Nocturnal Voids Research Articles

Independent Associations Between Nocturia and Nighttime Blood Pressure/Dipping in Elderly Individuals: The HEIJO-KYO Cohort.

To evaluate the association between nocturnal void frequency and ambulatory blood pressure (BP). Cross-sectional. Nara, Japan. Community-based elderly individuals (mean age 72.1, N = 867). Nocturnal void frequency and ambulatory BP. Two hundred twenty-four participants had no nocturnal void, 384 had one nocturnal void, and 259 had two or more nocturnal voids. Univariate comparisons showed that more-frequent nocturnal voiding was significantly associated with higher nighttime systolic BP (SBP) and lower dipping (nocturnal voids: ≥2, nighttime SBP 121.1 mmHg, dipping 11.8% vs 0, nighttime SBP 111.5 mmHg, dipping 15.8%, P < .001). Multivariate models revealed that two or more nocturnal voids was significantly associated with higher nighttime SBP and lower dipping than no nocturnal voids (adjusted mean difference for nighttime SBP (nocturnal voids ≥2 minus 0): 6.3 mmHg, 95% confidence interval (CI) = 2.6 to 10.1 mmHg, P < .001; adjusted mean difference for dipping (nocturnal voids ≥2 minus 0): -2.8%, 95% CI = -4.9% to -0.7%, P = .005) and that the associations were independent of potential confounding factors such as age, sex, body mass index, smoking status, antihypertensive use, diabetes mellitus, renal function, asymmetric dimethylarginine, bedtime, length of time in bed, daytime and nighttime physical activity, endogenous melatonin levels, and bedroom light levels. In contrast, one void per night was not significantly associated with nighttime SBP and dipping. Nocturia is significantly associated with nighttime SBP and dipping in the general elderly population, independent of several confounding factors such as age, sex, metabolic abnormalities, physical activity, and circadian rhythm parameters.

Quantitative association between nocturnal voiding frequency and objective sleep quality in the general elderly population: the HEIJO-KYO cohort

ObjectiveA significant association between nocturia and subjective sleep quality has previously been reported; however, the association between nocturia and objective sleep quality remains unclear. The purpose of this study was to evaluate the quantitative association between nocturnal voiding (NV) frequency and objective sleep quality in a large, general, elderly population. MethodsNocturnal voiding frequency, objective sleep quality, and subjective sleep quality were measured among 1086 community-based elderly individuals using actigraphy and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. ResultsIn multivariate analyses adjusted for potential confounding factors (such as age, gender, body mass index, medication use, renal function, bedtime, rising time, daytime physical activity, endogenous melatonin levels, and bedroom light levels), increased NV frequency, ranging from zero, one, two, three or more voids, was significantly associated with poorer objective sleep quality, including lower sleep efficiency (SE) and longer wake after sleep onset (WASO) (mean SE, 86.3, 84.8, 83.6, and 81.2%, respectively; p for trend <0.001; mean WASO: 42.6, 49.0, 53.6, and 66.1 min, respectively; p for trend <0.001), but shorter sleep onset latency (SOL) (mean SOL, 3.0, 3.0, 2.8, and 2.8 log min, respectively; p for trend = 0.018). In addition, an increased NV frequency was significantly associated with poorer subjective sleep quality in a multivariate model (mean PSQI global score, 4.60, 4.86, 5.22, and 5.48, respectively; p for trend 0.012). ConclusionThe present study revealed a quantitative association between NV frequency and objective sleep quality in the general elderly population.

