Incidence Of Nocturia Research Articles

Symptom and comorbidity burden in hypertensive patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is an important but frequently overlooked risk factor for hypertension (HTN). The prevalence of hypertension is high in patients with OSA, but the differences in clinical symptoms and comorbidities between patients with OSA with hypertension and those with normal blood pressure have not been fully defined. This study retrospectively analyzed OSA patients diagnosed for the first time in Lihuili Hospital Affiliated to Ningbo University from 2016 to 2020. Patients were divided into an OSA group with hypertension and an OSA group without hypertension. The sociodemographic information, clinical symptoms, comorbidities, and polysomnography results of the two groups were compared. The independent risk factors associated with hypertension in patients with OSA were explored. A total of 1108 patients with OSA initially diagnosed were included in the study, including 387 with hypertension and 721 without. Compared with OSA patients without hypertension, OSA patients with hypertension were older; had a higher body mass index (BMI) and Epworth sleepiness score (ESS); a higher incidence of nocturia; and a higher proportion of diabetes mellitus, coronary heart disease, and cerebrovascular disease. Multivariate analysis showed age (odds ratio [OR]:1.06, 95% confidence interval [CI]:1.04-1.08), BMI (OR:1.17, 95% CI:1.11-1.23), ESS score (OR:0.97, 95%CI: 0.94-1.00) and nocturia symptoms (OR:1.64, 95% CI:1.19-2.27) was independently associated with hypertension in OSA patients, and comorbid diabetes (OR: 3.86, 95% CI: 2.31-6.45), coronary heart disease (OR: 1.90, 95% CI:1.15-3.16), and ischemic stroke (OR: 3.69,95% CI:1.31-10.40) was independently associated with hypertension in OSA patients. Compared to OSA patients with normal blood pressure, OSA patients with hypertension had more significant daytime sleepiness, more frequent nocturnal urination, and a higher risk of diabetes, coronary heart disease, and cerebrovascular disease.

Prevalence of nocturia in young adolescents among preclinical, clinical, and agriculture students

Background: Nocturia is defined as a complaint of micturition that wakes a person up from sleep one or more times a night. Nocturia is one of the Lower Urinary Tract Symptoms (LUTS) that can be very disturbing for patients. All age ranges can experience nocturia, although the incidence is more prevalent in the elderly. The causative factors of nocturia vary widely. Several systemic diseases, hormonal imbalances, use of certain medications, and psychological conditions can play a role in the development of nocturia. Objective: Determine prevalence and potential influencing factors of nocturia in young adolescents. Method: This cross-sectional study was conducted online on students of the Preclinical, Clinical, and Agriculture students at Universitas Brawijaya, Malang, Indonesia using Google Form adapting the International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N). Results: A total of 384 respondents were obtained. The average age of respondents was 20 years. The incidence of nocturia among 384 respondents was 53%. Female respondents experienced more nocturia (67.64%) than males. Conclusion: Nocturia is a common complaint among younger age groups, and is predominantly experienced by women.

Analysis on fluid intake and urination behaviors among the elderly in five cities in China: a cross-sectional study.

