Obstructive Sleep Apnea in a Danish Population of Men and Women Aged 60-80 Years with Nocturia
2012; American Academy of Sleep Medicine; Volume: 08; Issue: 05 Linguagem: Inglês
10.5664/jcsm.2144
ISSN1550-9397
AutoresMette Hornum Bing, Poul Jennum, Lars Alling Møller, Svend Mortensen, Gunnar Lose,
Tópico(s)Urinary Bladder and Prostate Research
ResumoFree AccessObstructive Sleep ApneaObstructive Sleep Apnea in a Danish Population of Men and Women Aged 60-80 Years with Nocturia Mette Hornum Bing, Ph.D., M.D., Poul Jennum, D.M.Sc., M.D., Lars Alling Moller, Ph.D., M.D., Svend Mortensen, D.M.Sc., M.D., Gunnar Lose, D.M.Sc., M.D. Mette Hornum Bing, Ph.D., M.D. Address correspondence to: Mette Hornum Bing, M.D., Ph.D., Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark(+ 45) 24 25 28 16 E-mail Address: [email protected] Department of Obstetrics and Gynaecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark , Poul Jennum, D.M.Sc., M.D. Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Herlev, Denmark , Lars Alling Moller, Ph.D., M.D. Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Herlev, Denmark , Svend Mortensen, D.M.Sc., M.D. Department of Urology, Herlev Hospital, University of Copenhagen, Herlev, Denmark , Gunnar Lose, D.M.Sc., M.D. Department of Urology, Herlev Hospital, University of Copenhagen, Herlev, Denmark Published Online:October 15, 2012https://doi.org/10.5664/jcsm.2144Cited by:13SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTIntroduction and Hypothesis:The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea, in men and women who had nocturia ≥ 2 per night (nocturics) compared to those without nocturia (controls).Methods:Participants were randomly selected among respondents in a population study of 4000 elderly individuals. Nocturia was assessed using the validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire (NNES-Q). Nocturia (≥ 2 voids/night) or control (< 1 void/night) status was assessed by a 3-day frequency volume chart (FVC). Furthermore, all participants completed an overnight ambulatory polygraphic recording to identify obstructive sleep apnea (OSA).Results:Of 1111 eligible individuals, a total of 75 nocturics and 75 controls (13.5%) were included. Overall, the prevalence and severity of OSA among nocturics and controls was not significantly different. In a sub-analysis we found that 22 nocturics with OSA (69%) had nocturnal polyuria. This led to a significantly increased risk of having OSA (OR 2.8, 95% CI: 1.1-7.3, p < 0.05) when having nocturnal polyuria compared to other pathophysiological causes of nocturia (polyuria, low bladder capacity, a combination of nocturnal polyuria/low bladder capacity, and neither nocturnal polyuria/low bladder capacity).Conclusions:Nocturia twice or more was not significantly associated with OSA. However, nocturics with nocturnal polyuria had a significantly higher risk of having OSA than nocturics with other pathophysiologies.Citation:Bing MH; Jennum P; Moller LA; Mortensen S; Lose G. Obstructive sleep apnea in a danish population of men and women aged 60-80 years with nocturia. J Clin Sleep Med 2012;8(5):515-520.INTRODUCTIONSleep apnea patients often have nocturia, mainly due to nocturnal polyuria,1,2 possibly because of increased plasma and urine levels of atrial natriuretic peptide (ANP), leading to increased natriuresis and diuresis.3,4 Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) treatment may reduce the nocturia.5–7The frequency of sleep disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), increases with age.8 The main cause of SDB is OSA, a repetitive partial or complete obstruction of the upper airway during sleep leading to repetitive hypoxic episodes.9 If OSA is combined with excessive daytime sleepiness (EDS), the condition is termed obstructive sleep apnea syndrome (OSAS). The prevalence of OSA in Denmark is 10% to 15% of men and 5% to 8% of women 30-60 years old10; however, a minority of persons with OSA have OSAS, estimated at 2% to 4% of men and 1% to 2% of women.11 Despite the