274 Is the reduction to less than two nocturnal voids a relevant clinical treatment goal in nocturia patients?

274 Is the reduction to less than two nocturnal voids a relevant clinical treatment goal in nocturia patients?

Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review

ObjectiveTo systematically review and evaluate the impact of the International Continence Society (ICS)‐2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and nocturnal polyuria (NP). In 2002, the ICS defined NP as a Nocturnal Polyuria Index (nocturnal urine volume/total 24‐h urine volume) of &gt;0.2–0.33, depending on age.Materials and MethodsIn April 2013 the PubMed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativeness. Quality scores of items were compared between studies published before and after the ICS‐2002 report.ResultsThe search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, interquartile range [IQR] 4–6) but low for external validity. After publication of the ICS‐2002 report, external validity showed a significant change from 1 (IQR 1–2) to 2 (IQR 1–2.5; P = 0.019). Nocturia remained undefined in 12 studies. In all, 19 different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n = 11) of studies before and 66% (n = 27) after the ICS‐2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies after the ICS‐2002 report, respectively.ConclusionThe ICS‐2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voids between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.

The burden of nocturia among middle-aged and older women.

To examine the prevalence, predictors, and effects of nocturia in women and evaluate overlaps with established urinary tract disorders. This was a cross-sectional analysis of 2,016 women, aged 40 years and older, recruited from Kaiser Permanente Northern California from 2008 to 2012. Nocturia and other urinary symptoms were assessed using structured interviewer-administered questionnaires. Nocturia was defined as patient-reported nocturnal voiding of two or more times per night over a typical week. Thirty-four percent (n=692) reported nocturia, and 40% of women with nocturia reported no other urinary tract symptom. Women with nocturia were older (mean age 58 compared with 55 years) (odds ratio [OR] per 5-year increase 1.21, 95% confidence interval [CI] 1.12-1.31), more likely black (45%) (OR 1.75, 95% CI 1.30-2.35) or Latina (37%) (OR 1.36, 95% CI 1.02-1.83) compared with non-Latina white (30%), have worse depression (mean Hospital Anxiety and Depression Scale score 3.8 compared with 2.8) (OR per 1-point increase in Hospital Anxiety and Depression Scale score 1.08, 95% CI 1.04-1.12), and worse mobility (mean Timed Up-and-Go 11.3 compared with 10 seconds) (OR per 5-second increase in Timed Up-and-Go 1.29, 95% CI 1.05-1.58). Nocturia occurred more among women with hysterectomy (53% compared with 33%) (OR 1.78, 95% CI 1.08-2.94), hot flushes (38% compared with 32%) (OR 1.49, 95% CI 1.19-1.87), and vaginal estrogen use (42% compared with 34%) (OR 1.50, 95% CI 1.04-2.18). Nocturia is common in women and not necessarily attributable to other urinary tract disorders. Factors not linked to bladder function may contribute to nocturia risk, underlining the need for multiorgan prevention and treatment strategies. II.

Determinants of nocturia severity in men, derived from frequency–volume charts

Objective. Nocturia may be characterized by indices derived from the frequency–volume chart (FVC). The objective of this study was to determine how these parameters relate to the severity of nocturia in men with and without lower urinary tract symptoms (LUTS). Materials and methods. A retrospective analysis of FVCs was performed in two cohorts of men: those presenting with LUTS in a New York ambulatory urology clinic and those from the longitudinal population-based Krimpen study. Nocturnal urine volume (NUV), nocturia index (Ni), nocturnal polyuria index (NPi), nocturnal maximal voided volume (nMVV) and sleep duration were derived from FVCs. Comparisons were made using Spearman’s rank correlation coefficient between actual number of nightly voids (ANV) and the other diary parameters. Results. Eighty-eight consecutive men who presented with LUTS completed a 24 h FVC [median age 70 years, interquartile range (IQR) 64.5–74.5, median ANV 2, IQR 1.5–4]. Nocturnal voiding frequency and volume were analyzed in 1082 community-dwelling men (median age 61 years, IQR 56.1–66.4, range 49.4–78.2; median ANV 1.5, IQR 1.0–2.0, range 0–4.5). Both cohorts demonstrated strong correlations between nocturia severity (represented as ANV) and Ni (0.797, 0.658 for cohorts 1 and 2, respectively). There were moderate correlations between nocturia severity and NPi (0.545, 0.394), NUV (0.463, 0.432) and sleep duration (0.306, 0.272). The nMVV correlated poorly with nocturia severity (0.159, 0.146). Conclusions. Treatment of nocturia should aim to match nocturnal urine production with bladder capacity. Given the lack of known effective pharmacotherapy for low bladder volume, the first attempt nocturia treatment could focus on volume reduction.

