Impact of Nocturia on Sleep and Energy

The mediating role of sleep quality in the association between nocturia and health-related quality of life

BACKGROUND

Even though the negative impacts of nocturia on sleep quality and health-related quality of life (HRQOL) have been documented in previous research, their interrelationship has been poorly studied. This study aimed to explore whether nocturia would affect sleep quality, which in turn affects HRQOL.

METHODS

Participants aged 40 and above were randomly recruited from a Hong Kong public primary care clinic. Participants were asked to report the average number of nocturia (waking up at night to void) pisodes per night over a 1-month period. The Pittsburgh Sleep Quality Index (PSQI) and the 12-Item Short Form Health Survey version 2 (SF-12 v2) were administered. The mediation analysis was tested using multistage regression approach and bootstrap method.

RESULTS

Of the 500 subjects who completed the survey, 31.2% reported symptomatic nocturia (having ≥2 nocturia episodes per night), and 60.4% experienced poor sleep quality (a PSQI global score > 5). Respondents with symptomatic nocturia had a poorer HRQOL in the domains of physical functioning (PF), role physical (RP) and social functioning (SF), general health (GH), vitality (VT) and physical component summary (PCS) of the SF-12 v2 than those without. Compared with the respondents without poor sleep quality, those with poor sleep quality had poorer HRQOL across all domains and summaries of the SF-12 v2. Mediation analysis found that sleep quality fully mediated the association between nocturia and the PF, RP and SF domains of the SF-12 v2, respectively, and partially mediated the association between nocturia and the GH, VT and PCS domains of the SF-12 v2, respectively.

CONCLUSIONS

We found that sleep quality mediated the association between nocturia and HRQOL. To enhance the HRQOL of patients with nocturia, clinicians should not only focus on nocturia symptoms, but also on their sleep quality.

Inpatient bladder retraining: is it beneficial on its own?

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is a common problem with serious effect on the quality of life. Bladder training aims to increase the interval between voids, either by a mandatory or self-adjustable schedule, so that incontinence is avoided. This study aimed to assess the effectiveness of inpatient bladder retraining.

METHODS

A retrospective case-note analysis was conducted over a period of 24 months. Outcome measures were decrease in incontinence episode frequency (IEF) and nocturia and increase in interval between voids. Subjective improvement was assessed on a four-point scale.

RESULTS

The study revealed statistically significant decrease in IEF and nocturia and increase in the interval between voids. Twenty-three percent was cured of their symptoms, 36% reported improvement, 27% did not find any change, whereas 14% reported that they were worse off their after bladder retraining.

CONCLUSION

The study confirms the usefulness of inpatient bladder retraining as a treatment option, especially in people refractory to outpatient management.

Nocturia in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH)

OBJECTIVE

This study aimed to assess the prevalence of nocturia and its impact on quality of life (QoL) in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

RESEARCH DESIGN AND METHODS

This was a Spanish, multicentre, cross-sectional study. Outpatients aged 60 years and over with LUTS/BPH, a prostate size > or = 25 g, untreated for LUTS/BPH and responding to the International Prostate Symptom Score (I-PSS) were included. Nocturia was defined as > or = 2 nocturnal voids/night. The Spanish version of the Nocturia-specific Quality of Life (N-QoL) questionnaire assessed the impact of nocturia on QoL, with a low score indicating a poor QoL due to nocturia.

RESULTS

A total of 502 patients were included; mean age 68.1 +/- 5.7 years, mean I-PSS 14.9 +/- 7.1, mean prostate size 50.9 +/- 20 g. The overall prevalence of nocturia was 83.1% (95% confidence interval [CI]: 79.8-86.4). Patients with nocturia had a lower score on the overall N-QoL questionnaire and the sleep/energy and bother/concern domains than those without nocturia (p < 0.001); 42.9% of patients with nocturia stated that they had a good-very good QoL compared to 90.6% in those without nocturia (p < 0.001).

CONCLUSION

This study shows a high prevalence of nocturia in Spanish LUTS/BPH patients. Nocturia negatively impacts on the QoL of LUTS/BPH patients, which is reflected in worse sleep, reduced energy levels and increased bother and concern. Therefore adequate treatment of this symptom is necessary.