Nocturnal Enuresis and Rapid Maxillary Expansion

NCT ID: NCT02178826

Last Updated: 2020-03-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-31

Study Completion Date

2019-03-31

Brief Summary

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Nocturnal enuresis (NE) is the involuntary loss of urine that occurs only at night in children aged 5 years or more.

NE is a common problem, affecting about 10% of school children. The prevalence declines with each year of maturity but for some it persists in to adolescents and early adulthood. It can lead to bad self-confidence and low self-esteem, which can have psychosocial consequences.

NE is a multifactorial condition. Three central factors have been identified:

A) Many bedwetting children produce large amounts of urine at night due to a deficiency of the antidiuretic hormone vasopressin.

B) Other children have a lack of inhibition of bladder emptying during sleep. C) Almost all children are deep sleepers with high arousal thresholds. They simply don't wake up when the bladder is full or when it contracts.

There are two well established and evidence based treatments today: the bed-wetting alarm and the pharmacologic treatment desmopressin. The alarm emits a sound when the child wets the bed, which conditions the child to wake up or inhibit bladder emptying. This method is curative for about half of the patients who try this, but relapse occurs. Desmopressin is a synthetic analog of arginine vasopressin and works by decreasing the urine volume at night. About half of the patients become dry with this medication but only as long as they take the medicine. To day, at least 25% of all children with NE do not respond to any of the above treatment.

Rapid maxillary expansion (RME) is a common orthodontic technique to treat patients with a narrow upper jaw. The brace is fitted by an orthodontist, and has a jack-screw, which is activated twice every day for 10-14 days. The procedure is neither painful nor harmful and is not very visible at all.

There are a few reports about children who have become dry after RME treatment. None of them have been randomised or placebo controlled but indicates that quite a few children do become dry after this treatment. A recently carried out study in Sweden show that half of the children became dry after RME treatment. These children were all classed as therapy resistant and had already tried the alarm and medication without success.

The reports are intriguing, but invite the question why a brace would help cure NE? It is likely that sleep and respiration is involved. This study will investigate these children's sleep during the treatment. The trial is a randomised, placebo controlled trial.

Detailed Description

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Conditions

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Nocturnal Enuresis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Rapid Maxillary Expansion
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Rapid Maxillary Expansion

A Rapid Maxillary Expander will be fitted and the palate will be expanded approximately 5mm.

Group Type EXPERIMENTAL

Rapid Maxillary Expansion

Intervention Type DEVICE

The Rapid Maxillary Expander will over 10-14 days create a palatal expansion of about 5mm.

Placebo group

A Sham appliance is fitted and activated for 10-14 days. The patients in this group will after it has been revealed they were randomized into the placebo group have a true Rapid Maxillary Expander fitted and the palate will be expanded approximately 5 mm.

Group Type PLACEBO_COMPARATOR

Placebo Appliance

Intervention Type DEVICE

The Placebo Appliance looks exactly like the Rapid maxillary Expander but the expansion screw does not work. When the expansion screw is activated it does not create a palatal expansion.

Interventions

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Rapid Maxillary Expansion

The Rapid Maxillary Expander will over 10-14 days create a palatal expansion of about 5mm.

Intervention Type DEVICE

Placebo Appliance

The Placebo Appliance looks exactly like the Rapid maxillary Expander but the expansion screw does not work. When the expansion screw is activated it does not create a palatal expansion.

Intervention Type DEVICE

Other Intervention Names

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Hyrax screw Sham Device

Eligibility Criteria

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Inclusion Criteria

* Patients aged 7-14 years old
* At least 7 wet nights out of 14

Exclusion Criteria

* Daytime incontinence
* Constipation
* ADHD
Minimum Eligible Age

7 Years

Maximum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Örebro County Council

OTHER_GOV

Sponsor Role collaborator

Uppsala County Council, Sweden

OTHER_GOV

Sponsor Role collaborator

Uppsala University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ingrid Jönson Ring

Dr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ingrid M Jönson Ring, DDS, MSc

Role: PRINCIPAL_INVESTIGATOR

Uppsala University Hospital

Farhan Bazargani, DDS, PhD

Role: STUDY_DIRECTOR

Örebro County Council

Tryggve Nevéus, MD, PhD

Role: STUDY_CHAIR

Uppsala University Hospital

Locations

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Folktandvården Uppsala län

Uppsala, Uppland, Sweden

Site Status

Countries

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Sweden

References

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Bower WF, Moore KH, Shepherd RB, Adams RD. The epidemiology of childhood enuresis in Australia. Br J Urol. 1996 Oct;78(4):602-6. doi: 10.1046/j.1464-410x.1996.13618.x.

Reference Type BACKGROUND
PMID: 8944518 (View on PubMed)

Neveus T. Nocturnal enuresis-theoretic background and practical guidelines. Pediatr Nephrol. 2011 Aug;26(8):1207-14. doi: 10.1007/s00467-011-1762-8. Epub 2011 Jan 26.

Reference Type BACKGROUND
PMID: 21267599 (View on PubMed)

Timms DJ. Rapid maxillary expansion in the treatment of nocturnal enuresis. Angle Orthod. 1990 Fall;60(3):229-33; discussion 234. doi: 10.1043/0003-3219(1990)0602.0.CO;2.

Reference Type BACKGROUND
PMID: 2202238 (View on PubMed)

Kurol J, Modin H, Bjerkhoel A. Orthodontic maxillary expansion and its effect on nocturnal enuresis. Angle Orthod. 1998 Jun;68(3):225-32. doi: 10.1043/0003-3219(1998)0682.3.CO;2.

Reference Type BACKGROUND
PMID: 9622759 (View on PubMed)

Usumez S, Iseri H, Orhan M, Basciftci FA. Effect of rapid maxillary expansion on nocturnal enuresis. Angle Orthod. 2003 Oct;73(5):532-8. doi: 10.1043/0003-3219(2003)0732.0.CO;2.

Reference Type BACKGROUND
PMID: 14580020 (View on PubMed)

Schutz-Fransson U, Kurol J. Rapid maxillary expansion effects on nocturnal enuresis in children: a follow-up study. Angle Orthod. 2008 Mar;78(2):201-8. doi: 10.2319/021407-71.1.

Reference Type BACKGROUND
PMID: 18251602 (View on PubMed)

Other Identifiers

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LUL-2012/379

Identifier Type: -

Identifier Source: org_study_id

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