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A randomized prospective trial comparing the effectiveness of the voice recordable alarm with the buzzer alarm for nocturnal enuresis.
Elizabeth Jackson, MD, Denise Ferguson, PNP, Marion Schulte, RN, MHSA.
Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA.

Introduction: Enuresis alarms are accepted as a highly successful method of achieving nocturnal continence but many children do not wake to the buzzer type alarm. In 2006 sleep lab experiments using a smoke alarm with mother’s voice was effective in arousing children who slept through a buzzer smoke alarm.1 We compare a voice recordable enuresis alarm which is commercially available with a similar buzzer enuresis alarm.
Materials and Methods:
Based on large studies on the effectiveness of bedwetting alarms, we calculated that 200 children would need to be enrolled in order to show a difference in resolution rate of nocturnal enuresis. Studies suggest a slightly faster time to resolution in girls and there may also be a different resolution rate according to age. For that reason, children were divided into 4 groups: girls and boys ages 6-11 years, girls and boys 12-18 years. After discussing treatments for bedwetting, the children and families were offered medicines or alarms. Those choosing alarms were offered participation in this study and were then randomized to buzzer or voice alarms. Alarms were the Malem voice recordable alarm which can be turned to buzzer or voice by an internal switch. All alarms were set to vibrate as well as produce sound. All children had at least 2 wet nights per week prior to starting the alarm and success was defined as 4 consecutive weeks of dry nights with no alarms up to 4 months of alarm use. The study was approved by the human investigational review board.
Results:
1. To date 188/200 children have enrolled and 48 have completed the 16 week trial and returned their alarms.
2. 10 children (6 boys, 4 girls) stopped using the alarm without achieving the dry night goal.
3. Of these 10 children, 8 had the buzzer alarm
4. Of the remaining 38, 20 children were successful with the voice alarm and 18 with the buzzer alarm
5. The number of weeks to the dry night goal of 4 weeks of consecutive dry nights was 9.5 weeks in both the buzzer and voice alarm groups.
Conclusion:
Based on the preliminary outcome of 48 children using alarms, our success rate at 16 weeks is 80%. The number of children achieving a dry bed for 4 weeks was equal in the buzzer and voice alarm groups. The average time to goal was the same in both groups. Of the children who did not become dry with the alarm, most had a buzzer alarm. The small numbers do not reach statistical significance but suggest that the voice alarm may lead to a lower dropout rate.
1Smith GA, Hayes JR, and Xiang H. Comparison of a personalized parent voice smoke alarm with a conventional residential tone smoke alarm for awakening children. Pediatrics 118:1623-1632, 2006


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