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Öberg S, Sandlund C, Westerlind B, Finkel D, Johansson L. The existing state of knowledge about sleep health in community-dwelling older persons - a scoping review. Ann Med 2024; 56:2353377. [PMID: 38767211 PMCID: PMC11107849 DOI: 10.1080/07853890.2024.2353377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVES It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people. AIM This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons. METHOD We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485. RESULTS The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty. CONCLUSION Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.
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Affiliation(s)
- Sandra Öberg
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Björn Westerlind
- Department of Geriatrics, County Hospital Ryhov, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
| | - Deborah Finkel
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
- Center for Economic and Social Research, University of Southern CA, Los Angeles, CA, USA
| | - Lennarth Johansson
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
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Verbakel I, Lazar J, Sinha S, Hashim H, Weiss JP, Abrams P, Everaert K. How should we assess the cardiovascular system in patients presenting with bothersome nocturia? ICI-RS 2023. Neurourol Urodyn 2024; 43:1391-1399. [PMID: 37942826 DOI: 10.1002/nau.25331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
AIMS The link between nocturia and cardiovascular disease (CVD) is frequently discussed in literature, yet the precise nature of this relationship remains poorly characterized. The existing literature was reviewed in order to address issues concerning the origin, diagnosis, management, and implications of the co-occurrence of CVD and nocturia. METHODS This review summarizes literature and recommendations regarding the link between CVD and nocturia discussed during a think-tank meeting held at the 2023 International Consultation on Incontinence-Research Society. RESULTS Cardiovascular disorders are often underestimated contributors to nocturia, with various potential mechanisms influencing nighttime urination, such as impact on fluid retention, atrial natriuretic peptide, and glomerular filtration rate. The redistribution of fluid from leg edema in supine position can lead nocturnal polyuria (NP). Additionally, sleep disturbances due to nocturia in itself may lead to CVD through an increase in blood pressure, insulin resistance, and inflammation. Disrupted circadian rhythms (e.g., in sleep pattern and urine production) were identified as critical factors in most etiologies of nocturia, and their contribution is deemed imperative in future research and treatment approaches, particularly in the aging population. NP can be detected through a simple bladder diary and can even be used to distinguish cardiac from noncardiac causes of nocturia. For the treatment of NP, desmopressin can be effective in select patients, however, caution and close monitoring is warranted for those with CVD due to increased risk of side effects. CONCLUSIONS Gaps were identified in the available evidence and clear cut recommendations were put forth for future research. It is essential to gain a deeper understanding of the mechanisms linking nocturia and CVD to develop optimal management strategies.
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Affiliation(s)
- Irina Verbakel
- Department of Urology, ERN Accredited Center, Ghent University Hospital, Gent, Belgium
| | - Jason Lazar
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Karel Everaert
- Department of Urology, ERN Accredited Center, Ghent University Hospital, Gent, Belgium
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Tsubouchi K, Maeda T, Emoto T, Aoyagi C, Matsuoka W, Yamazaki F, Nakagawa C, Fukuhara Y, Tominaga K, Gunge N, Miyazaki T, Okabe Y, Matsuzaki H, Nakamura N, Arima H, Haga N. Improvement of medication adherence for desmopressin by adjusting the prescription dosage in male patients with overactive bladder: A claims database analysis. Neurourol Urodyn 2024. [PMID: 38979828 DOI: 10.1002/nau.25541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/22/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES Desmopressin is widely used for nocturia in patients with nocturnal polyuria. We investigated the continuation rate and adherence for desmopressin in patients with overactive bladder and nocturia using a claims database and evaluated factors that improved adherence. METHODS Patients with nocturia in a Japanese claims database who started desmopressin between September 2019 and July 2021 were evaluated. Drug persistence was assessed using the Kaplan-Meier method for initial prescription of desmopressin. The proportion of days covered (PDC) was also evaluated among patients with prescription persistence. Multivariate analysis was performed using logistic regression analysis to identify factors predicting adherence to desmopressin. RESULTS The study included 72,888 patients entered into Japan Medical Data Center (JMDC) database between September 2019 and July 2021. For the 236 patients prescribed desmopressin formulations, mean prescription duration was 114 days. Among the total cases, 90 (38.1%) cases were prescribed only once, mean PDC was 0.60, and the number of high-adherence patients (PDC ≥ 0.80) was 108 (45.8%). Desmopressin prescription doses were fixed in 216 patients and adjusted in 20 patients. Multivariate analysis identified prescription dose adjustment for desmopressin as significantly associated with high PDC. CONCLUSION Desmopressin showed a 38% dropout rate after the first dose. However, high medication continuation and high medication adherence rates (PDC) could be maintained with prescription adjustments. Careful patient monitoring and appropriate adjustment of the desmopressin dosage appear to be important factors in improving nocturia.