Fluid intake in the elderly may influence urination behaviors and further influence their health status. This study investigated the behaviors of fluid intake, urination and their relationships among the elderly in China. Stratified random sampling was used to recruit the elderly participants who met the inclusion criteria from five cities in China. Participants' total fluid intake (TFI) level was investigated using a validated 7-day 24 h fluid intake questionnaire. Their urination behaviors in real time were also recorded using a validated 7-day 24 h urination behavior record. A total of 524 participants completed the study, including 233 males and 291 females. The average age was 69.7 years. The median daily TFI was 1,241 mL, with a frequency of 8.1 times per day. Approximately 73.3% of the participants did not reach the amount of adequate fluid intake (1.7 L for males and 1.5 L for females) recommended in China. Fluid intake in the morning, afternoon, and evening among participants was 594 mL, 305 mL and 342 mL, with a frequency of 3.0 times, 1.7 times, and 2.0 times, respectively. The median urination frequency was 7.4 times per day. The percentage of participants who urinated >7 times during the day was 44.3%. The percentage of participants who urinated ≥1 time at night was 77.5%. Age and BMI were not the main influence factors for fluid intake and urination behaviors. The preliminary analysis showed that higher TFI, plain water intake, dairy products intake, and fluid intake frequency were significantly associated with higher urination frequency (t = 6.553, p < 0.05; t = 5.291, p < 0.05; t = 4.667, p < 0.05; t = 13.413, p < 0.05). Higher fluid intake per time was significantly associated with lower urination frequency (t = -3.562, p < 0.05). Correlations between TFI, fluid intake frequency, fluid intake in night, fluid intake frequency in night and urination at night were also found (r = 0.114, p < 0.05; r = 0.091, p < 0.05; r = 0.146, p < 0.05; r = 0.331, p < 0.05). Fluid intake was inadequate in terms of the elderly participants. Participants with higher fluid intake and frequency in night had a greater incidence of nocturia. Thus, correcting fluid intake behaviors can improve urination behavior and promote health. https://www.chictr.org.cn/searchprojEN.html, identifier CTR1900023355.

Single-Centre Retrospective Study on the Effects of Bariatric Surgery on Nocturia.

The incidence of nocturia is increased in obesity, which causes significant negative impact on quality of life. Bariatric surgery is a reliable method in which to achieve major weight loss and this study aims to determine the effect of bariatric surgery on nocturia and other lower urinary tract symptoms (LUTS) in men and women. Retrospective study of patients undergoing bariatric surgery had pre- and post-operative questionnaires using the validated International Prostate Symptoms Score (IPSS) to assess nocturia between 2018 and 2021. The primary outcome was effect of bariatric surgery on nocturia RESULTS: A total of 99 patients were included with median age of 52.9 (44.9-60.2) and 83.8% being female. The median weight was 129.9kg (110-151.9) and median BMI was 45.5 (41.4-53.4). Improvements were demonstrated in all criteria assessed in IPSS and nocturia significantly improved with a decrease in 1.14 points (p < 0.05). Linear regression analysis showed that, in the post operative period assessed, there were no significant effect on variables measured such as obstructive sleep apnoea, type 2 diabetes on the effect of IPSS post-bariatric surgery within the follow-up period of 4-6 months. Bariatric surgery can have significant improvements on nocturia symptoms in men and women with obesity. This is another means in how bariatric surgery can reduce morbidity and improve quality of life.

A Novel Intravesical Dextrose Injection Improves Lower Urinary Tract Symptoms on Interstitial Cystitis/Bladder Pain Syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a painful recurrent condition characterized by the discomfort of the bladder, and current treatment options have limited effectiveness. Prolotherapy is a well-known treatment that involves the injection of non-biologic solutions to reduce pain and/or promote proliferation of soft tissue, and dextrose is the most common injectate. This study investigated the effects of dextrose prolotherapy in a rat model of IC/BPS and patients with IC/BPS. We used cyclophosphamide to induce IC/BPS in rats, and intravesical instillation of 10% dextrose solution was performed. After 1 week, we conducted a urodynamic test, bladder staining, and ECM-related gene expression analysis to examine the treatment’s efficacy. We found that dextrose treatment could recover the instability of the bladder, reduce frequent urination, and improve the glycosaminoglycan layer regeneration and the bladder wall thickness along with a significant intense expression of CD44 receptors. Furthermore, we enrolled 29 IC/BPS patients with previous hyaluronic acid/Botox treatment for more than 6 months with remained unchanged condition. In this study, they received intravesical injections of 10% dextrose solution followed by assessments for up to 12 weeks. Patient characteristics and a 3-day voiding diary before treatment were recorded. Patient responses were examined using IC/BPS-related questionnaires. Moreover, expressions of growth factors and cytokines were analyzed. The results demonstrated that dextrose prolotherapy in patients with IC/BPS reduced the frequency of treatment over time, with the mean number of treatments being 3.03 ± 1.52, and significantly reduced the incidence of nocturia and questionnaire scores associated with symptoms. Dextrose prolotherapy significantly enhanced EGF level and, in contrast, reduced the level of HGF, PIGF-1, and VEGF-D after several weeks following treatment. The cytokine analysis showed that the expressions of IL-12p70 and IL-10 were significantly up-regulated after dextrose prolotherapy in IC/BPS patients. The levels of most growth factors and cytokines in IC/BPS patients had no significant difference and showed a similar tendency as time progressed when compared to healthy controls. Overall, the alteration of growth factors and cytokines exhibited safe treatment and potential stimulation of tissue remodeling. In summary, our study demonstrated that dextrose prolotherapy is a promising treatment strategy for IC/BPS disease management.

