Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men

Sean A. Martin,
Sarah L. Appleton,
Robert J. Adams,
Anne W. Taylor,
Peter G. Catcheside,
R. Douglas McEvoy,
Nick A. Antic,
Gary A. Wittert

Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia Population Research and Outcome Studies, University of Adelaide, Adelaide, SA, Australia Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia The NHMRC Centres of Research Excellence, CIRUS and NEUROSLEEP, Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, NSW, Australia

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Abstract

http://www.sciencedirect.com/science/article/pii/S0090429516303132

Objectives:

To examine the influence of obstructive sleep apnea (OSA) on nocturia, controlling for their shared co-morbidities, in a population of community-based middle aged to elderly men.

Methods:

Participants were drawn from a randomly selected, community-dwelling cohort of men in Adelaide,Australia. Seven hundred and eight men (mean: 60.7 [41.6-88.2] years) who had polysomnographyrecordings, complete lower urinary tract symptoms (LUTS) measures (International Prostate SymptomScore), without prostate or bladder cancer and/or surgery, and no prior OSA diagnosis were selected.Nocturia was defined as ≥2 voids per main sleep. Unadjusted and multi-adjusted regression models ofnocturia were combined with OSA, wake after sleep onset, total sleep period, excessive daytimesleepiness (EDS), and sleep quality (SQ) data, together with socio-demographic, and health-relatedfactors.

Results:

Men with nocturia were found to have higher levels of OSA (32.2% [n = 65]), wake after sleep onsettime (97.2 ± 52.9 minutes), sleep period (467.3 ± 58.4 minutes), EDS (18.2% [n = 37]), and poorer SQ 54.3% [n = 108]). Multiple-adjusted models showed nocturia was positively associated with OSA(odds ratio:1.64, 95% confidence interval [1.03,2.55]), EDS (1.72 [1.01,2.93]), and poorer SQ (1.65[1.10,2.48]). Including other storage and voiding LUTS attenuated the effect of OSA and strengthenedthe association with EDS (2.44 [1.45,4.10] and 2.24 [1.19,4.22]), whereas voiding LUTS alsostrengthened the association with poorer SQ (2.61 [1.63,4.17]). Men with increasing nocturicfrequency spent less time in N2 and rapid eye movement stage sleep.

Conclusion:

Nocturia is strongly associated with OSA in community-based men. Nocturia also reduces sleepefficiency/SQ, N2, and rapid eye movement sleep time, while increasing EDS. Other LUTS increaseEDS through non-OSA means.

Philip Van Kerrebroeck

This study examines the influence of obstructive sleep apnea (OSA) on nocturia, in a population of community-based middle aged to elderly men. Participants were drawn from a randomly selected cohort of men in Adelaide, Australia. In total 708 men (mean: 60.7 [41.6-88.2] years) were included that had polysomnography recordings, complete lower urinary tract symptoms (LUTS) measures (IPSS), without prostate or bladder cancer and/or surgery, and no prior OSA diagnosis. Nocturia was defined as ≥2 voids per main sleep. Unadjusted and multi-adjusted regression models of nocturia were combined with OSA, wake after sleep onset, total sleep period, excessive daytime sleepiness (EDS), and sleep quality (SQ) data, together with socio-demographic, and health-related factors. Men with nocturia (32.2%[n = 65]), were found to have higher levels of OSA wake earlier after sleep onset time(97.2 ± 52.9 minutes), have shorter sleep period (467.3 ± 58.4 minutes), increased EDS(18.2%), and poorer SQ (54.3% ). Multiple-adjusted models showed nocturia was positively associated with OSA, EDS, and poorer SQ. Including other storage and voiding LUTS attenuated the effect of OSA and strengthened the association with EDS, whereas voiding LUTS also strengthened the association with poorer SQ. Men with increasing nocturic frequency spent less time in N2 and rapid eye movement stage sleep. Based on these results the authors conclude that nocturia is strongly associated with OSA in community-based men, and reduces sleep efficiency/SQ, N2, and rapid eye movement sleep time, while increasing EDS. They also indicate that other LUTS increase EDS through non-OSA means.