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Burr EF, Myer ENB, Kikuchi JY, Chen CCG. Nocturnal Urinary Symptoms as Screening Tools for Obstructive Sleep Apnea. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00204. [PMID: 38624031 DOI: 10.1097/spv.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
IMPORTANCE Nocturnal lower urinary tract symptoms are part of obstructive sleep apnea (OSA), and urogynecology clinics may serve as OSA screening sites. OBJECTIVE This study's aim was to determine the accuracy of nocturia and nocturnal enuresis (NE) as screening tools for OSA in new patients at a urogynecology clinic. STUDY DESIGN Using a retrospective study design, we gathered information regarding diagnostic OSA testing, continuous positive airflow pressure use, and lower urinary tract symptoms improvement from women in a urogynecology clinic who were previously screened for OSA using validated questionnaires. Nocturia and NE were tested for sensitivity and specificity using positive OSA diagnosis by polysomnography as the gold standard. RESULTS Nocturia with a cutoff of ≥2 episodes per night had the best test characteristics-86.4% sensitivity (95% confidence interval [CI], 65.1-97.1) and 58.5% specificity (95% CI, 44.1-71.9) for an overall accuracy of 78.4% (95% CI, 67.0-89.8). Nocturnal enuresis with a cutoff of ≥1 episode per week had the best NE characteristics with 31.8% sensitivity (95% CI, 13.9-54.9) and 79.3% specificity (95% CI, 65.9-89.2) for an overall accuracy of 56.1% (95% CI, 41.2-71). CONCLUSIONS Lower urinary tract symptoms such as nocturia and NE are routinely assessed in urogynecology clinics, making them useful for OSA screening and referral. The present study found nocturia symptoms with ≥2 episodes per night to retain acceptable test characteristics in screening for OSA, whereas NE was found to have less acceptable test characteristics for OSA screening. Urogynecology clinics may utilize nocturia symptoms in clinical decision making for OSA referral.
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Affiliation(s)
- Eliza F Burr
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Di Bello F, Napolitano L, Abate M, Collà Ruvolo C, Morra S, Califano G, Capece M, Creta M, Scandurra C, Muzii B, Di Nola C, Bochicchio V, Nocini R, Abbate V, Maldonato NM, Dell'Aversana Orabona G, Longo N, Cantone E. "Nocturia and obstructive sleep apnea syndrome: A systematic review". Sleep Med Rev 2023; 69:101787. [PMID: 37167825 DOI: 10.1016/j.smrv.2023.101787] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
Lower urinary tract symptoms represent a significant public health problem worldwide, impairing patients' quality of life, especially in elderly people. Among LUTS, nocturia is assessed as the most experienced entity related to several disorders such as sleep disorders and/or obstructive sleep apnea syndrome (OSAS). Among OSAS patients, nocturia stands as a bothersome symptom that increases alongside with the OSAS severity. However, despite the nocturia and OSAS shared a long-acknowledged link, the causes, and the pathophysiology for development of nocturia in OSAS have remained largely unexamined. Generally, the patients with OSAS experienced nocturia due to easy waking or increased bladder filling. However, nor the effect of treatment on management of nocturia in OSAS patients are well-established.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy.
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Cristiano Scandurra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Benedetta Muzii
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Claudio Di Nola
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | | | - Riccardo Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vincenzo Abbate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Nelson Mauro Maldonato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | | | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
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Um YH, Oh JH, Kim TW, Seo HJ, Kim SM, Chung JS, Jeong JH, Hong SC. Nocturia and Sleep: Focus on Common Comorbidities and Their Association with Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shieu M, Morgenstern H, Bragg-Gresham J, Gillespie BW, Shamim-Uzzaman QA, Tuot D, Saydah S, Rolka D, Burrows NR, Powe NR, Saran R. US Trends in Prevalence of Sleep Problems and Associations with Chronic Kidney Disease and Mortality. KIDNEY360 2020; 1:458-468. [PMID: 35368590 PMCID: PMC8809315 DOI: 10.34067/kid.0000862019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/24/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND To better understand the relation between sleep problems and CKD, we examined temporal trends in the prevalence of self-reported sleep problems in adults in the United States and their associations with CKD and all-cause mortality. METHODS Using data from 27,365 adult participants in five biannual National Health and Examination Surveys (2005-2006 through 2013-2014), we studied five self-reported sleep problems-trouble sleeping, sleep disorder, nocturia (urinating ≥2 times/night), inadequate sleep (<7 hours/night), and excessive sleep (>9 hours/night)-plus a composite index. We conducted three types of analysis: temporal trends in the prevalence of each sleep measure by CKD status, using model-based standardization; cross-sectional analysis of associations between four CKD measures and each sleep measure, using logistic regression; and survival analysis of the association between each sleep measure and mortality, using Cox regression. RESULTS The prevalence of trouble sleeping and sleep disorder increased over the five surveys by 4% and 3%, respectively, whereas the other sleep problems remained relatively stable. All sleep problems, except inadequate sleep, were more common during the study period among adults with CKD than without CKD (40% versus 21% for nocturia; 5% versus 2% for excessive sleep; 30% versus 25% for trouble sleeping; 12% versus 8% for sleep disorder). Both eGFR <30 ml/min per 1.73 m2 and albuminuria were positively associated with nocturia and excessive sleep. Excessive sleep and nocturia were also associated with higher mortality (adjusted hazard ratio for >9 versus 7-9 hours/night=1.7; 95% CI, 1.3 to 2.1; and for nocturia=1.2; 95% CI, 1.1 to 1.4). CONCLUSIONS The high prevalence of sleep problems among persons with CKD and their associations with mortality suggest their potential importance to clinical practice. Future work could examine the health effects of identifying and treating sleep problems in patients with CKD.
