Degree of bother caused by nocturia in women

Role of circadian rhythms and melatonin in bladder function in heath and diseases

The circadian system modulates all visceral organ physiological processes including urine storage and voiding. The "master clock" of the circadian system lies within suprachiasmatic nucleus of the hypothalamus while "peripheral clocks" are found in most peripheral tissue and organs, including the urinary bladder. Disruptions of circadian rhythms can cause organ malfunction and disorder or exacerbate pre-existing ones. It has been suggested that nocturia, which develops mostly in the elderly, could be a circadian-related disorder of the bladder. In the bladder, many types of gap junctions and ion channels in the detrusor, urothelium and sensory nerves are likely under strict local peripheral circadian control. The pineal hormone, melatonin, is a circadian rhythm synchroniser capable of controlling a variety of physiological processes in the body. Melatonin predominantly acts via the melatonin 1 and melatonin 2 G-protein coupled receptors expressed in the central nervous system, and many peripheral organs and tissues. Melatonin could be beneficial in the treatment of nocturia and other common bladder disorders. The ameliorating action of melatonin on bladder function is likely due to multiple mechanisms which include central effects on voiding and peripheral effects on the detrusor and bladder afferents. More studies are warranted to determine the precise mechanisms of circadian rhythm coordination of the bladder function and melatonin influences on the bladder in health and diseases.

The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study

BACKGROUND

The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine during the main sleep period, has been investigated primarily in middle-aged to older men. There is thus a gap in the NP evidence base for women and for younger individuals.

OBJECTIVE

To estimate the prevalence of nocturia due to NP in the USA.

DESIGN, SETTING, AND PARTICIPANTS

This large epidemiologic study used a US population-representative sample of men and women aged ≥30 yr to assess the prevalence of NP (NCT04125186).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Consenting participants completed an online survey (Lower Urinary Tract Symptoms Tool and comorbidities). All who reported two or more voids per night and 100 random respondents each reporting no or one void per night were asked to complete a 3-d bladder diary. Two NP definitions were used: nocturnal urine production >90 ml/h (NUP90) and Nocturnal Polyuria Index >0.33 (NPI33). Crude and population-adjusted prevalence results were calculated from completed diaries for the following subgroups by sex and age: idiopathic NP; NP with overactive bladder (NP-OAB) or bladder outlet obstruction (NP-BOO; men only); NP associated with other comorbidities; and no NP (did not meet the NPI33 or NUP90 definition).

RESULTS AND LIMITATIONS

Among the 10,190 respondents who completed the survey, the mean age was 54.4 yr (range 30-95); 3,339 reported two or more nocturnal voids and 1,763 completed the 3-d diary (response rate 49.3%). The adjusted overall NP prevalence was 31.5% among men and 38.5% among women using the NPI33 definition, and 23.8% among men and 18.1% among women using NUP90. The adjusted idiopathic NP prevalence was lower among men (NPI33: 5.2%; NUP90: 1.4%) than among women (NPI33: 9.8%; NUP90: 4.0%). The prevalence of idiopathic NP decreased with age as NP associated with other possible causes increased with age in men (most common, BOO) and women (most common, OAB).

CONCLUSIONS

This is the first population-based study of NP prevalence to include men, women, and young adults. NP is common; a multifactorial etiology should be considered, particularly as age increases.

PATIENT SUMMARY

In this population-based US study, we examined the frequency of nighttime urination among men and women aged ≥30 y and older. We found that nighttime urination is common among men and women. Many conditions can lead to increased nighttime urination as people age.

Nocturia in women

PURPOSE OF REVIEW

Nocturia in women is a notable health concern, associated with significant morbidity and decreases in health-related quality of life. It is implicated in daytime somnolence and poor sleep quality, and has been found to negatively impact household activities, work, exercise, and sexual activity. This review is intended to relay new information regarding the prevalence, cause, risk factors, ramifications, and treatment options for nocturia in women as it gains traction as a clinical entity in and of itself.

RECENT FINDINGS

New literature exposes the prevalence and burden of nocturia among young, healthy nulliparous women; reveals its presence in women without daytime symptoms; suggests its relationship with abnormal bowel function; and supports its association with obesity, cardiac burden and poor sleep. The link between nocturia and menopause has been challenged, and recent nomenclature describing the genitourinary symptoms of menopause excludes it from the list. Desmopressin and tamsulosin trials in women have demonstrated safety and efficacy in limiting nocturia frequency and severity, as well as in improving sleep parameters.

