Citation Information :
Suri JC, Sen MK, Gupta M, Pilaniya V, Chatterjee P, Sood N, Adhikari T. Prevalence of Nocturia in Sleep-Disordered Breathing and its Correlation with Severity of the Disease. Indian Sleep Med 2012; 7 (1):23-28.
Background: Nocturia is a common complaint in the general population and prevalence varies across studies. It not only causes significant sleep disruption and daytime consequences such as impaired concentration and fatigue but also is independently associated with the risk of cardiovascular morbidity. Nocturia may be associated with various disorders including sleep-disordered breathing (SDB). The mechanism by which SDB causes nocturia is not clear from the various studies conducted so far. Several different hypotheses suggesting various different mechanisms have been proposed. A systematic large-scale study of the association between nocturia and SDB indicating its prevalence and association with its severity has not been performed. Objective: To investigate the occurrence of nocturia in SDB, identify its prevalence and explore its correlation with severity of the disease. Methodology: A prospective case-controlled study was conducted among 150 adult patients of SDB with obstructive sleep events, along with 150 age- and sex-matched healthy adult controls. The cases were subclassified into mild (respiratory disturbance index [RDI] >5–15/ h), moderate (RDI >15–30/h) and severe (RDI >30/h) categories comprising 50 patients each. Scoring was done and the diagnosis was made in accordance with the latest American Academy of Sleep Medicine guidelines. Both cases and controls were evaluated for the presence of nocturia, pathological nocturia (PN) and frequency of nocturia through a common questionnaire. Nocturia was defined as self-reported awakening at least once per night to urinate, while PN was defined as awakening at least twice per night to urinate. Statistical analysis was carried out using SPSS 16.0 (SPSS Inc., Chicago, IL USA) and GraphPad Prism 6.01 software and a p value of < 0.05 was considered as statistically significant. Results: Nocturia was found to be present in more than 4/5of the patients, and half of the patient population had PN (p<0.0001). The mean frequency of nocturia in patients was 1.75±1.29 and that in the control group was 0.51±.071 (p<0.0001). Nocturia was found to be more common in females compared with males. The prevalence of PN differed significantly (p<0.05) between various severities of SDB, thereby showing an increase in the frequency with increasing severity of the disease. The correlation between severity of SDB and frequency of nocturia was also found to be positive (p<0.001). Conclusions: Nocturia and PN are more common in patients of SDB as compared to the general population, and more commonly seen with increased severity of SDB. The frequency of nocturia shows an independent positive correlation with severity of SDB irrespective of the presence of various confounders for nocturia. High prevalence of both PN and SDB in the population suggests the likelihood of the presence of a large percentage of patients with nocturia having concomitant SDB.
Middelkoop HA, Smilde-van den Doel DA, Neven AK, et al. Subjective sleep characteristics of 1,485 males and females aged 50–93: effects of sex and age, and factors related to self-evaluated quality of sleep. J Gerontol A BiolSci Med Sci 1996; 51:108–115.
Asplund R. Mortality in the elderly in relation to nocturnal micturition. BJU Int 1999; 84:297–301.
Asplund R, Marnetoft SU, Selander J, et al. Nocturia in relation to somatic health, mental health and pain in adult men and women. BJU Int 2005; 95:816–819.
Tikkinen KA, Auvinen A, Johnson TM 2nd, et al. A systematic evaluation of factors associated with nocturia — the population based FINNO study. Am J Epidemiol 2009; 170:361–368.
Tikkinen KA, Johnson TM 2nd, Tammela TL, et al. Nocturia frequency, bother and quality of life: how often is too often? A population-based study in Finland. Eur Urol 2010; 57:488–496.
Van Kerrebroeck P, Abrams P, Chaikin D, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 2:179–183.
Malmsten UG, Milsom I, Molander U, Norlen LJ. Urinary incontinence and lower urinary tract symptoms: an epidemiological study of men aged 45 to 99 years. J Urol 1997; 158:1733–1737.