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Affiliation(s)
- Kazuna Tsubouchi
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiki Maeda
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Taiki Emoto
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Chikao Aoyagi
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Wataru Matsuoka
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihiro Yamazaki
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Chizuru Nakagawa
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuichiro Fukuhara
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kosuke Tominaga
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Nobuyuki Nakamura
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Nobuhiro Haga
- Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Getaneh FW, Kolm P, Awulachew H, Iglesia CB, Dieter AA. Comparing Impact of Overactive Bladder Therapies on Nocturia. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:264-271. [PMID: 38484241 DOI: 10.1097/spv.0000000000001465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Nocturia is a significant symptom in overactive bladder with little data regarding the impact of overactive bladder treatments on nocturia. OBJECTIVES Compare the effect of anticholinergic (AC) medication, onabotulinum toxin A (BTX), and sacral neuromodulation (SNM) on nocturia. STUDY DESIGN Secondary analysis of the ABC and ROSETTA trials using data from the National Institutes of Health Data and Specimen Hub database. Patients reporting mean ≥2 voids/night on 3-day diary were included and divided into cohorts by treatment: the ABC trial: (1) AC and (2) BTX 100 units, and the ROSETTA trial: (3) BTX 200 units and (4) SNM. Primary outcome was change in mean voids/night on 3-day diary from baseline to 6 months assessed by mixed-effects models for repeated-measures data with interaction between treatment cohort and time included in model. RESULTS A total of 197 patients were included: 43 (22%) AC, 37 (19%) BTX 100 U, 63 (32%) BTX 200 U, and 54 (27%) SNM. There were no significant differences in baseline voids/night, demographics, or urodynamic values except for younger age in AC and BTX 100 U cohorts (P = 0.04). At 6 months, all cohorts demonstrated a mean 41% decrease in mean voids/night (2.7 ± 0.4 at baseline to 1.6 ± 0.5 at 6 months; P < 0.001), with no significant difference in change in mean voids/night between treatment cohorts (decrease of 44% in AC, 46% in 100 U BTX, 32% 200 in U BTX, and 33% in SNM; P > 0.05). CONCLUSION For women with nocturia ≥2/night, treatment with AC, BTX 100 or 200 units, or SNM led to a significant decrease in voids/night at 6 months.
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Affiliation(s)
- Feven W Getaneh
- From the Department of Obstetrics and Gynecology, MedStar Washington Hospital Center
| | | | | | - Cheryl B Iglesia
- From the Department of Obstetrics and Gynecology, MedStar Washington Hospital Center
| | - Alexis A Dieter
- From the Department of Obstetrics and Gynecology, MedStar Washington Hospital Center
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Hafner M, Yerushalmi E, Andersson FL, Burtea T. Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia. HEALTH ECONOMICS 2023; 32:654-674. [PMID: 36424887 PMCID: PMC10100343 DOI: 10.1002/hec.4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.