SUMMARY

Nocturia is an impactful health issue at risk of being missed, especially in younger female patients. Open dialogue, purposeful questioning, and screening surveys can help elicit this symptom in women who are embarrassed or who accredit it to normal aging and therefore do not seek medical attention. In light of a growing geriatric population, nocturia is a clinical entity of increasing importance as it can be a clue to underlying systemic disorder or it can be an isolated symptom with significant clinical implications if left unaddressed.

Can botox improve night-time overactive bladder symptoms in women?

AIMS

Despite the efficacy of intravesical onabotulinumtoxinA (Botox) therapy for urgency, urgency incontinence, and daytime frequency, its value in treatment of nocturia remains unclear. The aim of the prospective observational study was to assess the effect of onabotulinumtoxinA on night-time symptoms in women with overactive bladder (OAB), including nocturia, night-time urgency incontinence, and nocturnal voided volume as end-points.

METHODS

Women with idiopathic OAB (with at least one episode of urgency urinary incontinence (UUI) per day, ≥8 micturitions per 24 hr, and ≥2 nocturia episodes per night) were enrolled. Patients with nocturnal polyuria were excluded. Botox (100 U) was administered in 20 intra-detrusor injections. Post-void residual volumes (PVR) were checked at 2, 4, and 12 weeks. Participants completed a 3-day bladder diary and the King's Health Questionnaire (KHQ) before and 12 weeks after treatment, and reported the efficacy of the treatment on visual analog scale (VAS) at the final follow-up visit.

RESULTS

Seventy-six women completed the study. Botox injections were effective in the reduction of nocturia episodes (mean -0.98; P < 0.001) and night-time UUI episodes (-0.37; P < 0.001) compared to the baseline. The increase of mean voided volume of the night-time micturitions was 92.6 ml (P < 0.001). Patients reported a mean 58 points of improvement on the VAS. Urinary retention, which required self-catheterization, was observed in three patients.

CONCLUSIONS

Intravesical Botox injection provides significant benefit for night-time symptoms in OAB patients. Our results are applicable for women without nocturnal polyuria, and should prove useful when counseling patients about the risks and benefits of Botox. Neurourol. Urodynam. 36:648-652, 2017. © 2016 Wiley Periodicals, Inc.

Nocturia: current concepts and future perspectives

Nocturia is a prevalent highly bothersome urinary symptom that may significantly detriment the health and well-being of sufferers. It is characterized by waking at night to void, each void preceded and followed by sleep, hence leading to fragmentation of sleep and day-time tiredness. This may result in reduced productivity in the workplace, which contributes to the significant burden to the wider society that nocturia incurs. Nocturia was traditionally viewed as one of the many urinary tract symptoms that occur due to lower urinary tract dysfunction. However, recently it has been recognized that due to its multi-factorial aetio-pathogenesis, nocturia should be viewed as distinct clinical condition in its own right. Careful assessment of the nocturic patient is essential so that treatment strategies are guided by the likely causes. Much research is currently being undertaken into the underlying causes and the optimal management approaches. This review will explore the contemporary status of research on nocturia with a focus on the current and newly available pharmacotherapies.

Associations between subjective overactive bladder symptoms and objective parameters on bladder diary and filling cystometry

INTRODUCTION AND HYPOTHESIS

A study was conducted to assess associations between different overactive bladder (OAB) symptoms and their outcomes on bladder diary and filling cystometry parameters.

METHODS

We performed a retrospective cohort study in database of 6,876 Urinary Distress Inventories, 3,185 bladder diaries and 2,153 filling cystometries from women referred to our urogynecological center between 2003 and 2009. Women were dichotomized into two groups. Group I: those women without symptoms, and those with symptoms that were not bothersome. Group II: women with bothersome symptoms. Data obtained from bladder diaries were: daytime urinary frequency, nocturnal frequency, minimum voided volume, maximum voided volume, average voided volume, and incontinence episodes. From filling cystometries, volumes at first desire to void, normal desire to void, strong desire to void and maximum cystometric capacity, were extracted. Univariate and multiple linear regression analysis were performed to determine associations between OAB symptoms and bladder diary and filling cystometry measurements.