Swithinbank LV, Donovan J, James MC, Yang Q, Abrams P. Female urinary symptoms: age prevalence in a community dwelling population using a validated questionnaire. Neurourol Urodyn 1998; 16:432–434.
Yoshimura K, Terada N, Matsui Y, Terai A, Kinukawa N, Arai Y. Prevalence of and risk factors for nocturia: Analysis of a health screening program. Int J Urol 2004; 11:282–287.
Hunskaar S. Epidemiology of nocturia. BJU Int 2005; 96:4–7.
Tikkinen KA, Tammela TL, Huhtala H, et al. Is nocturia equally common among men and women? A population based study in Finland. J Urol 2006; 175:596–600.
Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol 2010; 184:440–446.
Van Kerrebroeck P. Nocturia: current status and future perspectives. Curr Opin Obstet Gynecol 2011; 23:376–385.
Yokoyama O, Lee SW, Ohkawa M, Amano T, Ishiura Y, Furuta H. Enuresis in an adult female with obstructive sleep apnea. Urology 1995; 45:150–154.
Ulfberg J, Thuman R. A non-urologic cause of nocturia and enuresis — obstructive sleep apnea syndrome (OSAS). Scand J Urol Nephr 1996; 30:135–137.
Umlauf M, Kurtzer E, Valappil T, Burgio K, Pillion D, Goode P. Sleep-disordered breathing as a mechanism for nocturia: preliminary findings. Ostomy Wound Manage 1999; 45:52–60.
Cole OJ, Osborn DE, Hanning CD. Obstructive sleep apnoea causing nocturia. BJU Int 2001; 87:414.
Krieger J, Petiau C, Sforza E, Delanoe C, Hecht MT, Chamouard V. Nocturnal pollakiuria is a symptom of obstructive sleep apnea. Urologia Internationalis 1993; 50:93- 97.
Pressman MR, Figueroa WG, Kendrick-Mohamed J, Greenspon LW, Peterson DD. Nocturia: A rarely recognized symptom of sleep apnea and other occult sleep disorders. Arch Internal Med 1996; 156:545–550.
Hajduk IA, Strollo PJ Jr., Jasani RR, Atwood CW Jr., Houck PR, et al. Prevalence and predictors of nocturia in obstructive sleep apnea–hypopnea syndrome — a retrospective study. Sleep 2003; 26:61–64.
Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev 2003; 7:403–411.
American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd ed, American Academy of Sleep Medicine, Westchester, Illinois 2005.
Follenius M, Krieger J, Krauth MO, et al. Obstructive sleep apnea treatment: peripheral and central effects on plasma renin activity and aldosterone. Sleep 1991; 14:211–217.
Fletcher EC. Obstructive sleep apnea and the kidney. J Am Soc Nephrol 1993; 4:1111–1121.
Berry RB, Kouch KG, Der DE, et al. Sleep apnoea impairs the arousal response to airway occlusion. Chest 1996; 109: 1490–1496.
Ichioka M, Hirata Y, Inase N, Tojo N, Yoshizawa M, Chida M, Miyazato I, Taniai S, Marumo F. Changes of circulating atrial natriuretic peptide and antidiuretic hormone in obstructive sleep apnea syndrome. Respiration. 1992; 59:164–168.
Lin C, Tsan K. Plasma levels of atrial natriuretic factor in moderate to severe obstructive sleep apnoea syndrome. Sleep 1993; 16: 37–39.
Kramer NR, Bonitati AE, Millman RP. Enuresis and obstructive sleep apnea in adults. Chest 1998; 114:634–637.
Nogaard JP, Ritting S, Djurhuus JC. Nocturnal enuresis: an approach to treatment based on pathogenesis. J Pediatr 1989; 114:705–710.
Romero E, Krakow B, Haynes P, Ulibarri V. Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep Breath 2009; 11:167–172.
Parthasarathy S, Fitzgerald MP, Goodwin JL, Unruh M, Guerra S, Quan SF. Nocturia, Sleep-disordered breathing, and cardiovascular morbid in a community-based cohort. PLoS ONE 2012; 7: e30969. doi:10.1371/journal.pone.0030969.