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Affiliation(s)
| | - Erez Yerushalmi
- Birmingham City Business SchoolBirmingham City UniversityBirminghamUK
| | | | - Teodor Burtea
- Ferring International Center SASaint‐PrexSwitzerland
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Wang CN, Sebesta EM, Moran GW, Chung DE. Urodynamic findings in female patients with nocturia: An age-matched case-control study. Neurourol Urodyn 2023; 42:221-228. [PMID: 36259768 DOI: 10.1002/nau.25071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 08/30/2022] [Accepted: 10/06/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Nocturia negatively impacts the quality of life and is associated with poor general health, but our understanding of its etiologies is incomplete. Urodynamic studies (UDS) findings in patients with nocturia are not well described and may help guide management. Our objective was to compare UDS findings with age-matched patients with and without nocturia. MATERIALS AND METHODS We retrospectively reviewed UDS findings of 1124 patients (2010-2017). A total of 484 (43%) presented with nocturia and 821 (73%) were female. Female patients were separated into age-matched groups with and without nocturia. Urinary symptoms, past medical diagnoses, demographic information, and UDS findings were compared. RESULTS A total of 596 female patients were included, 298 (50%) with nocturia and 298 without. Past medical history, including diabetes mellitus and cardiovascular disease, did not differ between groups. Patients with nocturia were more likely to have pelvic pain (p = 0.0014) and other daytime symptoms (frequency, urgency, and urgency incontinence). On UDS, patients with nocturia were more likely to have bladder outlet obstruction (BOO) (p = 0.025) and dysfunctional voiding (DV) (p < 0.0001). There was no difference in the frequency of detrusor overactivity (DO). Bladder capacity and postvoid residual volumes were lower, though not significantly, in the nocturia group. CONCLUSIONS When comparing UDS findings in contemporary, age-matched groups of female patients with and without nocturia, we found only BOO and DV to be associated with nocturia. While the treatment of nocturia is often aimed at managing DO, our data suggest that this may not be the primary urodynamic correlation with nocturia. Further studies are needed to assess whether successful treatment of BOO and DV can improve nocturia.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Elisabeth M Sebesta
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George W Moran
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
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Yang E, Ismail A, Kim Y, Erdogmus E, Boron J, Goldstein F, DuBose J, Zimring C. Multidimensional Environmental Factors and Sleep Health for Aging Adults: A Focused Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15481. [PMID: 36497555 PMCID: PMC9739530 DOI: 10.3390/ijerph192315481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
The timing, amount, and quality of sleep are critical for an individual's health and quality of life. This paper provides a focused narrative review of the existing literature around multidimensional environments and sleep health for aging adults. Five electronic databases, Scopus, Web of Science, PubMed/Medline; EBSCOhost, PsycINFO (ProQuest), and Google Scholar yielded 54,502 total records. After removing duplicates, non-peer reviewed academic articles, and nonrelevant articles, 70 were included for review. We were able to categorize environmental factors into housing security, home environment, and neighborhood environment, and, within each environmental category, specific elements/aspects are discussed. This paper provides a comprehensive map connecting identified levels of influence (individual, home/house, and neighborhood-level) in which subfactors are listed under each level of influence/category with the related literature list. Our review highlights that multidimensional environmental factors can affect aging adults' sleep health and eventually their physical, mental, and cognitive health and that sleep disparities exist in racial minorities in socioeconomically disadvantaged communities in which cumulative environmental stressors coexist. Based on this focused narrative review on the multidimensional sleep environments for aging adults, knowledge gaps are identified, and future research directions are suggested.
