Detrusor overactivity persisting at night and preceding nocturia in patients with overactive bladder syndrome: a nocturnal cystometrogram and polysomnogram study

Screening of overactive bladder syndrome and its relation with insomnia: A public health experience

Background

Overactive bladder (OAB) syndromes are a vital global issue linked to sleep disturbances and insomnia. This survey explores the relationship between these health burden issues and their risk factors.

Methodology

A survey-based study was conducted among Makkah city citizens' in April 2023. A standardized tool of OAB symptom score and Insomnia Severity Index was used to screen participants. The collected data were statistically analyzed using SPSS.

Results

Overall, 529 participants were enrolled in this survey with mean = 37.3 and standard deviation = 13.7. Most participants had mild OAB 74.67%, while insomnia represents no clinically significant subtype among the majority 55.39%. About 25.33% of participants had clinical OAB (moderate and severe), while approximately 44.61% had insomnia. Similarly, participants with the mild subtype of OAB show a significant correlation with no clinically significant subtype of insomnia (P ˃ 0.001). Furthermore, participants with moderate OAB were statistically associated with subthreshold insomnia (P ˃ 0.001).

Conclusion

Medical attention and public awareness are mandatory for the early detection of OAB and insomnia.

Overactive Bladder as a Key Driver of Nocturia: The Argument Against

Studies have shown that therapies for overactive bladder reduce urgency symptoms. However, these studies fail to demonstrate clinically significant increases in bladder capacity or changes in mean voided volumes at night.

Bladder sensations in women with nocturia due to overactive bladder syndrome

OBJECTIVES

Nocturia is the number of times urine is passed during main sleep. This definition tells us that it is a need to void; it does not tell us what triggers it. The aim of this study is to report bladder sensations that wake up women with nocturia (N). Descriptions of sensations in relation to various overactive bladder (OAB) symptoms, most bothersome symptoms, urinary incontinence (UI) and urodynamic findings are examined.

MATERIALS AND METHODS

A prospective study of women > 18 years old presenting with OAB and nocturia. Data collected included presenting and most bothersome symptoms, descriptions of bladder sensations associated with nocturia, number of frequency and nocturia episodes, nighttime UI and urodynamic findings.

RESULTS

One hundred fifty women were recruited with mean age 52 years, mean duration of symptoms 10.5 months and mean number of nocturia episodes 4.5. All women reported multiple presenting and bothersome symptoms. Fifty-five per cent had detrusor overactivity (DO). "Multiple" and "more intense" bladder sensation descriptions of nocturia were associated with advanced age, more frequent nighttime UI, when nocturia was considered most bothersome and in the presence of DO. The most frequent single description was "strong desire to void". The most frequently used combination was "strong desire to void, sudden compelling desire to void, bladder pain and full bladder".

CONCLUSION

Descriptions of bladder sensations associated with nocturia in women with OAB were diverse and overlapping. It is important to report clinically and in research why patients have nocturia as this will have bearing on its treatment.

Nocturia: consequences, classification, and management

Nocturia is a widespread condition that can negatively impact quality of sleep and overall health. This condition is multifactorial in nature and is best approached through the analysis of frequency volume charts. Through these charts, clinicians may classify each individual case of nocturia into one of four distinct categories: global polyuria, nocturnal polyuria, reduced bladder capacity, and mixed. Treatments should then be tailored to each individual based upon the category of their nocturia. In some cases, appropriate therapy will consist of behavioral modification techniques or addressing underlying systemic diseases. In other cases, medical therapy may be necessary, but, to date, medications have shown limited efficacy at treating nocturia.

Nocturnal Polyuria in Older Women with Urge Urinary Incontinence: Role of Sleep Quality, Time in Bed and Medications Used

PURPOSE

Nocturia is common and bothersome in older adults, especially those who are also incontinent. Since nocturnal polyuria is a major contributor, we examined factors associated with nocturnal polyuria in this population to identify those possibly amenable to intervention.

MATERIALS AND METHODS

We analyzed baseline data from 2 previously completed studies of urge urinary incontinence. The studies involved 284 women (mean age ± SD 72.9 ± 7.9 years) who also completed 3-day voiding diaries. Participants with a nocturnal polyuria index greater than 33% were categorized as having nocturnal polyuria (nocturnal polyuria index = nocturnal urinary volume per 24-hour urine volume). Associations between nocturnal polyuria and various demographic, clinical and sleep related parameters were determined.

RESULTS

Overall 55% of the participants had nocturnal polyuria. Multivariable regression analysis revealed that age, body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker, time spent in bed and duration of first uninterrupted sleep were independent correlates of nocturnal polyuria. Participants with a larger nocturnal excretion reported a shorter duration of uninterrupted sleep before first awakening to void and worse sleep quality despite spending similar time in bed.

CONCLUSIONS

Body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers, time in bed and duration of uninterrupted sleep before first awakening to void are independently associated with nocturnal polyuria in older women with urge urinary incontinence, and are potentially modifiable. These findings also confirm the association between sleep and nocturnal polyuria. Further studies should explore whether interventions to reduce nocturnal polyuria and/or increase the duration of uninterrupted sleep before first awakening to void would help to improve sleep quality in this population and thereby reduce or eliminate the need for sedative hypnotics.