Nocturia and effect on the quality of life. A study at Ramathibodi Hospital

Objective: To investigate the impact and the incidence of nocturia on the quality of life of patients in Ramathibodi Hospital. Materials and Methods: This study was a hospital-based cross-sectional study to measure the QoL of nocturia patients using a Nocturia Quality-of-Life questionnaire (N-QoL). Cronbach’s alpha coefficient was used to explore internal consistency. Pearson’s correlation coefficient (r) was used to determine the strength of the relationship between the scores for each item. Uni- and Multivariate analyses were used to explore the significant parameters. Results: One hundred and fifty-five nocturia patient were included in the study analysis. Most of the questionnaire respondents were male (80.65%) and the vast majority had at least 1 underlying disease requiring long-term follow-up by a physician (86.45%) with a median urination of 3 times per night and a 3 hour median first urination after retiring to bed. From our study questionnaire, most patients responded that they had moderate to good quality of life with a minor inconvenience from nocturia, requiring them to nap during the day on some days. An increasing frequency of urination per night and a first urination of less than 2 hours after retiring is significantly related to low levels of energy the next day, sleep deprivation, worry over treatment options, overall inconvenience and a reduction in quality of life. Conclusion: Our study demonstrated nocturia patients experience a significant reduction in quality of life, and a decrease in quality of sleep. The incidence of urination in the night and the timing of the first urination after bed had more impact on overall quality of life.

Jingui Shenqi pill for nocturia due to nocturnal polyuria: A protocol for systematic review and meta-analysis.

Background:The incidence of nocturia is high and will seriously affect patients’ physical and mental health. Nocturnal polyuria is the most critical cause of nocturia, There are few drugs currently used to treat nocturia due to Nocturnal Polyuria (NP). The guide highly recommends only Desmopressin. There is an urgent need to find new drugs. Jingui Shenqi pill (JSP) is a Chinese patent medicine, it is widely used in China to treat NP. However, there is no evidence-based medical evidence to prove its safety and effectiveness. The purpose of this systematic review is to evaluate the efficacy and safety of JSP in the treatment of NP.Methods:We will search the randomized controlled trials (RCTs) including JSP for NP and published from the inception of the database to Oct 2020 by the following eight databases: Embase, Cochrane Library, PubMed, MEDLINE, the China National Knowledge Infrastructure, Cqvip Database, and Wanfang Data, the Chinese Biomedical Literature Database. There is no language and publication status restriction. The primary outcomes will include Nocturnal urine volume, the number of nocturnal voids, Nocturnal polyuria index (Nocturnal total urine volume /24 h total urine volume). We will perform the data synthesis, sensitivity analysis, subgroup analysis, and bias assessment risk using RevMan V.5.3. The reporting bias will be assessed using a funnel plot and Egger test.Results:This study may provide additional evidence of JSP for NP in the effectiveness and safety and alternative therapy for NP.Conclusions:In this systematic review, we will assess whether JSP is an effective and safe medicine for nocturia.

Association between obstructive sleep apnea syndrome and nocturia: a meta-analysis.