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Affiliation(s)
- Monica Shieu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Environmental Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brenda W. Gillespie
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Q. Afifa Shamim-Uzzaman
- Division of Neurology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Delphine Tuot
- Departments of Medicine, University of California San Francisco, San Francisco, California
| | - Sharon Saydah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Rolka
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Neil R. Powe
- Departments of Medicine, University of California San Francisco, San Francisco, California
| | - Rajiv Saran
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Prevalence of Screening High Risk of Obstructive Sleep Apnea Among Urogynecology Patients. Female Pelvic Med Reconstr Surg 2020; 26:503-507. [PMID: 32217919 DOI: 10.1097/spv.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is limited knowledge on the prevalence of obstructive sleep apnea (OSA) among urogynecology patients. The aim of this study was to determine the prevalence of screening high risk of OSA (HR-OSA) in an ambulatory urogynecology clinic. METHODS Women presenting for a new patient visit to a single outpatient urogynecology clinic for any indication were screened for eligibility. Patients were included if they were 18 years or older, English speaking, nonpregnant, and not using treatment for OSA. Participants completed the STOP-BANG questionnaire to screen for OSA and additional questionnaires to assess the presence and classification of nocturia and urinary incontinence. RESULTS Among 130 participants, the prevalence of screening HR-OSA was 38.5%. Characteristics associated with screening HR-OSA included hypertension (P < 0.001), diabetes (P=0.003), untreated sleep apnea (P < 0.001), body mass index ≥30 kg/m (P < 0.001), and age >50 years (P < 0.001). Participants who screened HR-OSA were more likely to have bothersome bladder symptoms of nocturia (P < 0.001), nocturnal enuresis (P < 0.001), higher urinary distress inventory scores (P < 0.001), and incontinence severity index scores (P < 0.001). On multivariable analysis, age >50 years (odds ratio [OR], 7.54), hypertension (OR, 4.04), body mass index ≥30 kg/m (OR, 3.98), and nocturial enuresis (OR, 2.26) remained significantly associated with screening HR-OSA. Average time to complete the STOP-BANG was 1.2 minutes. CONCLUSIONS The prevalence of OSA among urogynecology patients is high, and screening is not time prohibitive. Patients who screen HR-OSA have more bothersome bladder symptoms. Providers should consider screening urogynecology patients for OSA, especially patients who are 50 years or older, are obese, and have nocturnal enuresis.
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Khan WAA, Conduit R, Kennedy GA, Jackson ML. The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health 2020; 6:330-337. [PMID: 32223969 DOI: 10.1016/j.sleh.2019.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of sleep and mental health issues, the role of chronotype, and the relationship between these variables in Australian paramedics. DESIGN A cross-sectional study. SETTINGS Cross-sectional survey. MEASUREMENTS Paramedics were invited to complete an online survey to assess stress, posttraumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift-work disorder, bruxism, obstructive sleep apnea, narcolepsy, chronotype, fatigue, and well-being. PARTICIPANTS A total of 136 paramedics responded to the survey (age, 39.1 ± 12.1 years; 45.8% men and 54.2% women; 85.4% rotating shift-workers, 7% rural shift-workers, and 7.6% fixed rosters). RESULTS Paramedics reported significantly higher levels of depression symptoms, anxiety symptoms, fatigue, PTSD symptoms, insomnia symptoms, narcolepsy, and significantly poorer sleep quality and general well-being than norms from the general population of Australia and Western countries (all p < .05). From regression analyses, insomnia explained the greatest amount of variance in depression and anxiety scores, followed by fatigue and PTSD (adjusted R-squared for depression and anxiety models = .58 and = .44, respectively, p < .001). The majority of participants were intermediate chronotype (57%), followed by morning (32%) and evening type (11%). Evening chronotypes showed significantly higher depression scores (p < .001), anxiety (p < .05), PTSD symptoms (p < .05), poorer sleep quality (p < .05), and general well-being (p < .001) compared with morning types. CONCLUSION Addressing sleep issues and matching chronotype to shift preference in paramedics may help to reduce depression, anxiety, and improve well-being.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia; Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Gerard A Kennedy
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Association between obstructive sleep apnea syndrome and nocturia: a meta-analysis. Sleep Breath 2020; 24:1293-1298. [DOI: 10.1007/s11325-019-01981-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/13/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023]
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