common occurrence of OSA in older adults, its clinical significance remains unclear12,13; it is especially unclear whether there is an association between nocturia and OSA in a general population. Data regarding this issue have mostly emerged from sleep clinic populations14,15; results from unselected populations are sparse.12,26 However, data demonstrate that older adults with severe sleep disordered breathing have an increased number of nocturia episodes.BRIEF SUMMARYCurrent Knowledge/Study Rationale: Nocturia and OSA are common conditions in the elderly population. Is there an association between the two conditions in the general population?Study Impact: The study showed no overall difference in prevalence of OSA among nocturics and controls. However, nocturics having nocturnal polyuria, had a significant increased risk of having OSA.Nocturia, defined as waking up at night to void,2 is highly prevalent in the elderly population.16–18 The pathophysiological causes of nocturia are polyuria, nocturnal polyuria, low bladder capacity, sleep disorders, or combinations of these. Age-related changes in the lower urinary tract (including prostatic disease) may cause nocturia, but factors unrelated to the lower urinary tract may also play a role.19,20 Factors like excessive fluid before bedtime, alcohol, caffeine, diuretics, and pathological conditions such as hypertension, congestive heart failure, diabetes mellitus, neurological diseases, and OSA may be involved.2,19,21Data regarding nocturia and OSA emerging from a general population are sparse; however, such data might elucidate the overall risk of having OSA in nocturics. This might support the clinician in selecting individuals with nocturia who should be referred for further work-up in a sleep clinic.The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea by comparing men and women who had nocturia ≥ 2 per night (nocturics) to those without nocturia (controls).MATERIALS AND METHODSNocturia was defined as waking up at night to void. Nocturnal polyuria was defined as nocturnal urine volume larger than 33% (in the elderly) of the total 24-h urine volume. All definitions were in accordance with ICS terminology.2Nocturia was assessed in a population study using the new and validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire (NNES-Q).18,22 Daytime sleepiness was evaluated using Epworth Sleepiness Scale (ESS).23 The ESS is designed to provide a measurement of an individual's general level of daytime sleepiness. Respondents are asked to rate on a scale of 0-3 how likely they would be to doze off or fall asleep in 8 situations, based on their usual way of life in recent times.Except for gender-specific items (e.g., deliveries, hormonal treatment, prior gynecological surgery, prior prostate surgery) the questionnaire as a whole, was similar to all. The total number of items in the questionnaire was 98 for women and 94 for men.Participants were randomly recruited among respondents in a population study of 4000 men and women aged 60-80 years. Details from this study have previously been reported.18 The inclusion criterion was if participants had completed a question on nocturia. Exclusion criteria were night shift work, severe physical disability, or mental impairment (dementia) and inability to follow instructions. Eligible for inclusion were participants who confirmed nocturic or control status by using a 3-day frequency volume chart (FVC), which recorded volumes and time of each micturition over 3 representative days. Voids that occurred between the time recorded for initiation of nighttime sleep and wake time in the morning were considered nocturia episodes; all other voiding was diurnal. Based on the FVC findings, individuals were categorized as nocturics if they had an average ≥ 2 nocturia episodes/night; controls had an average < 1 nocturia (less than one) episode/night over a 3-day period. Participants were asked to report urinary incontinence episodes in FVCs (Figure 1).Figure 1: Flow-chart of participantsDownload FigureMedical history