RESULTS

After multivariate analysis the objective daytime frequency was most strongly associated with the frequency symptom (β 0.27, p < 0.05), night time frequency with the nocturia symptom (β 0.40, p < 0.05) and the number of incontinence episodes with the urge incontinence symptom (β 0.37, p < 0.05). Both frequency and nocturia symptoms were significantly associated with bladder diary and cystometry filling volumes, and their effect size was the same. The urgency symptom proved to be poorly associated with objective parameters.

CONCLUSIONS

In contrast to the frequency and nocturia symptom, the urgency symptom is poorly associated with objective parameters on bladder diary and filling cystometry. Therefore, the current practice of using frequency and incontinence episodes in outcome research of OAB trials is justified.

Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial

AIMS

The primary objective was to investigate the efficacy of desmopressin orally disintegrating tablet versus placebo in patients with nocturia. Pharmacodynamics, safety and patient-reported quality of life (QoL) outcomes were also evaluated. One of several benefits of the new formulation is increased bioavailability. Exploring lower doses allows for a better evaluation of therapeutic effect versus tolerability.

METHODS

This was a 4-week, randomized, double-blind study comparing 10, 25, 50, or 100 µg desmopressin versus placebo in adults with defined nocturia.

RESULTS

The intent to treat population comprised 757 patients experiencing ∼3 voids/night and a high prevalence of nocturnal polyuria (∼90%). Increasing doses of desmopressin were associated with decreasing numbers of nocturnal voids and voided volume, greater proportions of subjects with >33% reduction in nocturnal voids, and increased duration of first sleep period. The lowest dose reaching statistical significance (P < 0.05 vs. placebo) varied by endpoint. Improvements were clinically meaningful, meaning that patients actually had fewer nightly voids. Post hoc analyses by gender suggested a lower minimum effective dose for women. Desmopressin was generally well tolerated. Reductions in serum sodium to <125 mmol/L in six women (taking >25 µg desmopressin) and two men (aged 67 and 82) taking 100 µg, support lower and gender-specific dosing to reduce the small but clinically significant risk of hyponatraemia. Each void reduced/hour of sleep gained was associated with significant improvements in QoL.

CONCLUSIONS

Desmopressin orally disintegrating tablet is an effective and well-tolerated treatment for patients with nocturia. Further exploration of the lower dose range is warranted.

Nocturia: current status and future perspectives

PURPOSE OF REVIEW

Nocturia is a bothersome and highly prevalent condition characterized by the need to wake to void at night. Nocturia is equally common in men and women, and although its prevalence increases with age, a significant proportion of younger people are also affected. Nocturia leads to fragmentation of sleep and consequently to a serious decline in daytime functioning and in quality of life and health. Its impact should not be underestimated by clinicians and therefore a review on nocturia is timely and relevant.

RECENT FINDINGS

Traditionally, nocturia is regarded as a symptom of benign prostatic enlargement and/or overactive bladder syndrome, with treatment therefore directed toward increasing the capacity of the bladder to hold urine. Such treatments have proven ineffective in many patients because nocturnal polyuria, an overproduction of urine at night, has been found to be present in the majority of patients. Nocturia can be attributed to some underlying pathological factors but it can also be a distinct clinical entity with specific pathogenesis. Frequency-volume charts are recommended for routine use in clinical practice, to determine whether nocturia is a result of excessive urine production at night, or of small voided volumes due to bladder problems, or a combination of these factors. Desmopressin, a synthetic analogue of the antidiuretic hormone, should be considered in patients with nocturia where nocturnal polyuria is present.

SUMMARY

Contrary to popular and medical misconception nocturia is an important condition leading to general morbidity and with serious impact on overall quality of life and health. We advise clinicians to pay attention to nocturia and diagnostics should be offered. Treatment modalities are available and have to be discussed with the patient.

Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia

PURPOSE

Nocturnal polyuria is a common but often overlooked cause of nocturia. We investigated the proportion of adults with 2 or greater voids nightly who had nocturnal polyuria in 2 cohorts from the United States and Europe.