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Affiliation(s)
- Eunhwa Yang
- School of Building Construction, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Aliaa Ismail
- School of Building Construction, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Yujin Kim
- School of Building Construction, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Ece Erdogmus
- School of Building Construction, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Julie Boron
- Department of Gerontology, University of Nebraska Omaha, Omaha, NE 68182, USA
| | - Felicia Goldstein
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Jennifer DuBose
- SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Craig Zimring
- SimTigrate Design Lab, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Prevalence and Risk Factors for Urinary Incontinence in Nulliparous Women: A Contemporary, Population-Based Cohort Study. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 29:520-527. [PMID: 36730707 DOI: 10.1097/spv.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE AND OBJECTIVES Epidemiologic studies of incontinence largely focus on parous women, and there are limited data regarding nulliparous women. Our objectives were to evaluate risk factors for urinary incontinence among a nationally representative, contemporary sample of nulliparous women of all ages in the United States and to describe the prevalence and subtypes of urinary incontinence and nocturia in this population. STUDY DESIGN This cross-sectional, population-based study used the National Health and Nutrition Examination Survey cycles 2011-2018 to assemble a sample of nulliparous women 20-80 years old. Crude and adjusted odds ratios were estimated using multivariable logistic regression for the exposures of interest: body mass index (BMI), age, physical activity, prior hysterectomy, and current smoking. Prevalence of urinary incontinence and nocturia were estimated. RESULTS Among 1,603 nulliparous women, prevalence of any urinary incontinence was 29.38%. Prevalence of stress, urgency, and mixed urinary incontinence and nocturia, respectively, were 27.68%, 19.64%, 10.57%, and 58.95%. Women with a BMI ≥25 (calculated as weight in kilograms divided by height in meters squared; adjusted odds ratio [aOR], 1.57; 95% confidence interval [CI], 1.11-2.23), at least 45 years (aOR, 3.75; 95% CI, 2.31-5.83), and current smoking (aOR, 1.63; 95% CI, 1.07-2.49) had increased the odds of incontinence compared with women without these risk factors. When stress urinary incontinence (SUI) was considered alone, only women with a BMI ≥25 (aOR, 1.66; 95% CI, 1.20-2.31) and age at least 45 years (aOR, 3.17; 95% CI, 2.01-5.00) had increased odds of SUI compared with women without these risk factors. CONCLUSIONS Urinary incontinence and nocturia are prevalent in nulliparous women, and age, elevated BMI, and current smoking may represent risk factors for incontinence in this population.
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Nocturia independently predicts left ventricular hypertrophy and left atrial enlargement among patients with cardiac symptoms. Sci Rep 2022; 12:14897. [PMID: 36050443 PMCID: PMC9436922 DOI: 10.1038/s41598-022-19190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Nocturia can be caused by urological disorders and systemic diseases, including heart diseases. We aimed to investigate the relationship between nocturia and structural abnormalities on echocardiography. Adult patients who underwent echocardiography for cardiac symptoms or heart murmur or had a history of structural heart disease were included. The voiding times during sleep hours were collected prospectively. Univariate and multivariate analyses were performed to evaluate the predictive value of bothersome nocturia (nocturia ≥ 2) on echocardiographic abnormalities. Of 299 patients, 182 (60.9%) reported bothersome nocturia. In patients aged ≥ 65 years, hypertension and left atrial enlargement (LAE) were associated with higher occurrences of bothersome nocturia. On multivariate analysis, bothersome nocturia was a predictive factor of LAE (odds ratio [OR] 2.453, 95% confidence interval [CI] 1.363–4.416, p = 0.003). Moreover, bothersome nocturia could predict both LAE and left ventricular hypertrophy (LVH) (OR 2.285, 95% CI 1.151–4.536, p = 0.018; OR 2.056, 95% CI 1.025–4.124, p = 0.043) in the elderly. Older age, hypertension, and LAE were risk factors for bothersome nocturia. Moreover, bothersome nocturia was predictive of LAE and LVH in the elderly. Patients with bothersome nocturia without other significant lower urinary tract symptoms should be referred to cardiologists.
