODS

24 patients were included. Patients had to maintain a diary including time of sleep and arousal, and whether they had a dry or a wet bed in the morning. We measured baseline melatonin profiles in saliva. Hereafter, patients were randomized to synthetic melatonin or placebo. After 3 and 6 months we evaluated the frequency of enuresis and the melatonin profiles.

RESULTS

11 patients were randomized to melatonin, 13 to placebo. We evaluated melatonin profiles of 7 patients in the melatonin group and of 8 in the placebo group. We observed a change in profile in the melatonin group, but we did not observe a difference in the sleep-wake cycle or the frequency of wet nights in either group.

CONCLUSION

This is the first time exogenous melatonin has been evaluated in the treatment of MNE. Although we observed a change in melatonin profile after the use of exogenous melatonin, we did not observe a change in enuresis frequency or in the sleep-wake cycle of this select group of patients.

Melatonin rhythm in children with enuresis

OBJECTIVE

To study the circadian rhythm of melatonin in children with enuresis.

PATIENTS AND METHODS

Twenty-five children, divided into two groups (enuretic patients and controls) were assessed; salivary samples were collected to measure melatonin by radioimmunoassay using commercial kits. Friedman two-way anova and Wilcoxon tests were used to assess the circadian rhythm of melatonin, and anova with between-patient factors and Mann-Whitney tests to compare melatonin values and groups.

RESULTS

Both groups had statistically significant differences in melatonin concentration during the 24-h period (both P < 0.001), with a circadian rhythm; the highest values were always at approximately 04.00 hours. There were no significant differences overall in melatonin values between cases and controls, but patients had lower peak values than controls at 04.00 hours, and higher melatonin levels at 24.00 hours, but with no significant differences.

CONCLUSION

There was some evidence for minor disturbances in the circadian rhythm of melatonin as a cause of enuresis, but the rhythm was not grossly disrupted.

Sleep problems in children with common medical disorders

Sleep problems are common in many pediatric medical disorders and complicate management and patient outcomes. A wide range of conditions, including asthma, cystic fibrosis, sickle cell disease, gastroesophageal reflux, neuromuscular diseases, scoliosis, craniofacial abnormalities, obesity, and chromosomal disorders, have various sleep disturbances, including sleep-disordered breathing, ventilatory dysfunction, sleep-onset and sleep maintenance problems, and circadian rhythm disturbances. Given the adverse neurocognitive and physiologic outcomes associated with a deranged night's sleep, it is important for pediatricians to be able to anticipate, recognize, and appropriately manage these problems. This article reviews the known sleep-related problems of a few relatively common pediatric disorders.

Nocturnal enuresis

PURPOSE OF REVIEW

The purpose of this review is to highlight and comment upon important areas of enuresis research.

RECENT FINDINGS

Current areas of pathophysiological focus are nocturnal urine production, in which alternative mechanisms other than deficient vasopressin secretion has been implicated in some patients. Bladder reservoir function has gained renewed interest, and has proved to be one of the best predictors of treatment response to desmopressin. Various aspects of central nervous system function, including arousability and pontine reflexes, are in focus, and molecular genetics has provided firm evidence of a link between enuresis and different chromosomal markers. The therapeutic focus is directed towards a differential approach based upon the underlying mechanism and towards combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Furthermore, new exciting treatment concepts such as laser acupuncture have shown promising results in initial studies.

SUMMARY

Despite recent advances in our understanding of nocturnal enuresis, we are still far from understanding in detail this socially discomfiting and scientifically intriguing condition, and many controversies remain. However, the substantiation that enuresis is a heterogeneous condition that requires a differential approach has provided the basis for further progress.