Intervention Review

Alarm interventions for nocturnal enuresis in children

  1. Cathryn MA Glazener1,*,
  2. Jonathan HC Evans2,
  3. Rachel E Peto3

Editorial Group: Cochrane Incontinence Group

Published Online: 20 APR 2005

Assessed as up-to-date: 27 FEB 2007

DOI: 10.1002/14651858.CD002911.pub2


How to Cite

Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002911. DOI: 10.1002/14651858.CD002911.pub2.

Author Information

  1. 1

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  2. 2

    Nottingham University Hospitals NHS Trust, Department of Paediatric Nephrology, Nottingham, UK

  3. 3

    University of York, NHS Centre for Reviews & Dissemination, York, UK

*Cathryn MA Glazener, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. c.glazener@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15 to 20% of five year olds, and up to 2% of young adults.

Objectives

To assess the effects of alarm interventions on nocturnal enuresis in children, and to compare alarms with other interventions.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 February 2007) and the reference lists of relevant articles.

Selection criteria

All randomised or quasi-randomised trials of alarm interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and complex behavioural methods, desmopressin, tricyclics, and miscellaneous other methods.

Data collection and analysis

Two reviewers independently assessed the quality of the eligible trials, and extracted data.

Main results

Fifty six trials met the inclusion criteria, involving 3257 children of whom 2412 used an alarm. The quality of many trials was poor, and evidence for many comparisons was inadequate. Most alarms used audio methods.

Compared to no treatment, about two thirds of children became dry during alarm use (RR for failure 0.38, 95% CI 0.33 to 0.45). Nearly half who persisted with alarm use remained dry after treatment finished, compared to almost none after no treatment (RR of failure or relapse 45 of 81 (55%) versus 80 of 81 (99%), RR 0.56, 95% CI 0.46 to 0.68). There was insufficient evidence to draw conclusions about different types of alarm, or about how alarms compare to other behavioural interventions. Relapse rates were lower when overlearning was added to alarm treatment (RR 1.92, 95% CI 1.27 to 2.92) or if dry bed training was used as well (RR 2.0, 95% CI 1.25 to 3.20). Penalties for wet beds appeared to be counter-productive. Alarms using electric shocks were unacceptable to children or their parents.

Although desmopressin may have a more immediate effect, alarms appeared to be as effective by the end of a course of treatment (RR 0.85, 95% CI 0.53 to 1.37) but their relative effectiveness after stopping treatment was unclear from two small trials which compared them directly. Evidence about the benefit of supplementing alarm treatment with desmopressin was conflicting. Alarms were not significantly better than tricyclics during treatment (RR 0.59, 95% CI 0.32 to 1.09) but the relapse rate was less afterwards (7 of 12 (58%) versus 12 of 12 (100%), RR 0.58, 95% CI 0.36 to 0.94). However, other Cochrane reviews of desmopressin and tricyclics suggest that drug treatment alone, while effective for some children during treatment, is unlikely to be followed by sustained cure as almost all the children relapse.

Authors' conclusions

Alarm interventions are an effective treatment for nocturnal bedwetting in children. Alarms appear more effective than desmopressin or tricyclics because around half the children remain dry after alarm treatment stops. Overlearning (giving extra fluids at bedtime after successfully becoming dry using an alarm), dry bed training and avoiding penalties may further reduce the relapse rate. Better quality research comparing alarms with other treatments is needed, including follow-up to determine relapse rates.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Alarm interventions for nocturnal enuresis (bedwetting) in children

Night-time bedwetting is common in childhood, and can cause stigma, stress and inconvenience. The review of trials found 56 studies involving 3257 children. Alarm interventions reduce night-time bed wetting in about two thirds of children during treatment, and about half the children remained dry after stopping using the alarm. Alarms take longer to reduce bedwetting than desmopressin, but their effects continue after treatment in half the children who use alarms. So alarms are better in the long term than treatment with desmopressin or tricyclic drugs. Overlearning (giving children extra fluids at bedtime after successfully becoming dry using an alarm) and dry bed training (getting children to go to the toilet repeatedly and changing their own sheets when they wet) may reduce the relapse rate. There are no serious side-effects, which can occur with drug treatment. However, children need more supervision and time from other family members at first. There was not enough evidence with which to compare alarms with other non-drug treatments. Because some of the studies were of poor quality, better research comparing alarms with other treatments is needed, including follow-up to measure relapse rates.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