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Weiss JP, Bosch JLHR, Chapple CR, Bacci ED, Simeone JC, Rosenberg MT, Mueller ER, Andersson FL, Juul K, Chughtai B, Coyne KS. The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study. Eur Urol Focus 2022; 8:1415-1423. [PMID: 35039242 DOI: 10.1016/j.euf.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Jeffrey P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Chen SH, Chin WC, Huang YS, Chuech LS, Lin CM, Lee CP, Lin HL, Tang I, Yeh TC. The effect of electromagnetic field on sleep of patients with nocturia. Medicine (Baltimore) 2022; 101:e29129. [PMID: 35960119 PMCID: PMC9371528 DOI: 10.1097/md.0000000000029129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Accumulated studies revealed that electromagnetic field can affect human brain and sleep. We explored the effectiveness of electromagnetic field [Schumann resonance (SR)] on nocturia symptoms, quality of life, and sleep in patients with nocturia. METHODS This is a randomized, open-label, and active-controlled study, in which 35 participants were randomized into 2 groups. Group A received oxybutynin and the SR device for 12 weeks, while the active-control group received only the medication. We followed these patients every 4 weeks with a number of questionnaires, including the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) for sleep, the American Urological Association Symptom Score (AUASS) for nocturia symptoms, and the Nocturia-Quality-of-Life-questionnaire (N-QOL) for quality of life. Descriptive statistics, pair t-tests, Chi-squared tests, and repeated measures were applied for data analysis. RESULTS No significant difference was found in the demographic data between the 2 groups. The AUASS, N-QOL, PSQI, and ESS total scores were significantly improved in the SR-sleep-device group (P < .001, P = .005, P < .001, P = .001) after treatment, but no significant change was found in the active-control group. Several variables of AUASS in the SR-sleep-device group were significantly improved, especially streaming and sleeping (both P = .001), and subjective sleep quality and sleep efficiency also demonstrated significant improvement (both P < .001). CONCLUSIONS Our study revealed that electromagnetic field (SR) as an add-on can improve not only sleep and quality of life but also nocturia symptoms in patients with nocturia. These findings suggest that SR can be effective for sleep disturbance secondary to physical disease, which can be a new application of the electromagnetic field.
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Affiliation(s)
- Shin-Hong Chen
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Wei-Chih Chin
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Yu-Shu Huang, MD, PhD, Department of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (e-mail: )
| | | | - Chang-Min Lin
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chin-Pang Lee
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Li Lin
- Division of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I Tang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chun Yeh
- Division of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
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12
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Ahmad T, Khan M, Al-Omari B. Mapping the global literature output on nocturia: A bibliometric and visualized analysis. Medicine (Baltimore) 2022; 101:e29455. [PMID: 35945764 PMCID: PMC9351897 DOI: 10.1097/md.0000000000029455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study aims to facilitate researchers' and clinicians' understanding of research frontiers and trends in nocturia. It explores the scientific research outcomes and key bibliometric indices and plots global research on nocturia. METHODS A bibliometric retrospective study was designed, and an online search was conducted in the Web of Science Core Collection database using the potential search keywords related to nocturia in the title field with some specific filtration. HistCite™ and VOSviewer software for windows were used to analyze the data obtained for authors, journals, countries, institutions, keywords, and visualization mapping. RESULTS The initial search retrieved 1479 hits. A total of 1445 publications were included in the final analysis. Of these, 43.53% were published as articles. The most studied area in nocturia is urology nephrology. The most productive year was 2019 (n = 121, citations = 335), and the most prolific author, both in terms of publications (n = 97) and citations (1658) was Weiss JP. The most cited journal in nocturia research was the Journal of Urology (n = 293, citations = 3050). The most widely used keyword in nocturia publications was nocturia (n = 1249). Visualization mapping shows that the USA was the most influential and highly cited country in nocturia research. CONCLUSION This study showed that there has been an increasing research trend in nocturia over the past few years. The current findings provide important empirical evidence for researchers, clinicians, and physicians to understand research frontiers and trends, achievements, collaborative networks, and hotspot research topics in the research field of nocturia.