The relationship between obstructive sleep apnea (OSA) and the risk of nocturia remains unclear. Therefore, we sought to identify whether or not OSA affects the incidence of nocturia. A thorough literature search was executed in September 1st 2018 from PubMed, Web of Science database, and Embase. We used DerSimonian and Laird random-effects to calculate the pooled relative ratio (RR). Total of 13 studies met inclusion criteria and in total comprised, 406 patients and 9518 controls. There was a significant association between OSA and the risk of nocturia (RR = 1.41, 95% CI 1.26-1.59). Through subgroup analysis by different severity of OSA, we found patients who had severe OSA were at high risk of nocturia. Through another subgroup analysis, we found a statistically significant association between OSA and risk of nocturia in the men (RR = 1.487, 95% CI 1.087-2.034, P = 0.013). However, there was no significant relationship between OSA and nocturia in the women (RR = 1.537, 95% CI 0.831-2.842, P > 0.05). Subgroup analysis of different diagnostic methods indicated that OSA was significantly associated with the risk of nocturia regardless what method was used to diagnose OSA (P < 0.05). The findings suggest that men with OSA have a high incidence of nocturia. A large multicenter study may be useful to explore the relationship between OSA and nocturia, in order to elucidate its causes.

Incidence of Nocturia in Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement and Outcomes After Medical Treatment: Results from the Evolution European Association of Urology Research Foundation Prospective Multinational Registry

BackgroundNocturia is one of the most prevalent and bothersome lower urinary tract symptoms (LUTS) in men, leading to increased morbidity and mortality and a considerable economic burden on healthcare systems. Understanding its natural history, effect of pharmacotherapy, and predictors of failure of pharmacotherapy would allow optimised patient management. ObjectiveTo evaluate the prevalence and effect of clinically relevant nocturia (crN) on quality of life in a contemporary cohort of European men aged ≥50 yr in a “real-life” setting, to understand its natural history, to detect any effect of pharmacotherapy, and to identify predictors of pharmacotherapy failure. Design, setting, and participantsThis is a secondary analysis of the data from the Evolution Registry—a European, multicentre, prospective, observational registry, conducted in five European countries within a sample of general practitioners’ and urologists’ clinics. A consecutive sample of 2175 men aged ≥50 yr with LUTS in association with benign prostatic enlargement was enrolled between February 2010 and April 2011, and followed up for 2yr. Overall, data from 1838 men were suitable for analysis. Outcome measurements and statistical analysisThe primary outcome was evaluation of the baseline incidence of nocturia in the study population. Secondary outcomes included the impact of nocturia on quality of life, efficacy of pharmacotherapy, and predictive factors associated with persistence of nocturia. Descriptive statistics were used to examine the data. Logistic regressions were used to analyse associations between comorbid conditions and risk factors in men with nocturia. Results and limitationsOverall, 1198 men (65%) reported crN (two or more voids per night). This increased age dependently from 59% in the 50–59-yr age group (n=74) to 89% in the 80–99-yr age group (n=25). Overall, the incidence of crN improved in those who commenced pharmacological treatment at study entry, from 69% at baseline to 49% at 24 mo (p<0.00001). This was statistically significant only in those <80 yr old. A weak correlation was found between the severity of nocturia at baseline and quality-of-life scores on the International Prostate Symptom Score questionnaire (r=0.33, p<0.001). Of the patients treated with an alpha-blocker or a 5-alpha reductase inhibitor, 62% still had crN at 24 mo. ConclusionsAlmost two-thirds of men in the Evolution Registry reported clinically significant nocturia with increased incidence with age. Despite prostate-targeted treatment, most patients, especially older men, still had persistent or worsening nocturia at 2-yr follow-up, and in this study, it was not possible to identify specific clinical factors that predicted those who could respond well to treatment in this regard. Patient summaryThis large study of men from five different European countries has shown that waking up at night to pass urine (nocturia) is very common and becomes more common with older age, and treatments that target the prostate do not significantly improve symptoms over 2yr in most men.

Effect of Nocturnal Hypoxia on Nocturia in Patients With Obstructive Sleep Apnea.