MATERIALS AND METHODS

Data on nocturnal polyuria were obtained from 3 or 7-day frequency-volume charts completed by patients as part of screening for inclusion in subsequent trials of nocturia therapy. Patients recorded the time and volume of each void. Nocturnal polyuria was defined as nocturnal urine volume greater than 33% of 24-hour volume, including the first morning void.

RESULTS

In the first cohort 1,003 patients were screened, of whom 846 provided evaluable diary data, including 641 (76%) with nocturnal polyuria. Of the total screened population of 1,003 patients 641 (64%) had confirmed nocturnal polyuria. The prevalence of nocturnal polyuria increased with age but was high in all age groups. In the second cohort 1,412 patients were screened, of whom 917 provided evaluable diary data, including 806 (88%) with nocturnal polyuria. Of the total screened population of 1,412 patients 806 (57%) had confirmed nocturnal polyuria. The prevalence of nocturnal polyuria increased with age but was high in all age groups. Of 158 patients receiving benign prostatic hyperplasia and/or overactive bladder medication 141 (89%) had nocturnal polyuria. In each cohort the nocturnal polyuria prevalence was high in all ethnic groups (63% or greater).

CONCLUSIONS

In this large study nocturnal polyuria was present in most patients with nocturia regardless of gender, age, ethnicity, country and concomitant benign prostatic hyperplasia/overactive bladder therapy.

Nocturia in women

Nocturia is a common problem in adults, which adversely affects quality of sleep and quality of life. This review summarizes the definition, epidemiology, clinical presentation, pathophysiology, diagnostic evaluation, and the therapeutic options with regard to a female population. Based on the degree of bother nocturia is classified as two or more episodes per night. It is most prevalent in older woman but also affects younger individuals. Voiding during nighttime leads to a disruption of sleep, affecting both sleep onset and maintenance. A clear understanding of its underlying pathophysiology, including diurnal polyuria, nocturnal polyuria, and bladder storage problems is necessary to address symptoms and co-morbid conditions. Diagnostic evaluation includes a detailed patient's history, physical examination, laboratory tests, and a voiding bladder diary. For treatment, tailored lifestyle and behavioural changes are able to decrease bother. In addition some patients profit from pharmacological therapy with antimuscarinic agents and analogue of arginine vasopressin, however this strategy is often restricted by side effects.

Prevalence and risk factors of nocturia and nocturia-related quality of life in the Chinese population

OBJECTIVES

To evaluate the prevalence, risk factors of nocturia and nocturia-related quality of life.

METHODS

Age, hypertension, cardiovascular disease, diabetes mellitus, benign prostatic hyperplasia (BPH), alcohol abuse and smoking were analyzed using logistic analysis. Multiple linear-regression analysis was used to identify factors predicting the score on the Nocturia Quality of Life (N-QOL) questionnaire.

RESULTS

1,198 adults completed this study. 411 individuals (34.3%) answered that they arose for urination at least twice during the night. The incidence of nocturia increased with age from 8.6% in individuals younger than 40 to 67.7% in those older than 70. Hypertension [odds ratio (OR) 2.322; 95% confidence interval (95% CI): 1.387-3.887] and diabetes (OR 2.298; 95% CI: 1.066-4.954) were possible risk factors for nocturia. In male individuals, BPH (OR 3.900; 95% CI: 1.890-8.049) was another risk factor. Gender was not found to be associated with nocturia. Increasing episodes of nocturia (regression coefficient: -2.564; 95% CI: -3.08 to -2.049) and decreasing total sleeping hours (regression coefficient: 1.738; 95% CI: 0.948-2.527) were independent factors predicting a significantly lower N-QOL score.

CONCLUSIONS

Hypertension, diabetes and BPH are associated with nocturia, suggesting that multiple approaches are needed when treating patients with nocturia. Nocturia has a significant impact on the nocturia-related quality of life when the patient has 2 or more episodes per night.