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Affiliation(s)
- Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210096, China
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Muhammad Khan
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21120, Khyber Pakhtunkhwa, Islamic Republic of Pakistan
| | - Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- *Correspondence: Basem Al-Omari, Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates (e-mail: )
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13
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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14
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Miyazato M, Gakiya M, Ashikari A, Kamijo TC, Kagawa H, Matsuo T, Miyata Y, Oshiro Y, Arai K, Machida N, Shinzato H, Chinen Y, Iwata H, Ueda S, Saito S. Evaluation of the influence of a history of childhood nocturnal enuresis on nighttime urinary frequency and the causes of nocturia in adults. Urology 2022; 164:106-111. [PMID: 35038490 DOI: 10.1016/j.urology.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine whether a history of nocturnal enuresis affects nighttime urinary frequency and to evaluate nocturia etiologies in adults. METHODS A total of 143 participants with at least one episode of nocturia per night were included in this study. The self-reported questionnaire collected data on demographic characteristics, medical history, history of nocturnal enuresis in elementary school, lower urinary tract symptoms, and frequency-volume charts. RESULTS A history of nocturnal enuresis was observed in 52.4% of participants. However, night-time urinary frequency was significantly lower in participants with a history of nocturnal enuresis in elementary school than in those without such history. On multivariate analysis, a history of nocturnal enuresis was also negatively associated with nighttime urinary frequency (p<0.01). There was a collinearity effect between age and nighttime urinary frequency. A history of nocturnal enuresis did not affect the presence of nocturnal polyuria or overactive bladder in participants. However, sleep disturbances were fewer in participants with a history of nocturnal enuresis (odds ratio 0.404). CONCLUSIONS A history of nocturnal enuresis might be negatively associated with nighttime urinary frequency due to fewer sleep disturbances. Further, progression of nocturia may depend on conditions, such as age and acquired diseases.
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Affiliation(s)
- Minoru Miyazato
- Department of Systems Physiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | | | - Asuka Ashikari
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tadanobu Chuyo Kamijo
- Department of Systems Physiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | - Tomohiro Matsuo
- Department of Urology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yasuyoshi Miyata
- Department of Urology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | | | | | | | | | - Hiroyoshi Iwata
- Department of Clinical Pharmacology and Therapeutics, University of The Ryukyus, Okinawa, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of The Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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15
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Pauwaert K, Bruneel E, Van Laecke E, Depypere H, Everaert K, Goessaert AS. Does hormonal therapy affect the bladder or the kidney in postmenopausal women with and without nocturnal polyuria? Results of a pilot trial. Maturitas 2022; 160:61-67. [DOI: 10.1016/j.maturitas.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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16
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Hwang EC, Jung HJ, Han MA, Kim MH, Yu SH, Jeong HC, Kim JS, Paick SH, Yeo JK, Jung JH. Korean guideline of desmopressin for the treatment of nocturia in men. Investig Clin Urol 2022; 63:499-513. [PMID: 36067995 PMCID: PMC9448671 DOI: 10.4111/icu.20220165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyun Jin Jung
- Department of Urology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seong Hyeon Yu
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyun Cheol Jeong
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Jun Seok Kim
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Seoul, Korea
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
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17
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Hudgens S, Howerter A, Polek E, Andersson FL. Psychometric validation and interpretation of the Nocturia Impact Diary in a clinical trial setting. Qual Life Res 2021; 31:1837-1848. [PMID: 34932192 PMCID: PMC9098619 DOI: 10.1007/s11136-021-03060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/02/2022]
Abstract
Purpose Psychometric evaluation of the Nocturia Impact (NI) Diary was conducted to support its use as a trial endpoint. Methods As part of a randomized, controlled Phase 2 clinical trial investigating a novel drug candidate for nocturnal polyuria, adult nocturia patients completed the NI Diary and a voiding diary for three nights preceding their clinic visit at Baseline and Weeks 1, 4, 8, and 12 (end of treatment). Exit interviews were conducted to obtain patient impressions of the NI Diary. Results A total of N = 302 participants were included. Confirmatory factor analysis (CFA) indicated that the 11-item measure is unidimensional with values of CFI, TLI, and RMSEA meeting relevant thresholds. Good internal consistency (Cronbach’s α 0.941) and test–retest reliability (intra-class correlation coefficients 0.730–0.880). Convergent validity with two reference measures was demonstrated with strong correlations of 0.573–0.730 were shown. Significant differences (P = 0.0018, standardized effect size = 0.372) between groups defined by number of night-time voids supported known-groups validity. Exit interviews in 66 patients indicated all participants experienced improvement in at least 1 NI Diary item and that a 1-point improvement on the item response scale and 1-void reduction per night (associated with an average best cut point on ROC analysis of − 11.6) constituted meaningful improvement. Anchor and distribution-based analyses identified a meaningful change threshold of − 15 to − 18 points on the NI Diary. Conclusion The NI Diary is a reliable and valid patient-reported psychometric instrument which is fit-for-purpose to evaluate the impact of nocturia on patient quality of life in the clinical trial setting. Trial registration number and registration date NCT03201419; June 28, 2017. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-03060-4.