was obtained through semi-structured interviews. Physical examination was performed, and height and weight measured. All participants completed an overnight ambulatory polygraphic recording identifying chest and abdominal movements, airflow through the nose, and pulse oximetry (Embletta PDS, Flaga, Iceland), which is a valid standard method of screening for SDB.24Participants were given oral and written instructions on how to use the polygraphic equipment on the day of the sleep study. The sleep recording equipment was returned within 1-2 days and data downloaded. Sleep data was evaluated for technical quality; if insufficient, the study was repeated.Data analysis was performed by initial automatic scoring, supervised by an experienced polygraphic technician and lastly evaluated by one of the authors (PJ) who was blinded for knowledge of nocturic or control status. Technically adequate recordings of ≥ 5 h sleep were required for the recording to be scored. When scoring the sleep recordings the following conventional definitions were used: Apnea was defined as the cessation of airflow through the nose ≥ 10 sec, and hypopnea was defined as the reduction in airflow ≥ 50% associated with a decrease in the pulse oximetry reading (desaturation) ≥ 4%.9 The severity of obstructive sleep apnea was described by number of apneas and hypopneas per hour of sleep (apnea-hypopnea index [AHI]). A central apnea event occurred if no abdominal movements were registered during an apnea event. OSA was defined as an AHI ≥ 5, and we defined OSAS as an AHI ≥ 5 and excessive daytime sleepiness (ESS score > 12).Statistical AnalysisA total of 46 participants in each group were needed to detect a difference ≥ 20% in frequency of OSA, with a statistical power of 80% and a 2-tailed type 1 error rate of 0.05. Fisher exact test or χ2 test was used to compare frequency data. Unpaired t-test or Wilcoxon rank sum test were used to compare continuous data. A logistic regression model was used to analyze the relationship between nocturic and control status, and the odds of having OSA. Prevalence of potential confounding factors in nocturic and control group was analyzed. Only factors in which a priori χ2 test (categorical data) or ANOVA (continuous data) was significant were included in the model. In all analyses, a 5% significance level was used.The study was approved by the local ethics committee, Copenhagen County (KA 02049).In all analyses, the significance level was chosen to be 0.05. The statistical packages JMP, Version 5 (SAS Institute Inc., http://www.jmpdiscovery.com) and SAS, Version 8.2 were used in the calculations.RESULTSRecruitment of ParticipantsOf 4,000 questionnaires sent, 2,799 (70.0%) answered affirmatively the question regarding nocturia, thereby becoming potential candidates for participation in the study. Of these, 1,022 participants were initially classified as nocturics and 1,777 participants as controls.18A total of 607 nocturics and 615 controls were invited to participate; 93 (7.7%) respondents did not fulfill inclusion criteria according to FVC findings. Another 18 individuals were not eligible for inclusion (1 had died, 6 had concomitant medical diseases prohibiting their participation, 7 had moved away, and 4 withdrew consent). A total of 1,111 individuals were eligible for inclusion. We included 50 women in each group; however, we were only able to include 25 men within the time period from January 2003 to January 2005. Thus, a total of 75 nocturics and 75 controls (13.5%) were included. Median age was 71 years (range: 60-82) in nocturics and 66 years (range: 60-82) in controls (Table 1). Participants in this study were slightly younger (median age 67 years [range: 60-82]) than participants in the population study (median age 70 years [range: 60-80]).18,22Table 1 Characteristics of participantsTable 1 Characteristics of participantsFrequency Volume ChartsMean (95% CI) number of nocturia episodes in nocturics was 2.5 (2.3-2.6), and in controls 0.2 (0.1-0.2), with no significant difference between