PurposeTo identify the association between nocturia and obstructive sleep apnea (OSA), we compared results of polysomnography (PSG) with the presence or absence of nocturia in patients with suspected OSA.MethodsPatients underwent PSG for suspected OSA. The International Prostate Symptom Score and quality of life (IPSS/QoL) questionnaire was evaluated to assess voiding symptoms that may affect sleep quality. The results of PSG were compared between patient groups with or without nocturia.ResultsIn logistic regression analysis, age (odds ratio [OR], 1.052; P=0.004), diabetes mellitus (OR, 6.675; P<0.001), mean O2 saturation (OR, 0.650; P=0.017), oxygen desaturation index (ODI) 3 (OR, 1.193; P=0.010), and ODI4 (OR, 1.136; P=0.014) affected nocturia independently among the OSA-suspected patients.ConclusionsHypoxia caused by OSA affects the incidence of nocturia. Less desaturated OSA patients with nocturia may require more urological evaluation and treatment for nocturia even after the correction of OSA.

AB033. Testosterone and nocturia

Nocturia is a major problem in the elderly and can be caused by a range of urologic and nonurologic conditions. Age-associated physiologic, structural, hormonal, and histologic changes play an important role in the increasing incidence of nocturia in elderly patients. Benign prostate hyperplasia (BPH) has been suggested as the main factor triggering nocturia, and therefore, efforts have focused on alleviating BPH through medical or surgical treatment. Although male lower urinary tract symptoms (LUTS) have traditionally been attributed to BPH, many evidences has shown that LUTS in some male patients might be derived from the bladder or systemic conditions. Recent investigations have reported that factors such as aging, late onset hypogonadism (LOH), and sleep disturbances are associated with nocturia. An increased prevalence of nocturia in elderly men is also caused by many factors other than BPH. Impaired kidney responsiveness to arginine vasopressin (AVP) and disrupted circadian nocturnal AVP secretion has been reported as a possible mechanism of nocturnal polyuria in older patients. Lack of sleep because of nocturia affects normal physiological actions in the human body, especially testosterone secretion. It is mostly secreted in the early morning and decreases to its minimum level after sleep. Therefore, sleep disturbances are believed to affect the pulsatile secretion of testosterone, and when sleep disturbances improve, testosterone secretion is expected to improve as well. Currently, it has not yet been revealed which of the following occurs first: nocturia-induced stress decreases testosterone levels or age induces decreased testosterone levels, which causes nocturia. Although the mechanism of action is still unknown, we suggest that desmopressin could correct disturbances of the circadian regulation of testosterone secretion. Because many factors are involved in testosterone and nocturia, further studies are needed to confirm our findings.

The impact of nocturnal polyuria in older people with nocturnal LUTS.

Bladder dysfunctions often express the presence of lower urinary tract symptoms (LUTS) and are common in older people. The aim of this study was to analyze the micturition, incontinence and residual in older subjects, evaluating the role of nocturnal polyuria. Eighty-six patients aged 65 or older with invalidating LUTS were hospitalized for 24 hours. The maximum bladder capacity, mean micturition volume, post voiding residual and incontinence volume were recorded and analyzed day-time and night-time. Three groups were defined, i.e. nocturia, nocturnal incontinence and nocturnal polyuria (NP), and patients with or without NP were analyzed. With a majority of female patients 85% and a mean age of 74.3±5.96 years, a high incidence of nocturia (76%) was observed. NP was associated with nocturia in 56 patients (86%). In the three groups, the maximum bladder capacity and mean micturition volume were statistically higher during the night. Patients with nocturia or nocturnal incontinence associated to NP presented with a higher nocturnal maximum bladder capacity and mean micturition volume. A higher nocturnal post-void residual (PVR) was observed in patients with Nocturnal Incontinence associated with NP (P=0.03). Patients without NP presented significantly higher diurnal results. Nocturnal LUTS in older people is the result of a high nocturnal urine production related to NP with a higher nocturnal bladder capacity. The analyses of micturition, incontinence and PVR, and the accurate evaluation of the presence or absence of NP seems to be the key point for a better therapeutic choice in patients suffering by Nocturnal LUTS.