Nocturia and its impact on health-related quality of life and health care seeking behaviour in German community-dwelling men aged 50 years or older.

To evaluate the prevalence of nocturia/nocturnal voiding frequency and its impact on overall physical and mental health status in German community-dwelling men and determine which lower urinary tract symptom (LUTS) is responsible for medical consultations in the 2-year follow-up period. A sample of German men aged 50-80 years from a community-dwelling study was chosen for re-evaluation 2 years after initial assessment. Men were clinically investigated and completed the International Prostate Symptom Score, American Urology Association-Symptom Problem Index (AUA-SPI), and the Short-Form Health Survey (SF-12). In total, 1,562 men were eligible for analysis. Mean nocturnal voiding frequency was 2.3 for all men and increased with ageing. SF-12 data indicated that physical but not mental health status was lower than in the average population. LUTS severity reduced both physical and mental health status (p < 0.001). Clinically relevant nocturia (≥ 2 voids/night) was present in 43 % of men and reduced both physical and mental health status (p < 0.001), whereas both HRQoL scales were not significantly reduced in men without or only one nocturnal void. In multivariate regression analysis using patient-reported bother (AUA-SPI) from LUTS, only bother from nocturnal voiding was significantly associated with medical consultations in the investigated 2-year follow-up period (odds ratio 2.6; 95 % confidence interval 1.6-4.2; p < 0.001). Our study confirmed that nocturnal voiding is highly prevalent in community-dwelling men and reduce both physical and mental health status. Bother from nocturnal voiding is the most relevant component of LUTS responsible for medical consultations in German men.

Low‐dose oral desmopressin for treatment of nocturia and nocturnal enuresis in patients after radical cystectomy and orthotopic urinary diversion

To assess the effect of oral desmopressin on nocturia and nocturnal enuresis in patients after orthotopic neobladder reconstruction. Of 55 patients who underwent radical cystectomy and orthotopic neobladder reconstruction at our medical centre in the period 2004-2011, 34 patients were deemed eligible for the present study. Inclusion criteria were estimated glomerular filtration rate >50 mL/min/1.73 m(2) , normal baseline sodium serum level, intact daytime urinary continence, and any degree of nocturia or nocturnal enuresis. Patients were treated daily with oral desmopressin 0.1 mg at bedtime for 30 days and completed the Nocturia, Nocturnal Enuresis and Sleep Interruption Questionnaire at trial enrollment and closure. Sodium serum levels were monitored throughout. Three patients withdrew from the trial because of headaches or anxiety. The mean (sd) number of nocturnal voids decreased from 2.5 (1.4)/night at baseline to 1.5 (1.3)/night at trial closure (P = 0.015). The number of patients with one or no episodes of nocturnal enuresis per week increased from six to 12 (19 to 39%; P = 0.065). Thirteen patients (42%) reported an increase of a minimum 1-2 h of sleep until the first nocturnal void; all of them asked to continue the drug. No significant adverse events or changes in sodium level were observed. Bedtime treatment with low-dose oral desmopressin appears to decrease episodes of nocturia and nocturnal enuresis effectively and safely in ∼50% of the patients with neobladder, allowing longer undisrupted sleep time and improved quality of life. Further investigation is warranted to determine if higher doses would result in a more meaningful clinical response.

Relationship between asymmetric dimethylarginine and nocturia in the general elderly population: The HEIJO-KYO cohort.