The effect of nocturia on sleep

Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

Thinking beyond the bladder: antidiuretic treatment of nocturia

Nocturia is a bothersome and highly prevalent urological condition characterised by the need to wake to void at night. Contrary to popular misconception, nocturia is equally common in men and women, and although its prevalence increases with age, a significant proportion of younger people are also affected. Nocturia leads to repeated fragmentation of sleep and consequently to a serious decline in daytime functioning and in overall quality of life and health. As such, its impact should not be underestimated by clinicians. Traditionally, nocturia has been regarded as a symptom of benign prostatic enlargement and/or overactive bladder syndrome, with treatment therefore directed towards increasing the capacity of the bladder to hold urine. Such treatments have proven largely ineffective in many patients, likely because nocturnal polyuria (NP), a condition that results in overproduction of urine at night, has been found to be present in the majority of nocturia patients. As such, the traditional belief that nocturia is attributable to some other underlying pathological factors, is now being replaced by the acknowledgment that it can be a distinct clinical entity with specific pathogenesis. Frequency-volume charts are an invaluable tool, recommended for routine use in clinical practice, to determine whether nocturia is a result of excessive urine production at night, or of small voided volumes (indicating bladder storage problems), or indeed a combination of these factors. Given the specific antidiuretic action of desmopressin, a synthetic analogue of the body's own antidiuretic hormone, it should be considered as first-line therapy for patients with nocturia where NP is present.

Urinary frequency in community-dwelling women: what is normal?

OBJECTIVE

The objective of the study was to assess urinary frequency in community-dwelling women.

STUDY DESIGN

Voiding habits were assessed in 4061 women 25-84 years of age using survey responses from the Epidemiology of Prolapse and Incontinence Questionnaire. Bother related to daytime and nighttime frequency was assessed with 100-mm visual analog scales and compared using t tests and analysis of variance.

RESULTS

Median daytime frequency was every 3-4 hours. Urinary frequency every 2 hours or more occurred in 27% and was more bothersome than every 3-4 hours or less (51.7 +/- 30.1 mm vs 23.6 +/- 23.7 mm; P < .001). Nocturia was reported in 72%, whereas 33% had 2 or more voids per night. Bother increased with increasing nighttime frequency (27.3 +/- 26.3 for 1 time vs 57.3 +/- 28.5 for > or = 2 times; P < .001).

CONCLUSION

Bothersome urinary frequency is common and occurs when frequency is at least every 2 hours by day and more than once per night.

Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland

BACKGROUND

Nocturia (ie, waking at night to void) is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless, yet the justification for this belief remains weak.

OBJECTIVE

To evaluate the association among frequency of nocturia and bother and health-related quality of life (HRQoL).

DESIGN, SETTING, AND PARTICIPANTS

In 2003-2004, a survey was mailed to a random sample of 6000 subjects aged 18-79 yr who were identified from the Finnish Population Register Centre (response proportion was 62.4%; 53.7% were females).

MEASUREMENTS

HRQoL and bother from nocturia were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). HRQoL was measured with the generic 15D instrument on a 0-1 scale with a minimum clinically important difference of 0.03.

RESULTS AND LIMITATIONS

Degree of bother increased with nocturia frequency (p<0.01). The most commonly cited degree of bother for those with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively. The mean age-adjusted 15D score for men (and women) without nocturia was 0.953 (0.950) and 0.925 (0.927) with one void per night, 0.898 (0.890) with two voids per night, and 0.833 (0.840) with three or more voids per night. Statistically significant decreases were found in 15D score and in all 15D dimensions except eating. Although the response rate was high, approximately one third of those contacted did not participate in the study.

CONCLUSIONS

At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.

Urodynamic Obstruction in Women With Stress Urinary Incontinence—Do Nonintubated Uroflowmetry and Symptoms Aid Diagnosis?

PURPOSE

We estimated the prevalence of urodynamic obstruction in women with stress urinary incontinence and determined which clinical indicator (nonintubated uroflowmetry or urinary symptoms) better predicts urodynamic obstruction.

MATERIALS AND METHODS

From December 2004 to June 2005, 101 women with urodynamic stress urinary incontinence were enrolled. Adjunctive lower urinary tract symptoms were also observed. Of 101 women with stress urinary incontinence 27 had abnormal and 74 had normal nonintubated uroflowmetry. Normal nonintubated uroflowmetry was defined as a bell-shaped curve with maximum flow more than 15 ml per second and post-void residual urine less than 50 ml. Urodynamic obstruction was diagnosed based on maximum urine flow less than 12 ml per second and maximum detrusor pressure at maximum flow more than 25 cm H(2)O.