AB71. Testosterone and nocturia

Nocturia is a major problem in the elderly and can be caused by a range of urologic and neurologic conditions. Age-associated physiologic, structural, hormonal, and histologic changes play an important role in the increasing incidence of nocturia in elderly patients.Benign prostate hyperplasia (BPH) has been suggested as the main factor triggering nocturia, and therefore, efforts have focused on alleviating BPH through medical or surgical treatment. Although male lower urinary tract symptoms (LUTS) have traditionally been attributed to BPH, much evidence has shown that LUTS in some male patients might be derived from the bladder or systemic conditions.Recent investigations have reported that factors such as aging, late onset hypogonadism (LOH), and sleep disturbances are associated with nocturia. An increased prevalence of nocturia in elderly men is also caused by many factors other than BPH. Impaired kidney responsiveness to AVP and disrupted circadian nocturnal AVP secretion has been reported as a possible mechanism of nocturnal polyuria in older patients. Lack of sleep because of nocturia affects normal physiological actions in the human body, especially testosterone secretion. It is mostly secreted in the early morning and decreases to its minimum level after sleep. Therefore, sleep disturbances are believed to affect the pulsatile secretion of testosterone, and when sleep disturbances improve, testosterone secretion is expected to improve as well.Currently, it has not yet been revealed which of the following occurs first: nocturia-induced stress decreases testosterone levels or age induces decreased testosterone levels, which causes nocturia. Although the mechanism of action is still unknown, we suggest that desmopressin could correct disturbances of the circadian regulation of testosterone secretion. Because many factors are involved in testosterone and nocturia, further studies are needed to confirm our findings.

Do rotational shifts affect micturition patterns in real practice? A pilot study in healthy, young female nurses.

PurposeHealthy, young individuals are known to exhibit circadian variation in urinary functions. However, the effects of chronic circadian disturbance on voiding functions are largely unknown. The present work compared the effects of rotational shifts on the micturition patterns of female nurses to that in female nurses with routine daytime shifts.MethodsA total of 19 nurses without lower urinary tract symptoms who worked rotational shifts for an average duration of 2 years were recruited. A voiding diary was kept for 9 consecutive days, and the overactive bladder symptom score (OABSS) questionnaire was completed three times, starting 3 days before their night duties until 3 days after completion of their night duties. For comparison, seven nurses with regular shifts completed a 3-day voiding diary and the OABSS questionnaire.ResultsFemale nurses working rotational shifts had lower overall urine production and had decreased urination frequency and nocturia than female nurses working regular shifts, even when the nurses who worked rotational shifts had a regular night's sleep for at least 7 days. Upon reinitiation of night duty, overall urine production increased significantly, with no significant changes in urgency and frequency. When these nurses returned to daytime duty, the volume of urine decreased but nocturnal urine production remained high, and the incidence of nocturia also increased significantly. However, the effects on OABSS score were not significant under the study design used.ConclusionsLong-term rotational shifts resulted in adaptive changes such as decreased urine production and frequency in healthy, young female nurses. In addition, their micturition patterns were significantly affected by abrupt changes in their work schedules. Although working in shifts did not increase urgency or frequency of urination in healthy, young female nurses working rotational shifts for an average 2 years, large-scale studies are needed to systematically analyze the influence of shift work timings on micturition in humans.

Determinants of Nocturia: the Krimpen Study

Many conditions and characteristics are cross-sectionally associated with nocturia. However, to our knowledge longitudinal associations of frequency-volume chart based nocturia have not yet been studied. We identify (modifiable) determinants of nocturia in older men in a longitudinal setting. A longitudinal, community based study was conducted among 1,688 men age 50 to 78 years in Krimpen aan den IJssel, The Netherlands with planned followup rounds at 2, 4 and 6 years. Men without a history of radical prostatectomy, transurethral surgery, or bladder or prostate cancer were included in the study. Data were obtained using frequency-volume charts, from which the nocturnal voiding frequency, maximum voided volume and (nocturnal) urine production were determined. Nocturia was defined as a nocturnal voiding frequency of 2 or more episodes. Polyuria was defined as greater than 2,800 ml voided per 24 hours. For nocturnal polyuria we used the 2 definitions of 1) greater than 33% of 24-hour voided volume and 2) nocturnal urine production of greater than 90 ml per hour. Conditions and characteristics were determined via medical examinations and questionnaires. A generalized linear mixed effect model was used to determine factors longitudinally associated with nocturia. Age (50 to 55 years vs greater than 60 years), maximum voided volume (greater than 300 ml vs less than 300 ml), 24-hour polyuria, nocturnal polyuria (both definitions) and lower urinary tract symptoms were all longitudinally associated with an increased prevalence of nocturia in older men. A smaller maximum voided volume, lower urinary tract symptoms, 24-hour polyuria and nocturnal polyuria are significant and potentially modifiable determinants of nocturia. The finding that both definitions for nocturnal polyuria are independent significant determinants may indicate a 2-step etiologic process for nocturnal polyuria.

