Suvorexant improves intractable nocturnal enuresis by altering sleep architecture

• Published in: BMJ case reports Vol. 14; no. 3; p. e239621
• Main Author: Matsumoto, Tohru
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 16.03.2021; BMJ Publishing Group
• Subjects: Azepines; Case Report; Case reports; Child; Cross-Over Studies; Double-Blind Method; Drug dosages; Eye movements; Families & family life; Humans; Insomnia; Male; Nocturnal Enuresis - drug therapy; Patients; Pediatrics; Sleep; Sleep Initiation and Maintenance Disorders - drug therapy; Triazoles; Urinary incontinence; paediatrics; sleep disorders; urology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-239621

Little is known about sleep-based approaches to the treatment of nocturnal enuresis (NE). This report is the first to describe the successful use of suvorexant, an orexin receptor antagonist, in a 12-year-old boy with intractable NE. With suvorexant, the frequency of NE gradually decreased from 14 of 14 days (100%) to 5 of 14 days (35.7%). Sleep polysomnography indicated that rapid eye movement (REM) sleep increased from 101.5 min (19.9%) before suvorexant to 122.1 min (24.9%) with suvorexant. Furthermore, N2 increased from 233 min (45.6%) to 287.5 min (58.7%) during non-REM sleep. In contrast, N3 decreased from 160 min (31.3%) to 65 min (13.3%) during non-REM sleep. Suvorexant appeared to lighten the depth of sleep and alter sleep architecture. Although the application of an insomnia medication for treating NE seems paradoxical, suvorexant reduced the frequency of NE in patients with severe intractable NE. Thus, this treatment strategy warrants further examination.