RESULTS

In our stress urinary incontinence population the prevalence of urodynamic obstruction was 15.7%. In urodynamically obstructed women storage symptoms were most common (56.3%), while voiding and post-micturition symptoms were less common (31.3% and 6%, respectively). A good correlation between abnormal nonintubated uroflowmetry and urodynamic obstruction (phi = 0.718, p <0.0001) was found. lower urinary tract symptoms correlated weakly with urodynamic obstruction. The diagnostic performance of abnormal nonintubated uroflowmetry for predicting urodynamic obstruction showed that it had relatively low positive predictive value (51.8%) with high negative predictive value (97.3%), sensitivity (87.5%) and specificity (84.1%). The diagnostic performance of lower urinary tract symptoms was weak.

CONCLUSIONS

Our study confirms the coexistence of obstruction and stress urinary incontinence. In this population abnormal nonintubated uroflowmetry cannot always confirm the presence of urodynamic obstruction and complete urodynamic study might be indicated. Conversely normal nonintubated uroflowmetry seems to accurately predict normal urodynamic study and might render the execution of this test not essential. Symptoms represent a poor clinical indicator of voiding disorder.

Prevalence and impact of nocturia in a urogynecologic population

To determine the prevalence of nocturia and associated bother among patients presenting to a tertiary urogynecology clinic and to describe patient characteristics related to nocturic frequency and associated bother. Chart review of sequential new patients presenting to our clinic between June 2004 and May 2005. We recorded patients' response to a question about their frequency of nocturia, the level of associated bother, demographic data, history of chronic medical illness and clinical urogynecologic diagnosis. Seven hundred sixty patients were of mean age 56 (19-95) years. Eighty-seven percent of patients voided at least once nightly, and 60% usually voided at least twice nightly. Forty one percent of patients reported bother >or=5/10 from nocturia. High bother rating was associated with increasing number of nocturic episodes (p < 0.0005) and mixed incontinence (p = 0.012). Nocturia is common and bothersome to women presenting for urogynecologic care. Concomitant mixed incontinence significantly increases bother arising from nocturia.

Differences between bothersome and non-bothersome night-time frequency

AIMS

To determine the distributions of bothersome and non-bothersome nocturnal voiding and the differences between them using a community-based study.

SUBJECTS AND METHODS

A total of 2,205 men and women aged 41-70 years from three Japanese towns responded to our postal questionnaire survey. The questionnaire included the International Prostate Symptom Score, Pittsburgh Sleep Quality Index (PSQI), Medical Outcome Study Short Form-8, medical history of several diseases, and history of cigarette smoking and alcohol consumption. We chose subjects who had one or two episodes of nocturnal voiding per night and divided them into two subgroups based on the answer to a question on trouble sleeping due to nocturnal voiding in the PSQI. We compared data regarding lower urinary tract symptoms (LUTS), sleep, and general health-related quality of life (GHQL) among these subgroups.

RESULTS

Of the subjects: 314 (14.2%), 693 (31.4%), 149 (6.8%), and 168 (7.6%) had once-bothersome, once-non-bothersome, twice-bothersome, and twice-non-bothersome nocturnal voiding per night, respectively. Regarding LUTS, the twice-bothersome nocturnal voiding group had the worst and the once-non-bothersome group had the best scores while the once-bothersome and twice-non-bothersome nocturnal voiding groups had equivalent scores. Regarding sleep and GHQL, trouble sleeping but not the frequency of nocturnal voiding per se affected the scores. The twice-non-bothersome nocturnal voiding group generally had better scores than the once-bothersome group, while the former had more frequent nocturnal voiding.

CONCLUSIONS

Sleep and GHQL of subjects with mild (once or twice) night-time frequency are considerably impacted by sleeping troubles.

Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60–80 years

OBJECTIVE

To study the prevalence and bother of nocturia, and sleep interruptions in an unselected population of Danish men and women aged 60-80 years.

SUBJECTS AND METHODS

A postal questionnaire was sent to 2000 women and 2000 men aged 60, 65, 70, 75, and 80 years. The population was selected at random from The Danish Civil Registration System, in which every person living in Denmark is identified. The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) was used to evaluate nocturia and bother, and sleep interruptions. Nocturia was defined as waking at night to void, according to the International Continence Society definition.