Nocturia: aetiology and treatment in adults

Nocturia is an extremely common condition that has major sequelae for affected patients. Through disruption of sleep, nocturia impairs quality of life and worsens health outcomes, and is associated with a variety of morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. Unsurprisingly, several studies have also linked nocturia with reduced survival. Nocturia is not simply a consequence of lower urinary tract disease; rather, it is a multifactorial disorder that is often a manifestation of an underlying renal or systemic disease. Through the use of the frequency volume chart, clinicians can accurately quantify nocturia and determine its aetiology. Evaluation of quality of life and sleep using simple measures is essential in order to assess the impact of nocturia on a patient. Numerous treatment options for nocturia exist, but most are associated with minor benefit or lack sufficient evidence supporting their use. By systematically analysing an individual's causes of nocturia, clinicians can design appropriate treatment strategies to most effectively treat this condition.

Nocturia: The circadian voiding disorder

Nocturia is a prevalent condition of waking to void during the night. The concept of nocturia has evolved from being a symptomatic aspect of disease associated with the prostate or bladder to a form of lower urinary tract disorder. However, recent advances in circadian biology and sleep science suggest that it might be important to consider nocturia as a form of circadian dysfunction. In the current review, nocturia is reexamined with an introduction to sleep disorders and recent findings in circadian biology in an attempt to highlight the importance of rediscovering nocturia as a problem of chronobiology.

Recent advances in the understanding of male lower urinary tract symptoms (LUTS)

In this review, we have looked at three important areas in understanding male lower urinary tract symptoms. These are improvement in terminology, detrusor underactivity, and nocturia. Benign prostatic hyperplasia leading to bladder outlet obstruction has been covered in a previous review.

Comparison of diary-derived bladder and sleep measurements across OAB individuals, primary insomniacs, and healthy controls

INTRODUCTION AND HYPOTHESIS

Can diary-derived bladder and sleep measurements differentiate individuals with overactive bladder syndrome (OAB) from individuals with primary insomnia and healthy controls?

METHODS

Bladder- and sleep-diary data were compared in nine OAB, ten insomnia, and five control individuals. One-way analysis of variance (ANOVA) was used for normally and Kruskal-Wallis test for nonnormally distributed variables, followed, when significant effects were found, by pairwise comparisons.

RESULTS

OAB individuals woke up as frequently as insomniacs, but their awakenings were respectively shorter in duration (18.6 vs. 38.1 min.) and were predominantly initiated by nocturic events (89.2 vs. 23.9 % respectively). Regardless, their reported quality of sleep was as impaired as for the insomniacs. Furthermore, smaller mean volume voided awakenings were evident not only in those with OAB but also in insomniacs compared to controls.

CONCLUSIONS

Bladder- and sleep-diary data provide means to differentiate those with OAB from those with insomnia and healthy controls. Awakenings in OAB individuals were shorter than those with insomnia and much more likely due to the need to void. Thus, a reduction in the number of nocturic voids could be the most appropriate sleep-related outcome for nocturia therapy in individuals with OAB. In addition, limited nocturnal bladder capacity, though expected in OAB, was unexpectedly found in insomnia, possibly reflecting the role of consciousness (wakefulness at night) in modulating bladder sensation.

Sleep analysis of patients with nocturia and benign prostatic obstruction

OBJECTIVE

To analyze the timing of nocturia during sleep and its effect on sleep quality using the polysomnography (PSG) findings from patients with benign prostatic obstruction.

METHODS

From August 2009 to August 2010, 20 patients diagnosed with benign prostatic obstruction were enrolled in the present study. The sleep evaluation was performed by PSG. The Epworth index was used to evaluate the sleepiness of the patients. The effect of nocturia on sleep quality is evaluated by sleep efficacy, total sleep time, and rapid eye movement sleep duration, calculated from the hypnograms derived from the polysomnograms.

RESULTS

The mean age, total International Prostate Symptom Score, nocturia frequency on International Prostate Symptom Score, and frequency of nocturia recorded during PSG was 60.4 ± 8.5 years (range 44-74), 19.3 ± 4.9 (range 10-28), 3.5 ± 1.05 (range 2-5), and 1.35 ± 1.2 (range 0-4), respectively. In 6 patients (30%), the Epworth sleepiness score was pathologic (score >8). Nocturia correlated positively with increased daytime sleepiness, however it did not correlate with sleep efficacy or total sleep time. These parameters were affected by the apnea-hypopnea index, the major determinant of obstructive sleep apnea. Of the 20 patients, 14 (70%) experienced nocturia during PSG, and in these patients, we recorded 23 nocturia episodes that mostly occurred in the superficial sleep stage (16 [70%] of 23). Only 7 nocturia episodes (30%) occurred in the deep sleep stage. The sleep quality of patients with deep sleep nocturia did not differ from that of patients with superficial sleep nocturia.

CONCLUSION

The results of our study have shown that nocturia predominantly occurs during the superficial sleep or rapid eye movement stage and is related to increased daytime sleepiness in patients with benign prostatic obstruction. The timing and frequency of nocturia had no significant affect on sleep quality; however, the presence of obstructive sleep apnea negatively interfered with these parameters.