Sleep Related Problems and Urological Symptoms: Testing the Hypothesis of Bidirectionality in a Longitudinal, Population Based Study

We evaluate the bidirectional association between urological symptoms (urinary incontinence, lower urinary tract symptoms and nocturia) and sleep related variables. Data were obtained from a prospective cohort study of 1,610 men and 2,535 women who completed baseline (2002 to 2005) and followup (2006 to 2010) phases of the BACH (Boston Area Community Health) Survey, a population based random sample survey. Sleep restriction (5 hours or less per night), restless sleep, sleep medication use and urological symptoms were assessed by self-report. Urinary incontinence was defined as weekly leakage or moderate/severe leakage, lower urinary tract symptoms (overall, obstructive, irritative) were defined by the AUA-SI (American Urological Association symptom index) and nocturia was defined as urinary frequency 2 or more times per night. At the 5-year followup 10.0%, 8.5% and 16.0% of subjects newly reported lower urinary tract symptoms, urinary incontinence and nocturia, respectively, and 24.2%, 13.3% and 11.6% newly reported poor sleep quality, sleep restriction and use of sleep medication, respectively. Controlling for confounders, the odds of urological symptoms developing were consistently increased for subjects who reported poor sleep quality and sleep restriction at baseline, but only baseline nocturia was positively associated with incident sleep related problems at followup. Body mass index, a potential mediator, reduced selected associations between sleep and incident urinary incontinence and irritative symptoms, but C-reactive protein did not. These data suggest that self-reported sleep related problems and urological symptoms are linked bidirectionally, and that body mass index may be a factor in the relationship between sleep and the development of urological symptoms.

Evaluation of Factors Influencing the Natural History of Nocturia in Elderly Subjects: Results of the Fujiwara-kyo Study

We evaluated the natural history of nocturia and determined factors influencing the incidence or remission of nocturia. Study subjects were 4,427 volunteers 65 years old or older who participated in the Fujiwara-kyo Study. The nocturia prevalence was assessed at baseline and 1 year later. Nocturia incidence and remission rates were calculated and factors influencing these results were evaluated based on characteristics, including gender, age, body mass index, HbA1c, creatinine clearance, life style, comorbidities, depressive status, metabolic syndrome and voiding symptoms. Independent factors were determined by multivariate analysis. Of the 4,427 subjects 3,685 provided complete replies to self-administered questionnaires at baseline and 1 year later. The prevalence of nocturia at baseline and 1 year later was 47.0% and 50.3%, and nocturia incidence and remission rates were 20.0% and 15.4%, respectively. Male gender, high body mass index, voiding symptom deterioration and new onset overactive bladder were independent factors associated with the nocturia incidence. Male gender, sum of the voiding symptoms, age and new onset overactive bladder were independent negative factors associated with nocturia remission. The prevalence of nocturia worsened with time, although nocturia in older subjects progressed dynamically. Male gender, age, body mass index, sum of voiding symptoms, voiding symptom deterioration and new onset overactive bladder influence the natural history of nocturia.