探討使用警報器在改善小兒夜間尿床上扮演的角色

遺尿(尿床),這個社會上擾人且令人緊張的狀況,影響著大約百分之十五到二十的五歲兒童,以及多達百分之二的年輕成人。

目標

評估使用鬧鈴對孩子尿床的改善效果,以及比較使用警報器與其他治療方式的差異

搜尋策略

我們搜尋考科藍實證醫學資料庫失禁評論小組的專門試驗名單(2008年2月28日)以及相關的參考文獻。

選擇標準

搜尋以隨機或半隨機對照試驗評估鬧鈴改善小兒夜間尿床狀況的文章,並排除那些只針對白天尿床的研究。比較使用警報器與不治療,或簡單與複雜性的行為治療,或使用desmopressin(抗利尿激素),tricyclics,及其他五花八門治療方法的差異。

資料收集與分析

兩位評論者各自評估符合搜尋條件的試驗文章,並摘錄研究數據。

主要結論

共有五十六篇試驗文章研究符合搜尋的條件,包含了3257個小孩,其中有2412個使用鬧鈴治療。許多試驗的品質很差,且有很多比較的證據並不適當。大部分警報器的方式是聲音。若與沒有治療時的情形做比較,大約有三分之二的兒童使用警報器後不再尿床(失敗的RR:0.38, 95% 信賴區間:0.33 to 0.45)。有將近一半持續使用警報器的兒童在治療結束後也能保持不再尿床,而沒有接受治療的兒童則幾乎沒有人有改善(失敗或復發的RR:45 of 81 (55%) versus 80 of 81 (99%), RR:0.56, 95%信賴區間 0.46 to 0.68)。對於各種類型警報器之間的差異,或警報器與其他行為療法的差異,目前並沒有足夠的證據可以做出推論。使用警報器再加上反覆的學習(RR:1.92, 95%信賴區間:1.27 to 2.92)或是乾床訓練(dry bed training)(RR:2.0, 95%信賴區間:1.25 to 3.20)都可以使尿床的復發率更低。但懲罰尿床的兒童卻達到反效果。使用電刺激的警報器並不被小孩或他們的父母所接受。雖然使用desmopressin(抗利尿激素)可以達到立即的效果,但使用警報器在一個療程過後也能達到一樣的效果(RR:0.85, 95%信賴區間:0.53 to 1.37),但是從兩篇直接比較這兩個方法的小試驗來看,在結束療程後的相對效果尚未清楚。關於使用警報器同時合併desmopressin療法的益處,目前的證據仍兩極化。警報器與tricyclics的比較上,在療程中警報器並沒有比起使用tricyclics有顯著的效果(RR:0.59, 95%信賴區間:0.32 to 1.09),但往後其復發率較低(7 of 12 (58%) versus 12 of 12 (100%), RR:0.58, 95%信賴區間:0.36 to 0.94)。然而,其他考科藍實證醫學資料庫針對desmopressin及tricyclics的評論文章提出,單獨使用藥物即使對一些治療中的兒童有效果,但因為幾乎所有的兒童都會復發,並不被用來作為持續治療的方法。

作者結論

使用警報器對於兒童夜間尿床是個有效的治療方法。因為大約一半使用警報器的兒童在停止治療後不會再復發,警報器便顯得比desmopressin或tricyclics來得更有效。過度學習(在使用警報器成功克服尿床後,在睡前喝下更多的飲料),乾床訓練以及避免懲罰,都可以進一步降低尿床的復發率。目前我們需要的是較佳品質的研究去比較警報器與其他療法的差異,包括針對復發率的長期追蹤。

翻譯人

本摘要由中國醫藥大學附設醫院江語蓁翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

夜間尿床在兒童是相當常見的情形,帶來了羞愧,壓力與不便。這篇評論蒐集了五十六篇臨床試驗,包含3257個兒童,有三分之二的受試者在使用警報器治療時減少了尿床的情形,其中又有大約一半的兒童在停止警報器治療後沒有復發。雖然警報器比起使用desmopressin,需要更長的時間才能見效,但有一半使用警報器療法的兒童在停止治療後不再復發。因此長期來看,使用警報器比用desmopressin或tricyclic等藥物治療都還好。過度學習(在使用警報器成功克服尿床後,在睡前喝下更多的飲料),乾床訓練(每隔一段時間就叫孩子去上廁所,讓孩子自己更換尿濕的被單)都可以降低復發率。使用藥物會有嚴重的副作用,但警報器療法不會。然而,使用警報器首先需要家人更多的監督以及花更多的時間。在比較使用警報器及其他非藥物治療上,並沒有足夠的證據。因為目前許多研究的品質都很差,我們需要更好的研究去比較警報器與其他療法的差異,包括針對復發率的評估。