BERKELEY, CA (UroToday.com) - The International Continence Society (ICS) has defined nocturia as a condition where an individual wakes in the night with the desire to void. Nocturia, which adversely affects the quality of life, is especially frequent in older men. It is regarded as one of the most bothersome lower urinary tract symptoms (LUTS), which include frequency, urgency, and difficulty in initiating urination.
Nocturia has been reported to cause various problems, particularly fractures, as well as an increased risk of nighttime falls, fatigue, depression, obesity, decreased work efficiency, traffic accidents, coronary heart disease, and sudden death, especially for elderly men who have difficulty walking due to awakening during the night.[4, 5]
It has been suggested that the most common causes of LUTS are benign prostatic hyperplasia (BPH) causing urethral obstruction, and conditions that increase the volume of urine, such as the use of diuretics. Other conditions are also considered contributing reasons for nocturia and the other symptoms of LUTS: heart failure, diabetes mellitus (DM), sleep apnea syndrome, metabolic syndrome and problems that reduce the bladder’s functional capacity.[3, 6]
The aim of this study was to investigate the roles of certain factors, including age, metabolic syndrome, nocturnal polyuria, and sleep disorders in patients with LUTS.
Material and Methods
A total of 118 consecutive patients (56, ± 10 years) with LUTS were enrolled in this study. After medical histories were taken and physical examinations conducted, biochemical tests and measures for LUTS were carried out and International Prostate Symptom Scores (IPSS) were calculated. Anthropometric measurements were performed, and Epworth scores (ES) were examined for sleep disturbances. Metabolic syndrome, daily urine output and nocturnal polyuria were investigated, and body mass index (BMI) was calculated.
Patients were divided into two groups with respect to nocturia: the first (n=31) group having no or one incident of nocturia per night, and the second group (n=87) with two or more nightly incidents of nocturia. The factors investigated were compared between the two groups. The data were analysed statistically; p < 0.05 was considered significant.
Results and a Brief Discussion
An association has been found between nocturia and a large waist circumference, which indicates central obesity. In addition, the patients’ heights and weights were both found to be associated with the frequency of nocturia, and BMIs obtained from these data were significantly different between the two groups in the study. A significant association was observed between high fasting insulin levels and nocturia, but insulin resistance was similar in both groups.
In this study, patients with one or no incidents of nocturia had significantly fewer sleep disturbances than patients with two or more. Nevertheless, as stated by Yoo et al., the degree of sleep disturbance might be more than what the study determined, because some people mask or omit their sleep problems. A strong and significant association was observed between nocturnal polyuria and nocturnal frequency. Similarly, an association between nocturnal polyuria and IPSS was noted. Although weak, an association between ES and nocturnal polyuria has been established. It has therefore been suggested that sleep disturbances might influence nocturnal frequency due to nocturnal polyuria. Although nocturia is defined as waking up one or more times to void, it has been suggested that it has more impact in terms of daily consequences when it occurs two or more times per night.[1, 2, 4, 7] In this study it has also been shown that patients perceive nocturia as more inconvenient when the nocturnal voiding frequency is two or more times.
In conclusion, age, nocturnal polyuria, metabolic syndrome, and sleep disturbances have been determined to be important factors in the frequency of nocturia, and, consequently, in LUTS. Therefore, steps taken to alleviate factors that can be altered—such as hypertension, weight gain, sleep disturbances and IPSS—may improve the individual’s quality of life.
- 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, 21(2), 179–183.
- Varilla V, Samala RV, Galindo D, et al. Nocturia in the elderly. A wake-up call. Rev. Cleve Clin J Med 2011, 78 (11), 757–764.
- Parsons JK. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms, Epidemiology and Risk Factors. Curr Bladder Dysfunct Rep 2010, 5(4), 212–218.
- Kim SO, Choi HS, Kim YJ, et al. Impact of Nocturia on Health-Related Quality of Life and Medical Outcomes Study Sleep Score in Men. Int Neurourol J 2011, 15 (10), 82–86.
- Yoo SS, Shim BS, Lee DH, et al. Correlation between Nocturia and Sleep, A Questionnaire Based Analysis. KJU 2010, 51(11),757–762.
- McVary KT. Clinical Evaluation of Benign Prostatic Hyperplasia. Clin Ther 2007 Mar, 29(3), 387–398.
- Furtado D, Hachul H, Andersen ML, et al. Nocturia × disturbed sleep, a review. Int Urogynecol J 2012 Mar, 23(3), 255–267.
Hasan S. Sağlam, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Sakarya University Medical School, Urology Dept., Sakarya, Turkey