Mortality in Older Men With Nocturia. A 15-Year Followup of the Krimpen Study

Although nocturia seems to be related to increased mortality in older men, it is unclear whether this is an independent association. Therefore, we studied the association of nocturia and mortality in community dwelling older men. A longitudinal, population based study was conducted among 1,688 men 50 to 78 years old. Recruitment started in 1995. At baseline all men completed a questionnaire and a 3-day frequency-volume chart. Nocturnal voiding frequency was derived from the frequency-volume chart and nocturia was defined as 2 or more voids per night. In 2010 all general practitioners' patient records were checked for possible date of death. Univariable and multivariable Cox regression analyses were performed. A subanalysis was performed to determine the effect of 3 longitudinal nocturia patterns (ie incident, persistent or transient/resolved) on the mortality rate. A total of 1,114 men were eligible for analysis. Median followup was 13.4 years (quartiles 1 to 3: 10.3-14.1) for a total of 12,790 person-years of followup. Univariably nocturia was associated with an increased mortality rate (HR 1.63, 95% CI 1.20-2.21, p = 0.002). After correction for possible confounding factors nocturia had no significant influence on mortality (p = 0.838) in contrast to age, chronic obstructive pulmonary disease, smoking and hypertension (all p <0.05). Men with persistent nocturia had the highest mortality rate compared to those without nocturia. However, this association was not significant (p = 0.083). In an analysis based on frequency-volume chart data, the association between nocturia and mortality was explained by confounding factors, predominantly age. Furthermore, the mortality risk was not associated with the 3 nocturia patterns.

Prevalence and Risk Factors of Nocturia and Nocturia-Related Quality of Life in the Chinese Population

Objectives: To evaluate the prevalence, risk factors of nocturia and nocturia-related quality of life. Methods: Age, hypertension, cardiovascular disease, diabetes mellitus, benign prostatic hyperplasia (BPH), alcohol abuse and smoking were analyzed using logistic analysis. Multiple linear-regression analysis was used to identify factors predicting the score on the Nocturia Quality of Life (N-QOL) questionnaire. Results: 1,198 adults completed this study. 411 individuals (34.3%) answered that they arose for urination at least twice during the night. The incidence of nocturia increased with age from 8.6% in individuals younger than 40 to 67.7% in those older than 70. Hypertension [odds ratio (OR) 2.322; 95% confidence interval (95% CI): 1.387–3.887] and diabetes (OR 2.298; 95% CI: 1.066–4.954) were possible risk factors for nocturia. In male individuals, BPH (OR 3.900; 95% CI: 1.890–8.049) was another risk factor. Gender was not found to be associated with nocturia. Increasing episodes of nocturia (regression coefficient: –2.564; 95% CI: –3.08 to –2.049) and decreasing total sleeping hours (regression coefficient: 1.738; 95% CI: 0.948–2.527) were independent factors predicting a significantly lower N-QOL score. Conclusions: Hypertension, diabetes and BPH are associated with nocturia, suggesting that multiple approaches are needed when treating patients with nocturia. Nocturia has a significant impact on the nocturia-related quality of life when the patient has 2 or more episodes per night.

The Effects of Lifestyle Factors on the Incidence of Nocturia

Cross-sectional studies have shown an association between obesity and nocturia but controversial findings on the relationship between smoking, alcohol and coffee consumption, and nocturia. Prospective studies of the role of lifestyle factors in individuals with nocturia are scarce. We investigated the effects of lifestyle factors on the incidence of nocturia. The target population consisted of men who were 50, 60 or 70 years old and residing in Tampere in 1994. A questionnaire was mailed to 3,143 randomly selected men in 1994 and the survey was repeated in 1999 with the 2,837 who were still eligible. The followup sample consisted of 1,580 men with information on nocturia at baseline and 5-year followup. Nocturia was assessed by the Danish Prostate Symptoms Score 1 questionnaire and graded as mild--1 or 2, moderate--3 or 4 and severe--5 or more nightly voids. Higher body mass index at baseline was associated with an increased incidence of nocturia. Obese men were at 1.6 times (95% CI 1.1-2.4) higher risk for mild nocturia and at 2.3 times (95% CI 1.1-4.7) higher risk for moderate or severe nocturia compared with men who had a normal body mass index. Men who consumed less than 150 gm alcohol per week were at lower risk for moderate or severe nocturia than abstainers (adjusted incidence rate ratio 0.4, 95% CI 0.2-0.8). No statistically significant associations were found for smoking and coffee consumption. The frequency of nocturia at baseline did not increase the incidence of obesity at followup. Our findings suggest that obesity increases the risk of nocturia. The link between other lifestyle factors and nocturia is weak or absent.