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Affiliation(s)
- Stacie Hudgens
- Clinical Outcomes Solutions, Tucson, AZ, USA. .,Clinical Outcomes Solutions, 1820 E River Rd, Ste 220, Tucson, AZ, 85718, USA.
| | | | - Ela Polek
- Clinical Outcomes Solutions, Folkestone, UK
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18
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Van Besien W, Shire S, Decalf V, Ervin CE, King S, Baldrey C, Da Silva A, Wagg A, Everaert KE, Bower WF. The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia. Int J Clin Pract 2021; 75:e14876. [PMID: 34525254 DOI: 10.1111/ijcp.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/20/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs. METHODS A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. RESULTS Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. CONCLUSION Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.
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Affiliation(s)
- Wouter Van Besien
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Samia Shire
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Claire E Ervin
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Sharyn King
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Christine Baldrey
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Alisha Da Silva
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
| | - Adrian Wagg
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karel E Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy F Bower
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
- Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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19
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Martins T, Walter FM, Penfold C, Abel G, Hamilton W. Primary care use by men with symptoms of possible prostate cancer: A multi-method study with an ethnically diverse sample in London. Eur J Cancer Care (Engl) 2021; 30:e13482. [PMID: 34152656 DOI: 10.1111/ecc.13482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to investigate primary care use by men with recent onset of lower urinary tract symptoms (LUTS) to identify differences in presentation and investigation that may explain ethnic inequality in prostate cancer outcomes. METHODS This is a multi-method study of men presenting LUTS to primary care. Two hundred seventy-four men completed a self-administered questionnaire, and 23 participated in face-to-face interviews. Regression analyses investigated ethnic differences in (a) the period between symptom onset and first primary care presentation (patient interval) and (b) the interval between first primary care presentation and investigation with prostate-specific antigen (PSA) and digital rectal examination (DRE). Interview data were analysed using thematic analysis. RESULTS Half (144, 53%) reported a solitary first symptom, although multiple first symptoms were also common, particularly in Asian and Black men. There was no difference between ethnicities in patient interval or time from presentation to investigation. However, Asian men were offered less PSA testing (odds ratio 0.39; 95% confidence interval 0.17-0.92; p = 0.03). Qualitative data revealed ethnic differences in general practitioners' offer of DRE and PSA testing and highlighted limitations in doctor-patient communication and safety netting. CONCLUSION Our study showed only small differences in primary care experiences, insufficient to explain ethnic inequalities in prostate cancer outcomes.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clarissa Penfold
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, London, UK
| | - Gary Abel
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - William Hamilton
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
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20
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A Comprehensive Community-Based Prevalence Study on Nocturia in Hong Kong Male Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179112. [PMID: 34501700 PMCID: PMC8431019 DOI: 10.3390/ijerph18179112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022]
Abstract
Background: Most prevalence surveys on nocturia have focused on older populations. This study aimed to measure the nocturia prevalence across the full spectrum of male adults living in Hong Kong, where severity and associated quality-of-life (QoL) were also explored. Methods: A cross-sectional population-based survey was conducted in men aged 18 or above using the ICIQ-NQoL Questionnaire. Results: With 1239 respondents at age ranged 18–99, the overall nocturia prevalences were found to be 63.0% (ranged 41.6–84.6% at different age groups) and 31.2% (ranged 13.0–56.3% at different age groups), for ≥1 and ≥2 bedtime voiding episodes, respectively. The chance of nocturia was dramatically increased at age 60 or above while both prevalence and voiding frequency were increased with advancing age. About 83% of the nocturia men experienced one to two voiding episodes per night, but many of them had self-rated their QoL poor or very poor and indicated moderate-to-high bothersome. Younger men at age 18–39 were found to have high prevalence as 41.6% and almost 30% of them rated poor or very poor QoL. Conclusions: Nocturia was not only affecting the older populations but also caused significant bothersome and negative impacts on QoL in younger males.
