Nocturnal enuresis and rapid maxillary expansion: – long-term effect, prognostic variables, respiration during sleep and quality of life

  • Date:
  • Location: sal IV, Universitetshuset, Biskopsgatan 3, Uppsala
  • Doctoral student: Jönson Ring, Ingrid
  • About the dissertation
  • Organiser: Institutionen för kvinnors och barns hälsa
  • Contact person: Jönson Ring, Ingrid
  • Disputation

This thesis aims to approach an answer to the following questions, with a randomized, placebo-controlled method: 1) Does rapid maxillary expansion have a curative effect on therapy-resistant NE? 2) Is the potential curative effect due to respiratory events that can be measured during sleep? 3) Do enuretic children have an impaired quality of life (QoL)?

Background:The orthodontic technique rapid maxillary expansion (RME) has been reported to have a potentially curative effect on nocturnal enuresis (NE). The mechanism behind this is unknown but could possibly be due to placebo and/or effects on respiration during sleep. 

Aim: This thesis aims to approach an answer to the following questions, with a randomized, placebo-controlled method: 1) Does rapid maxillary expansion have a curative effect on therapy-resistant NE? 2) Is the potential curative effect due to respiratory events that can be measured during sleep? 3) Do enuretic children have an impaired quality of life (QoL)?  

Subjects & Methods: In study I we evaluated the QoL in enuretic children while assessing the test re-test reliability of a Swedish version of an established QoL questionnaire. Study II and IV assess respiration during sleep in children with NE; in study II comparisons are made with healthy control children and in study IV we evaluate the respiratory effects of RME. Study III is a randomized placebo-controlled study investigating whether RME is a useful therapy for NE and if the treatment effect is due to placebo.

Results: Study I:The Swedish version of the questionnaire proved to be a reliable tool (Chronbach’s alpha 0.87) with excellent test-retest stability (ICC = 0.762). Enuresis affects the children’s QoL and interactions with peers.

Study II:The hypopnea index (HI) and the oxygen desaturation index were both significantly higher in the enuretic children compared to the healthy controls, (p=0.04 and p=0.05) but all values fell within the normal range.

Study III:RME resulted in a significant reduction in wet nights i.e. the mean number of wet nights out of 14 was 11.4 before and 9.2 after RME. (p=0.003) This was not observed in the placebo group (p=0.40).

Study IV:There was a significant reduction of sleep efficiency during RME. (p=0.001) The mean HI was also affected. (p=0.005)

Conclusions:

• Children with nocturnal enuresis have an impaired self-esteem and their quality of life is affected in their relationship with friends.

• There were no major differences in respiration during sleep between enuretic children and controls.

• Rapid maxillary expansion reduces the number of wet nights in children with enuresis, but the effect is of limited clinical value.

• The antienuretic effect does not seem to be due to a placebo effect of the appliance.

• The majority of the children in our study sample did not have sleep disordered breathing as a co-morbidity to their nocturnal enuresis.