To evaluate the relationship between asymmetric dimethylarginine (ADMA) and nocturia. A total of 862 community-based elderly individuals were examined in this cross-sectional study (mean age, 72.1 years). We measured nocturnal void frequency and serum ADMA levels. Nocturia was ascertained for a frequency of two or more nocturnal voids. Nocturia was observed in 262 (30.4%) participants. Univariate logistic regression models revealed a significant association between prevalent nocturia and ADMA levels (crude odds ratio [OR], 1.556 [2nd vs. 1st tertile]; 95% confidence interval [CI], 1.066-2.270; P = 0.022; crude OR, 2.114 [3rd vs. 1st tertile]; 95% CI, 1.453-3.072; P < 0.001). Univariate logistic regression models also revealed marginal to significant associations between prevalent nocturia and age, gender, calcium channel blocker use, nitric oxide-related drug use, diabetes, estimated glomerular filtration rate, insomnia, benign prostatic hyperplasia, overnight urine volume, and endogenous melatonin levels. In the multivariate model simultaneously adjusted for the former variables, higher ADMA levels were significantly associated with higher OR for nocturia (adjusted OR, 1.556 [3rd vs. 1st tertiles]; 95% CI, 1.010-2.397; P = 0.045). Serum ADMA levels, an endogenous inhibitor of nitric oxide synthase, are significantly associated with prevalent nocturia in the general elderly population.

Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH: re-evaluation of four controlled clinical studies.

To determine the effects of the herbal fixed-dose combination PRO 160/120 (extracts from saw palmetto fruits and stinging nettle roots) on nocturnal voiding frequency, as measured by question 7 of the IPSS questionnaire, in patients with moderate-to-severe LUTS/BPH after 24 weeks of treatment compared to placebo, to the α-blocker tamsulosin, or to the 5α-reductase inhibitor finasteride. The study is about post hoc evaluation of four published randomized, double-blind clinical trials on PRO 160/120, two compared with placebo, one with finasteride and one with tamsulosin. In addition, a pooled data analysis of the two placebo-controlled trials was conducted. We analyzed data from a total of 922 patients with a mean age of 66 years and a mean baseline nocturnal voiding frequency of 2.1. In the pooled analysis of placebo-controlled trials, nocturnal voids improved by 0.8 (29 %) with PRO 160/120 compared to 0.6 (18 %) with placebo (p = 0.015, Wilcoxon test, one-tailed). The 69 % responder rate to PRO 160/120 was significantly superior to the placebo response (52 %; p = 0.003, χ (2)-test, two-tailed). The majority of responders improved by 1 void/night. Absolute improvements and response rates were consistently higher with PRO 160/120 than with placebo over a range of baseline nocturnal voiding frequencies. There were no differences between PRO 160/120 and finasteride or tamsulosin regarding absolute improvement of nocturnal voids or responds rates. PRO 160/120 significantly improved nocturnal voiding frequency compared to placebo and similar to tamsulosin or finasteride.

Relationship between urinary incontinence and quality of life/depression in elderly patients

PurposeThe aim of this study was to investigate the relationship between urinary incontinence (UI) and quality of life/depression in elderly patients. MethodsThe study included a total of 109 elderly adults aged 65 years and older, consisting of 44 patients with and 65 patients without UI. Demographic data were recorded and UI was assessed using a questionnaire. The Standardized Mini-Mental State Examination was used to evaluate cognitive function. Depression status was assessed using the Yesavage Geriatric Depression Scale and quality of life was assessed using Short Form-36 (SF-36) Health Survey scoring. ResultsThe mean ± standard deviation (SD) age of the elderly patients with UI was 80.06 ± 6.25 years; 21 (47.7%) were women and the other 23 (52.3%) were men. The mean ± SD visual analog scale score for the severity of UI was 6.22 ± 0.85; the mean ± SD number of diurnal voidings was 7.20 ± 0.87 and the mean ± SD number of nocturnal voidings was 3.81 ± 0.97. The mean ± SD depression score of elderly patients with UI was significantly higher than those without UI (p < 0.0001). There was a strong negative correlation between depression and UI (p < 0.0005; r = −0.886). Both the mental and physical scores of the SF-36 quality of life scale were significantly lower in elderly patients with UI than in those without (p < 0.005). An increased risk of depression (5.90-fold) was found in elderly patients with UI compared with those without UI. UI was found to cause a 0.037 point reduction in the physical component score and a 0.055 point reduction in the mental component score; these are statistically significant. ConclusionUI in elderly adults leads not only the loss of physical abilities, but also to changes in their mental condition.