genders (Table 2). Frequency of individuals having nocturnal polyuria was 55% in nocturics vs. 20% in controls (p < 0.0001).Table 2 Nocturia, Epworth Sleepiness Scale (ESS) score, and sleep variables in participantsTable 2 Nocturia, Epworth Sleepiness Scale (ESS) score, and sleep variables in participantsObstructive Sleep ApneaEleven initial sleep recordings (7.3 %) required repeated evaluation. Two participants with apneas/hypopneas had missing oxygenation recording even after repeated measurements; however they were classified according to their AHI. Further, more women nocturics had oxygen desaturation < 90% compared to controls (Table 2), whereas there was no difference in men. As seen in Figure 2 and Table 2, mean AHI in women was significantly higher in nocturics than controls, whereas no difference in men was observed. In terms of the Epworth Sleepiness Scale, score no significant difference between nocturics and controls was observed.Figure 2: AHI index in relation to nocturic and control status in men (A) and women (B)The solid line is the median, the box the interquartile range, the bars the 10th and 90th percentile and the points the outliers.Download FigureIn nocturics and controls, no significant difference in prevalence and severity of OSA was observed (Table 3). In women, 34% of nocturics had AHI ≥ 5 vs. 24% of controls; in men 56% of nocturics had AHI ≥ 5 vs. 60% of controls. With a more strict definition of OSA based on AHI ≥ 15, the prevalence among nocturics dropped to 16% of nocturics vs. 4% of controls (women) and 32% of nocturics vs. 32% of controls (men). Only one nocturic had OSAS, and this patient had been previously diagnosed with narcolepsy.Table 3 Obstructive sleep apnea (OSA) distribution according to nocturic or control status, stratified by genderTable 3 Obstructive sleep apnea (OSA) distribution according to nocturic or control status, stratified by genderOverall, no significant association between OSA and nocturia in general was demonstrated (OR 1.4, 95% CI: 0.7-2.9; Table 4). One participant had both OSA and central apnea events, and one had predominantly central apnea events. Exclusion of these participants did not change the result. Among those with nocturnal polyuria, there was no significant association between OSA in nocturics vs. controls (OR 1.3 [95% CI: 0.4-4.3]).Table 4In a sub-analysis among nocturics only, we found that 22 individuals with OSA (69%) had nocturnal polyuria. This gives a significant increased risk of having OSA (OR 2.8, 95% CI: 1.1-7.3) when a nocturic had nocturnal polyuria compared to other pathophysiological causes of nocturia (polyuria, low bladder capacity, a combination of nocturnal polyuria/low bladder capacity, or neither nocturnal polyuria/low bladder capacity). In addition, only 7 controls with OSA (27 %) had nocturnal polyuria, and there was no significant increased risk of having OSA when nocturnal polyuria occurred in controls (OR 1.9, 95% CI: 0.6-6.0).We found no significant difference in the prevalence of potential confounders such as hypertension, cardiac disease, neurological disease, use of hypnotics, diabetes, or alcohol intake between nocturics and controls (Table 1). Only time spent in bed differed between the groups. BMI and smoking differed only between women nocturics and controls (Table 1).DISCUSSIONOur study assesses the association between nocturia and OSA in an unselected elderly population of nocturics and controls. We used the validated Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) for assessing nocturia22; nocturia was defined according to the International Continence Society2 and OSA according to the American Academy of Sleep Medicine Task Force.9 Assessing voiding and sleep related respiratory variables within the same sample, selected from a general population have only been addressed in few studies.12,26 These studies demonstrated that older adults with severe sleep disordered breathing have an increased number of nocturia episodes. Most previous studies have been performed in patients