RESULTS

In all, 92% (3664) subjects returned the questionnaire; 71% completed the questionnaire satisfactorily and were included in the study. The prevalence of nocturia increased with age. The overall prevalence of nocturia was 77% and there was no difference between men and women (P = 0.11), but men had slightly more severe nocturia than women. The bother caused by nocturia in men and women increased with the severity of nocturia, and women were slightly more bothered than men when the degree of nocturia was >2 voids/night. Nocturia was the most frequent self-reported reason for waking at night, followed by thirst.

CONCLUSION

The prevalence of nocturia increased with age. There was no difference between the genders in the overall prevalence of nocturia, but nocturia of > or = 2 voids/night was more frequent in men. The degree of bother increased with the severity of nocturia, even after correcting for generic quality of life, and the younger groups were the most bothered. Nocturia was the major reason for waking at night, followed by thirst.

The puzzle of overactive bladder: controversies, inconsistencies, and insights

Overactive bladder (OAB) affects millions of individuals and may severely impair the quality of life of those affected. The contribution of human behavior to manifestations of this symptom complex remains poorly understood. Continued evolution of our understanding of the pathophysiology of OAB has identified contributory mechanisms, which in turn may open new therapeutic avenues. Recent improvements in drug delivery systems represent advances in the management of OAB. However, more complete symptom control with greater tolerability is desirable; this awaits the development of agents specific for newly emerging and as yet unidentified pathophysiologic pathways. Importantly, as understanding of outcomes assessment in OAB matures, refined assessments of disease severity, response to intervention, and patient preference should be possible.

Impact of nocturia on symptom-specific quality of life among community-dwelling adults aged 40 years and older

OBJECTIVES

To evaluate factors predicting the effect of nocturia in a community-based cohort of adults using a nocturia-specific quality-of-life (N-QOL) questionnaire.

METHODS

From October 2004 to February 2005, adults aged 40 years old or older living in Matsu, Taiwan and reporting nocturia of one episode or more per night were interviewed with a 12-item N-QOL questionnaire consisting of Sleep/Energy and Bother/Concern subscales. Univariate analyses were used to analyze the effects of demographic characteristics, frequency and duration of nocturia, and sleeping characteristics on the N-QOL score. Multiple linear regression analysis was used to identify factors predicting the N-QOL score.

RESULTS

A total of 663 adults completed this study (mean age 59.4 years). The average N-QOL scores (a lower score indicates worse QOL) were 91.4 +/- 11.2, 83.7 +/- 13.2, 77.6 +/- 16.8, and 67.6 +/- 21.2 for nocturia episodes of 1, 2, 3, and 4 or more per night, respectively (P < 0.001). Men reported significantly lower N-QOL (85.6 +/- 15.1 versus 88.9 +/- 13.1, P = 0.003) and Bother/Concern subscale scores (42.0 +/- 8.4 versus 44.0 +/- 7.4, P < 0.001), but not Energy/Sleep subscale scores (43.6 +/- 7.8 versus 44.4 +/- 7.3, P = 0.158) than women. On multiple linear regression analysis, increasing nocturia episodes (regression coefficient -6.2, 95% confidence interval -7.4 to -5.0), male sex (regression coefficient -3.5, 95% confidence interval -5.4 to -1.5), and degree of sleeping disturbance after nocturia (regression coefficient -4.5, 95% confidence interval -5.6 to -3.4) independently predicted a significantly lower N-QOL score.

CONCLUSIONS

The results of our study have confirmed that nocturia has a more significant QOL impact when the patient has two or more episodes per night. Moreover, men experienced a greater impact from nocturia than women, particularly in the Bother/Concern domain.

Validity and Reliability of a Questionnaire for Evaluating Nocturia, Nocturnal Enuresis and Sleep-Interruptions in an Elderly Population

OBJECTIVES

To validate a new questionnaire evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population of men and women in Denmark.