Nocturia improvement in the combination of Avodart(®) and tamsulosin (CombAT) study.

The purpose of the study was to assess the impact of dutasteride plus tamsulosin combination therapy, compared with dutasteride or tamsulosin monotherapy, on nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) using data from the 4-year CombAT study. Nocturia was assessed using Question 7 of the International Prostate Symptom Score questionnaire. Efficacy measures included as follows: mean change in nocturia at 3-month intervals up to 48 months; proportion of patients with improvement/worsening in nocturia; nocturnal voiding frequency at baseline and study end, overall and by baseline subgroups; and nocturnal voiding frequency <2 at study end in patients with a baseline score ≥ 2. In total, 4,722 patients with a mean age of 66 years were included. Mean nocturia improvements were significantly superior (p ≤ 0.01) with combination therapy than with either monotherapy (adjusted mean change from baseline in IPSS Question 7 score at month 48: combination therapy -0.5, dutasteride -0.4, tamsulosin -0.3). Reduction in nocturia score with combination therapy was significantly (p ≤ 0.01) better than tamsulosin monotherapy across all baseline subgroups tested, except for men with previous 5ARI use. Among those with a baseline IPSS Q7 score ≥ 2, more patients with combination therapy had a score <2 at month 48 (34 %) compared with dutasteride (30 %, p = 0.018) or tamsulosin (26 %, p < 0.0001). Combination therapy provided greater improvements and less worsening of nocturia compared with both dutasteride and tamsulosin monotherapies. These analyses are the first to show greater improvement with a 5ARI/α-blocker combination versus either agent alone for the management of nocturia in patients with LUTS/BPH.

The economic impact of nocturia

Sleep disturbances associated with nocturia cause direct, indirect, and intangible costs. Direct costs are primarily associated with injuries from falling. Indirect costs are associated with loss of work productivity. Intangible costs include emotional distress, behavioral modifications, feelings of loss of control, poor mood, and cancellation of planned activities. A study that compared the number of falls for patients with varying numbers of voids per night demonstrated that the incremental risk (population attributable risk [PAR]) of falling as a result of nocturia (≥ 2 voids compared with ≤ 1 void) was 16.2%. Using the 16.2% PAR, the annual direct cost of nocturia in the USA was estimated at $1.5 billion. An analysis in the EU-15 countries estimated the total annual cost of hospitalizations for hip fracture due to severe nocturia to be approximately € 1 billion. Studies have shown that periods of sick leave are significantly greater in both men and women who have more nocturnal voids, with an estimated annual indirect cost of nocturia of $61 billion in the USA. A similar European analysis showed an estimated annual cost of lost work productivity due to nocturia of € 29 billion in the EU-15. The intangible personal costs of nocturia are related to diminished quality of life and overall health status. High-quality articles on the cost of illness associated with nocturia, as well as cost-benefit analyses of nocturia treatment, are generally lacking.

Management of nocturia: the role of antidiuretic pharmacotherapy.