attending sleep clinics.37,39The protocol included an intensive examination program, which may partly explain the low participation rate (13.5%). It is likely that the subgroup studied represents a more mobile and healthier population than the total population, which may limit the external validity of the study.Except from time spent in bed, and BMI, and smoking in women, the frequency of potential confounders did not differ between nocturics and controls (Table 1). This is in contrast with results from our earlier population study, which showed that several morbidities were associated with increasing nocturia severity.29 It has previously been demonstrated that time spent in bed differed between nocturics and controls,25 which was confirmed in our study, and we thus adjusted for this effect in the analyses (Table 4).Frequency Volume ChartsWe found that significantly more nocturics than controls had nocturnal polyuria (p < 0.0001), with no difference between genders.41 This finding corresponds with studies by Swithinbank et al. (women),30 Rembratt et al. (men and women),31 and Massolt et al. (incontinent women)32 who found a markedly higher frequency of nocturnal polyuria in subjects having nocturia (≥ 2 voids) compared to no nocturia.Obstructive Sleep ApneaWe found no significant association between nocturia per se and obstructive sleep apnea (Table 4). An explanation could be that the association between nocturia and OSA is only found in severe OSA as previously described in a study of community dwelling elderly.12 Further, a type II error may influence the results.The finding of nocturnal polyuria in the vast majority of nocturics with OSA emphasizes the importance of elucidating the pathophysiology of nocturia in the individual person with nocturia twice or more. The present study shows that AHI was significantly higher in women with nocturia (Table 2); however, the AHI level was relatively low in both nocturics and controls, and the clinical impact of this gender difference remains unclear.In a cross-sectional study of community older adults, Endeshaw et al.12 observed that elderly with an AHI of 25 or greater had significantly more nocturia episodes. This finding agreed with reports on sleep clinic patients.33 Endeshaw et al.12 noted that subjects were not randomized, which could have biased the results.OSA may be associated with increased renal sodium and water excretion mediated by plasma atrial natriuretic peptide (ANP) levels.7,34,35 However, whether ANP level is associated with nocturnal polyuria in the elderly remains unclear.36 In a recent study by Svatikova et al.,37 the effect of moderate-to-severe OSA (AHI ≥ 20) on plasma ANP levels was examined. The authors concluded that acute untreated OSA and subsequent treatment with CPAP significantly altered the levels of ANP. Among contributing factors to nocturnal polyuria may be an age-related reduction in the diurnal variation in the secretion of plasma arginine vasopressin (AVP)38; AVP is often undetectable in elderly with nocturia. However, studies of elderly persons have failed to find any correlation between nocturnal polyuria and AVP levels.42Mechanisms other than those mentioned above may be involved in the pathogenesis of nocturia. Sagaya et al.40 studied biochemical and body composition differences between elderly with nocturia ≥ 2 with young and elderly control groups. The main finding was that in elderly persons with nocturia, a sleep disorder related to a decrease of melatonin may be considered, and a sleep disorder may decrease the threshold for awakening by the desire for voiding.The above studies demonstrate that the mechanism explaining the association between nocturia and obstructive sleep apnea in the elderly remains unclear.In conclusion, nocturia twice or more was not significantly associated with OSA in the present study. However, female nocturics had significantly higher AHI and more desaturations < 90% than female controls, indicating a trend towards women having more severe obstructive sleep apnea if they had nocturia. Furthermore, nocturics with nocturnal polyuria had a significantly higher risk of having OSA than nocturics with other pathophysiologies.DISCLOSURE STATEMENTThis was not an industry supported study. The authors have indicated no financial conflicts of interest.REFERENCES1 Umlauf MGChasens ERSleep disordered breathing and nocturnal polyuria: nocturia and enuresisSleep Med Rev2003740311, 14573376CrossrefGoogle Scholar2 van Kerrebroeck PAbrams PChaikin D, et al.Standardisation Sub-committee of the International Continence Society. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence SocietyNeurourol Urodyn20022117983, 11857672CrossrefGoogle Scholar3 Krieger JLaks LWilcox I, et al.Atrial natriuretic peptide during sleep in patients with obstructive sleep apnea before and during treatment with nasal continuous positive airway pressureClin Sci19897740711, 2530023CrossrefGoogle Scholar4 Ichioka MHirata YInase N, et al.Changes of circulating atrial natriuretic peptide and antidiuretic hormone in obstructive sleep apnea syndromeRespiration1992591648, 1439228CrossrefGoogle Scholar5 Rodenstein DOD′Odemont JPPieters TAubert-Tulkens GDiurnal and nocturnal diuresis and natriuresis in obstructive sleep apnea. Effects of nasal continuous positive airway pressure therapyAm Rev Respir Dis1992145136771, 1596005CrossrefGoogle Scholar6 Zhang LHuang XLi XWu QAlterations in renal function in patients with obstructive sleep apnea syndrome and effects of continuous positive airway pressureChin Med J (Engl)19971109158, 9772401Google Scholar7 Umlauf MKurtzer EValappil TBurgio KPillion DGoode PSleep-disordered breathing as a mechanism for nocturia: preliminary findingsOstomy Wound Manage1999455260, 10687667Google Scholar8 Young TShahar ENieto FJ, et al.Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health StudyArch Intern Med2002162893900, 11966340CrossrefGoogle Scholar9 Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task ForceSleep19992266789, 10450601CrossrefGoogle Scholar10 Jennum PSjol AEpidemiology of snoring and obstructive sleep apnoea in a Danish population, age 30-60J Sleep Res199212404, 10607057CrossrefGoogle Scholar11 Jennum PThonnesen PRasmussen NNorregaard OSleep disordered breathing: definition, prevalence, pathophysiology and consequencesUgeskr Laeger200416723804, 15987026Google Scholar12 Endeshaw YWJohnson TMKutner MHOuslander JGBliwise DLSleep-disordered breathing and nocturia in older adultsJ Am Geriatr Soc20045295760, 15161461CrossrefGoogle Scholar13 Ancoli-Israel SCoy TAre breathing disturbances in elderly equivalent to sleep apnea syndrome?Sleep1994177783, 8191206CrossrefGoogle Scholar14 Pressman MRFigueroa WGKendrick-Mohamed JGreenspon LWPeterson DDNocturia. A rarely recognized symptom of sleep apnea and other occult sleep disordersArch Intern Med199615654550, 8604961CrossrefGoogle Scholar15 Dahlstrand CHedner JWang YHPettersson SSnoring - a common cause of voiding disturbance in elderly menLancet19963472701, 8551922CrossrefGoogle Scholar16 Jackson SLower urinary tract symptoms and nocturia in men and women: Prevalence, aetiology and diagnosisBJU Int19998458, 10674886CrossrefGoogle Scholar17 Middelkoop HSmilde-van den Doel DNeven AKKamphuisen HACSpringer CPSubjective sleep characteristics of 1,485 males and females aged 50-93: effect of gender and age, and factors related to self-evaluated quality of sleepJ Gerontol A Biol Sci Med199651M10815CrossrefGoogle Scholar18 Bing MHMoller LAJennum PMortensen SLose GPrevalence and bother of nocturia, and causes of sleep-interruption in a Danish population of men and women aged 60-80 yearsBJU Int200698599604, 16827903CrossrefGoogle Scholar19 Weiss JPBlaivas JGStember DSBrooks MMNocturia in adults: etiology and classificationNeurourol Urodyn19981746772, 9776009CrossrefGoogle Scholar20 Homma YYamaguchi OKageyama S, et al.Nocturia in the adult: Classification on the basis of largest voided volume and nocturnal urine productionJ Urol200016377781, 10687975CrossrefGoogle Scholar21 Yoshimura KTerada NMatsui YTerai AKinukawa NArai YPrevalence of and risk factors for nocturia: Analysis of a health screening programInt J Urol2004112827, 15147543CrossrefGoogle Scholar22 Bing MHMoller LAJennum PMortensen SLose GValidity and reliability of a questionnaire for evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly populationEur Urol2006497109, 16442700CrossrefGoogle Scholar23 Johns MWA new method for measuring daytime sleepiness: the Epworth Sleepiness ScaleSleep1991145405, 1798888CrossrefGoogle Scholar24 Redline STosteson TBoucher MA, et al.Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring deviceChest199110012816, 1935282CrossrefGoogle Scholar25 Yoshimura KTerai AClassification and distribution of symptomatic nocturia with special attention to duration of time in bed: a patient-based studyBJU Int200595125962, 15892812CrossrefGoogle Scholar26 Umlauf MGChasens ERGreevy RAArnold JBurgio KLPillion DJObstructive sleep apnea, nocturia and polyuria in older adultsSleep20042713944, 14998251CrossrefGoogle Scholar27 Kaynak HKaynak DOztura IDoes frequency of nocturnal urination reflect the severity of sleep-disordered breathing?J Sleep Res2004131736, 15175098CrossrefGoogle Scholar28 Hajduk IAStrollo PJJasani RRAtwood CWHouck PRSanders MPrevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome - a retrospective studySleep20031614, 12627734Google Scholar29 Bing MHMoller LAJennum PMortensen SLose GNocturia and associated morbidity in a Danish population of men and women aged 60-80 yearsBJU Int200810280814, 18564133CrossrefGoogle Scholar30 Swithinbank LVVestey SAbrams PNocturnal polyuria in community dwelling womenNeurourol Urol1998173145Google Scholar31 Rembratt ANorgaard JPAndersson KEDifferences between nocturics and non-nocturics in voiding patterns: an analysis of frequency-volume charts from community-dwelling elderlyBJU Int2003914550, 12614249CrossrefGoogle Scholar32 Massolt ETWooning MMStijnen TVierhout MEPrevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent womenInt Urogynecol J Pelvic Floor Dysfunct2005161327, 15789146CrossrefGoogle Scholar33 Krieger JFollenius MSforza EBrandenberger GPeter JDEffects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoeaClin Sci (Lond)1991804439, 1851683CrossrefGoogle Scholar34 Matthiesen TBRittig SNorgaard JPPedersen EBDjurhuus JCNocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptomsJ Urol199615612929, 8808857CrossrefGoogle Scholar35 Yalkut DLee LYGrider JJorgensen MJackson BOtt CMechanism of atrial natriuretic peptide release with increased inspiratory resistanceJ Lab Clin Med19961283228, 8783640CrossrefGoogle Scholar36 Ouslander JJohnson TNasr SSchnelle JMiller MAtrial natriuretic peptide levels in geriatric patients with nocturia and nursing home residents with nighttime incontinenceJ Am Geriatr Soc199947143944, 10591239CrossrefGoogle Scholar37 Svatikova AShamsuzzaman ASWolk RPhillips BGOlson LJSomers VKPlasma brain natriuretic peptide in obstructive sleep apneaAm J Cardiol20049452932, 15325948CrossrefGoogle Scholar38 Asplund RAberg HDiurnal variation in the levels of antidiuretic hormone in the elderlyJ Intern Med19912291314, 1997638CrossrefGoogle Scholar39 Johnson TMMiller MPillion DJOuslander JGArginine vasopressin and nocturnal polyuria in older adults with frequent nighttime voidingJ Urol20031704804, 12853804CrossrefGoogle Scholar40 Sugaya KNishijima SOda MMorozumi MHatano TOgawa YBiochemical analysis of nocturia in the elderlyNeurourol Urodyn200120458(abstract 55)Google Scholar41 Bing MHMoller LAJennum PMortensen SLose GPathophysiological aspects of nocturia in a danish population of men and women age 60-80 yearsJ Urol20071785527, 17570415CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Normative noninvasive bladder function measurements in healthy women: A systematic review and meta‐analysisWyman J, Zhou J, LaCoursiere D, Markland A, Mueller E, Simon L, Stapleton A, Stoll C, Chu H and Sutcliffe S Neurourology and Urodynamics, 10.1002/nau.24265, Vol. 39, No. 2, (507-522), Online publication date: 1-Feb-2020. Lower urinary tract symptoms and obstructive sleep