METHODS

The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) emerged from review of the literature and expert consensus. The questionnaire was a subset of a larger questionnaire comprising several domains on health status and voiding. Convergent and discriminatory validity was assessed in an unselected population of 2000 men and 2000 women 60-80 years old. To test reproducibility, 400 respondents were mailed a separate questionnaire 2 weeks apart. A subgroup of men and women with and without nocturia was used for evaluating reliability of number of nocturia episodes.

RESULTS

A total of 2825 (70.6%) filled in the questionnaire. A decrease in health status was correlated with increasing bother (range: -0.25 to -0.36, p<0.001, Spearman's r). These findings indicate acceptable convergent validity. Significant discriminatory validity was proven in separate groups of symptom severity (p<0.0001, Kruskal-Wallis test). Median kappa was 0.70 (range 0.58-0.86) indicating substantial agreement in the retest analysis. Number of nocturia episodes in questionnaires correlated with frequency volume charts (Spearman's rho 0.88; p<0.001).

CONCLUSION

These data support that the NNES-Q has a good discriminatory and convergent validity, and is reliable over time. The NNES-Q may be useful in epidemiological studies and may also have a potential in daily clinical work up in patients with nocturia and nocturnal enuresis.

Normative values for the American Urological Association Symptom Index (AUA-7) and short form Urogenital Distress Inventory (UDI-6) in patients 65 and older presenting for non-urological care

OBJECTIVE

To determine the scores of two commonly used urologic questionnaires in community dwelling elderly patients receiving non-urologic primary care.

METHODS

Patients 65 years and older presenting for routine non-urologic primary care from April to July 2004 were eligible for enrollment. They completed a questionnaire evaluating demographics, AUA-7, UDI-6, and one visual analogue quality of life (QOL) question (range 0, pleased to 10, terrible). Total and question specific scores were analyzed. In addition, correlations among urinary symptoms and QOL scores were performed.

RESULTS

In 157 patients who satisfied the study criteria, total and question-specific scores for the AUA-7 and UDI-6 were mildly elevated and similar across age groups in both sexes. Question 1 (frequency) rendered the highest score for both women and men from the UDI-6 questionnaire (mean 1.3 and 0.74, respectively). Question 7 (nocturia) rendered the highest score for both women and men from the AUA-7 questionnaire (mean 1.87 and 0.940, respectively). A total of 32 (27%) of 118 women and 6 (15%) of 39 men were found to have high elevation in QOL scores (>5).

CONCLUSION

The total scores for the AUA-7 and UDI-6 were found to be mildly elevated but stable with age over time in this older population. These data provide useful information for urologists regarding baseline ranges for urinary symptoms in the elderly population. Over one-third of women were found to have a significant elevation in QOL scores (>5) which suggest a need for improvement in identifying and addressing urinary symptoms among elderly women.

Nicturia en mujeres con síntomas de incontinencia urinaria: análisis de las variables clínicas y urodinámicas asociadas

BACKGROUND

There is little information about urodynamic characteristics of females with symptoms of urinary incontinence (UI) and nocturia.

METHOD

Descriptive study of 1731 females consecutively referred with symptoms of UI for study and treatment. Urogynaecological history, physical examination and urodynamic study were carried out. Patients with pelvic organ prolapse greater than second degree were excluded. Frequency of nocturia symptom and its relationship with urodynamic, personal and clinical variables were analysed.

RESULTS

743 patients (43%) of those included presented nocturia. Urodynamic diagnoses in patients with nocturia were: stress UI in 262 patients (35.4%); detrusor overactivity in 166 (22.3%); and both in 220 (29.6%). The rest (12.7%) had other diagnoses. Mean (S.D.) bladder capacity of patients with nocturia was less than that of the rest of patients: 459.8 (159.8) vs 530.6 (216.9) ml (p<0.001). Of all the variables associated with nocturia, those which showed independent association were (ExpB; 95%CI): age >65 years (1.88; 1.34-2.63); menopause (2.11; 1.56-2.86); hypertension (1.42; 1.04-1.94) and bladder cistometric capacity less than 300 (1.71; 1.01-2.91) and between 300 and 400 (1.67; 1.17-2.38). The urodynamic diagnosis of Stress UI was associated with the absence of nocturia.

CONCLUSION

Nocturia is a frequent symptom among females complaining of urinary incontinence. Its presence is associated to age over 65 years, menopause, hypertension and reduced bladder capacity.