Strategies to manage nocturia include lifestyle modifications and treatment with alpha-blockers, antimuscarinic therapies, and antidiuretics. The concept of achieving success should not be limited to reduction of nighttime voids; it should ideally include proof of improvement of conditions generally associated with nocturia, such as falls, quality of life, and overall health. Few studies have looked specifically at parameters other than nocturnal voids, such as sleep latency, first undisturbed sleep period (FUSP), and total sleep time, including their clinical relevance to patient well-being. Lifestyle modifications, such as voiding before bedtime, limiting caffeine and alcohol, and adjusting medication timing, may be initially effective in mild cases of nocturia. Statistically significant reductions in voiding have been reported with antimuscarinic agents and alpha-blockers as initial therapy, but these reductions generally are not clinically relevant. The antidiuretic therapy desmopressin acetate, a selective vasopressin receptor 2 agonist, is effective in adults with nocturia associated with nocturnal polyuria; however, hyponatremia can occur. The newest formulation-desmopressin orally disintegrating sublingual tablet (ODST)--has greater bioavailability; thus, lower doses can be used, potentially reducing hyponatremia risk. A phase 3 study demonstrated statistically significant reductions in nocturnal voids for desmopressin ODST 50 and 100 µg versus placebo (-1.18 and -1.43 vs. -0.86; P = 0.02 and P < 0.0001, respectively) in patients with nocturia. Treatment was well-tolerated, and low-dose desmopressin ODST was associated with statistically significant increases in duration of FUSP. Development of a validated composite endpoint may help clinicians identify and compare strategies for treating nocturia.

Terminology, epidemiology, etiology, and pathophysiology of nocturia

Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia affects men and women and is more prevalent among the elderly. More than two nocturnal voids is considered to be a clinically meaningful threshold associated with significant negative outcomes for health and well-being, and the timing of awakening has a significant bearing on the negative consequences of nocturia. Several serious underlying pathophysiologic conditions may be associated with nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient's nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient's nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturnal polyuria is defined as more than 20% of daily urine output at night in young patients and more than 33% in elderly patients. Reduced bladder capacity may be a result of idiopathic or neurogenic detrusor overactivity, bladder outlet obstruction, or reduced nocturnal bladder capacity. The pathophysiology underlying the findings of the FVC falls into five main categories: global polyuria, nocturnal polyuria, reduced bladder capacity, sleep disorders, and circadian clock disorders. This review discusses the epidemiology, etiology, and pathophysiology of nocturia.

Renal physiology of nocturia.

Renal function, diurnal fluctuations in arginine vasopressin (AVP) secretion, sex, and advanced age affect urine formation and may contribute to nocturia. Renal effects of AVP are mediated by AVP V2 receptors in the kidney collecting duct. Changes in AVP concentration have the greatest relative effects on urine volume when AVP levels are low; therefore small changes can have a large effect on renal water excretion. AVP is the major regulator of water excretion by the kidneys, and AVP levels have been shown to affect nocturnal voiding. Results of several studies show that patients with nocturia had no significant variation in plasma AVP, whereas patients without nocturia had significant diurnal variation in plasma AVP. The V2 receptor gene is located on the X chromosome, which has important sex-specific consequences. For example, mutations in the V2 gene can cause nephrogenic diabetes insipidus, predominantly in men. Age-related changes in water metabolism are associated with overall body composition, kidney, and brain. Older people generally experience decreased extracellular fluid and plasma volume, which leads to increased adverse consequences from net body water gain or loss. Renal function declines with age, and the ability to concentrate urine and conserve sodium is reduced in the elderly. Thirst perception is also decreased in the elderly, who, compared with younger people, tend to hypersecrete AVP in response to higher plasma osmolality, possibly resulting in hyponatremia. These aspects of renal physiology should be considered when antidiuretic drugs are prescribed for the treatment of nocturia.

A Systematic Review of the Efficacy and Safety of Desmopressin for Nocturia in Adults

We systematically reviewed desmopressin as treatment for nocturia ingenerally healthy adults with a focus on benefits and harms. After a literature search we identified 10 articles (2,191 patients) that met our inclusion criteria of parallel group design, randomized, controlled trials with information on at least 1 benefit or harm of desmopressin in patients with nocturia. We evaluated the quality of included trials based on The Cochrane Collaboration criteria, assessed heterogeneity using the I(2) statistic and performed random effects meta-analysis. Studies were generally of high quality, although 4 used an active run-in period to titrate the dose and exclude patients with adverse effects or who were nonresponders. Thus, they were at high risk for bias. Desmopressin doses of at least 25 mcg or greater decreased nocturnal voids and increased time to first void. A dose of 100 mcg provided just more than an hour of additional sleep before the first void compared with placebo as well as 0.72 fewer voids per night. Higher doses provided no significant increase in benefit. Hyponatremia (RR 5.1) and headache (RR 4.3) were the most common adverse effects. Serious adverse effects were rare. Desmopressin appears to offer a modest benefit for treating nocturia in generally healthy adults with adequate safety. The initial dose should bebetween 50 and 100 mcg. Higher doses should only be used with caution and a lower initial dose of 25 to 50 mcg is appropriate in elderly patients. All patients should be monitored for hyponatremia. The drug should be used with caution in patients with chronic lung disease due to the rare occurrence of respiratory failure. Additional well designed, adequately powered studies 1 or more years in duration are needed.