apnea syndrome: Urodynamic evolution before and after one year of treatment with continuous positive airway pressureFernández-Pello S, Gil R, Escaf S, Rodríguez Villamil L, Alzueta A, Rodríguez C and Gonzalo-Orden J Actas Urológicas Españolas (English Edition), 10.1016/j.acuroe.2019.03.009, Vol. 43, No. 7, (371-377), Online publication date: 1-Sep-2019. Síntomas de tramo urinario inferior y síndrome de apnea obstructiva del sueño: evolución urodinámica antes y después de un año de tratamiento con presión continua positiva de la vía aéreaFernández-Pello S, Gil R, Escaf S, Rodríguez Villamil L, Alzueta A, Rodríguez C and Gonzalo-Orden J Actas Urológicas Españolas, 10.1016/j.acuro.2019.03.004, Vol. 43, No. 7, (371-377), Online publication date: 1-Sep-2019. Is obstructive sleep apnea syndrome related to nocturia?Arslan B, Gezmis C, Çetin B, Gönültas S, Gökmen E, Gürkan O and Ozdemir E LUTS: Lower Urinary Tract Symptoms, 10.1111/luts.12250, Vol. 11, No. 3, (139-142), Online publication date: 1-May-2019. Bliwise D and Scullin M Normal Aging Principles and Practice of Sleep Medicine, 10.1016/B978-0-323-24288-2.00003-9, (25-38.e8), . Obstructive sleep apnea and urological comorbidities in males: a population-based studyChung S, Hung S, Lin H, Tsai M and Kao L Sleep and Breathing, 10.1007/s11325-016-1336-x, Vol. 20, No. 4, (1203-1208), Online publication date: 1-Dec-2016. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of menAdams R, Appleton S, Vakulin A, Lang C, Martin S, Taylor A, McEvoy R, Antic N, Catcheside P and Wittert G Respirology, 10.1111/resp.12829, Vol. 21, No. 7, (1314-1321), Online publication date: 1-Oct-2016. Nocturia, Insomnia Symptoms and Mortality among Older Men: The Health, Aging and Body Composition StudyEndeshaw Y, Schwartz A, Stone K, Caserotti P, Harris T, Smagula S and Satterfield S Journal of Clinical Sleep Medicine, Vol. 12, No. 06, (789-796), Online publication date: 15-Jun-2016. Sleep disordered breathing at the extremes of age: the elderlyMcMillan A and Morrell M Breathe, 10.1183/20734735.003216, Vol. 12, No. 1, (50-60), Online publication date: 1-Mar-2016. A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICTMcMillan A, Bratton D, Faria R, Laskawiec-Szkonter M, Griffin S, Davies R, Nunn A, Stradling J, Riha R and Morrell M Health Technology Assessment, 10.3310/hta19400, Vol. 19, No. 40, (1-188) Low-dose oral desmopressin for treatment of nocturia and nocturnal enuresis in patients after radical cystectomy and orthotopic urinary diversionGoldberg H, Baniel J, Mano R, Gillon G, Kedar D and Yossepowitch O BJU International, 10.1111/bju.12598, Vol. 114, No. 5, (727-732), Online publication date: 1-Nov-2014. Editorial Comment to Nocturnal polyuria and decreased serum testosterone: Is there an association in men with lower urinary tract symptoms?Kim S International Journal of Urology, 10.1111/iju.12360, Vol. 21, No. 5, (524-524), Online publication date: 1-May-2014. The Association between Nocturia and Nocturnal Polyuria in Clinical and Epidemiological Studies: A Systematic Review and Meta-AnalysesHofmeester I, Kollen B, Steffens M, Bosch J, Drake M, Weiss J and Blanker M Journal of Urology, 10.1016/j.juro.2013.10.100, Vol. 191, No. 4, (1028-1033), Online publication date: 1-Apr-2014. Volume 08 • Issue 05 • October 15, 2012ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationSeptember 1, 2011Submitted in final revised formFebruary 1, 2012Accepted for publicationApril 1, 2012Published onlineOctober 15, 2012 Information© 2012 American Academy of Sleep MedicineKeywordsnocturiaCase-control studynocturnal polyuriaelderlyobstructive sleep apnea.ACKNOWLEDGMENTSThis study was financially supported mainly by Lions Club (Scandinavia), Augustinus Foundation, Director Jacob Madsen and Olga Madsens Foundation, AP Moeller Foundation and Ferring Pharmaceuticals. Research Centre for Prevention and Health, Glostrup County Hospital, Denmark has contributed with advice regarding design of the study and layout of the questionnaire, and technical support.PDF download
Referência(s)