Effects of Imipramine on Enuretic Frequency and Sleep Stages

[摘要] Four children with a history of primary enuresis were evaluated in both the sleep laboratory and at home in a 68 consecutive-night protocol with successive conditions of 10 placebo-baseline nights, 27 drug (imipramine) nights, and 31 placebo-withdrawal nights. On the placebo conditions, two thirds of the enuretic events occurred during the first third of the night. Enuretic events occurred out of each sleep stage in approximate proportion to the time spent in that sleep stage for each third of the night. Thus, primary enuresis was found to be chiefly related to time of night and not any specific sleep stage such as stage 3 or 4 (slow wave) sleep.Administration of imipramine in a manner simulating clinical use of the drug resulted in a marked decrease in overall enuretic frequency. The reduction of enuretic frequency was not related to the effects of imipramine on sleep stages. There was a reduction of enuretic events in the first two thirds of the night with an increase in enuretic events in the last third of the night. Also, with long-term drug administration, there was a significant increase in wakefulness in the last third of the night. These findings suggest that early in the night when sleep is deepest, imipramine decreases bladder excitability and/or increases the child's bladder capacity. This allows the child to continue to sleep without micturition and, later in the night when sleep is lighter, to be more aware of the stimuli from the bladder. Immediately following withdrawal of imipramine, enuretic frequency approximated baseline levels.Administration of imipramine resulted in a moderate degree of rapid eye movement (REM) suppression. With long-term administration, there was a dimunition of the REM suppressant effect. Initial withdrawal of imipramine produced a marked REM rebound.

[学科分类] 儿科学