Excessive daytime sleepiness and nocturia in women

ObjectiveTo investigate associations between excessive daytime sleepiness and nocturia in women. MethodA total of 488 women aged 18–89years who underwent screening for cervical cancer at one institution in Florianópolis, Brazil, took part in this investigation. Sleep issues and daytime sleepiness, urinary frequency, and nutritional status were investigated. ResultsThe prevalence of excessive daytime sleepiness was 31.3%. Most of the women reported having nocturia, since 32.4% reported one nocturnal voiding, and 24.3% two or more nocturnal voidings. Higher nocturnal voiding frequency was identified in women who spent longer in bed (P=0.028) and had worse quality of sleep (P<0.001), higher daytime sleepiness (P=0.016) and excess body weight (P<0.001). A higher prevalence of daytime sleepiness was also observed in those women assumed to have urine leakage (P=0.006). Women with two or more nocturnal voidings presented 1.58 (CI: 1.06–2.37) higher prevalence of daytime sleepiness independent of time in bed (P=0.030). ConclusionWomen with at least two nocturnal voidings presented higher prevalence of daytime sleepiness, worse sleep quality, and longer time in bed. Moreover, women with daytime sleepiness presented higher frequency of urine leakage.

Consistent and significant improvement of nighttime voiding frequency (nocturia) with silodosin in men with LUTS suggestive of BPH: pooled analysis of three randomized, placebo-controlled, double-blind phase III studies

Nocturia is prevalent and bothersome in men with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). α-Adrenoceptor antagonists without subtype selectivity have inconsistently shown significant effects on nocturia in these patients. We explored the effects of the α1A-adrenoceptor subtype-selective antagonist silodosin on nocturia by analyzing three placebo-controlled registration studies. Responses to question 7 of the IPSS questionnaire were analyzed for the entire study population and patients with ≥ 2 voids/night at baseline. Improvement/worsening rates for nocturia were calculated for once-daily silodosin 8 mg and placebo. Silodosin effects on the mean number of nocturnal voids were compared with placebo, and the number of patients in whom nocturia was reduced to <2 times was calculated. In total, 1,479 men were treated with silodosin or placebo; 1,266 men (85 %) had ≥ 2 voids/night at baseline. Compared to placebo, more men treated with silodosin reported about nocturia improvement (53.4 vs. 42.8 %, p < 0.0001) and fewer patients about worsening (9.0 vs. 14.3 %, p < 0.0001). Silodosin significantly reduced nocturia within each study and pooled cohort compared to placebo (p < 0.001). In men with ≥ 2 nocturnal voids at baseline, 61 and 49 % of patients with silodosin and placebo had reductions of ≥ 1 voids/night, respectively (p = 0.0003), and significantly more patients with silodosin had <2 nocturia episodes at study end compared to placebo (29.3 vs. 19.0 %; p = 0.0002). Although a weak impact on nocturia is already known from α-adrenoceptor antagonists without subtype selectivity, the individual placebo-controlled studies and the pooled data analysis showed that the α1A-adrenoceptor subtype-selective antagonist silodosin consistently and significantly improves nocturia in men with LUTS/BPH.

Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study.

PurposeThe aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU).MethodsPatients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia.ResultsA total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in both groups.ConclusionsCombination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI. Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.