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21
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Cheng W, Fan YH, Liou YJ, Hsu YT. The predictive factors of nocturia in young Asian adult males: an online survey. Sci Rep 2021; 11:16218. [PMID: 34376776 PMCID: PMC8355330 DOI: 10.1038/s41598-021-95836-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022] Open
Abstract
The present study investigated the association between severity of depressive mood and nocturia in young Asian adult men. Participants were 3127 adult male Facebook users aged 20–40 years who could read and write traditional Chinese. Participants completed online questionnaires on demographic characteristics, frequency of waking to urinate during the night (International Prostate Symptoms Score [IPSS]), and frequency of depressive symptoms (Taiwanese Depression Questionnaire [TDQ]). Those who awoke to pass urine during the main sleep period were considered to have nocturia. Student’s t test and Pearson’s chi square test were used to compare participants with and without nocturia. Univariate and multivariate logistic regression were used to evaluate predictive factors for nocturia. One thousand four hundred thirty (45.7%) participants had nocturia, and 21.9% were suspected to have depression. Age over 30 years, body mass index over 25 kg/m2, and higher IPSS score (except times of nocturnal voiding) were factors predictive of nocturia. Higher TDQ somatic subscores, rather than affective/cognitive subscores, were also predictive of nocturia. Associations were found between normal-high TDQ scores and nocturia. Young men with nocturia at risk of developing depression should be identified with a culturally relevant questionnaire. Early referral for psychiatric assessment and intervention may be warranted.
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Affiliation(s)
- Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.,Program in Molecular Medicine, College of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biopharmaceutical Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ting Hsu
- Division of Urology, Department of Surgery, Taipei City Hospital, Renai Branch, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei, 106243, Taiwan.
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22
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Yow HY, Tiong JJL, Mai CW, van der Werf E, Zainuddin ZM, Toh CC, Ngoo KS, Goh EH, Fadzli AN, Lok SH, Ong TA. Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia. BMC Urol 2021; 21:95. [PMID: 34187440 PMCID: PMC8243763 DOI: 10.1186/s12894-021-00860-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. METHODS A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. RESULTS There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31-40 (1.91 [1.52-2.40]) or > 60 years old (2.03 [1.48-2.71]), and those who presented with hypertension (2.84 [2.28-3.53]), diabetes mellitus (1.78 [1.42-2.25]), renal disease (3.58 [1.93-6.63]) or overactive bladder (1.61 [1.10-2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41-50 (0.73 [0.59-0.91]), male (0.78 [0.69-0.88]) and Chinese (0.47 [0.30-0.74]) or Indian (0.34 [0.21-0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. CONCLUSIONS The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.
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Affiliation(s)
- Hui-Yin Yow
- grid.452879.50000 0004 0647 0003School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University (Lakeside Campus), Subang Jaya, Malaysia
| | | | - Chun-Wai Mai
- grid.411729.80000 0000 8946 5787School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Esther van der Werf
- grid.425326.40000 0004 0397 0010Louis Bolk Institute, Bunnik, The Netherlands
| | - Zulkifli Md Zainuddin
- grid.412113.40000 0004 1937 1557Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Charng-Chee Toh
- grid.413442.40000 0004 1802 4561Department of Urology, Hospital Selayang, Selangor, Malaysia
| | - Kay-Seong Ngoo
- Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | - Eng-Hong Goh
- Urology, Nephrology & Men’s Health Clinic, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Nazran Fadzli
- grid.10347.310000 0001 2308 5949Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sze-Han Lok
- grid.452879.50000 0004 0647 0003School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University (Lakeside Campus), Subang Jaya, Malaysia
| | - Teng-Aik Ong
- grid.10347.310000 0001 2308 5949Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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23
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Alford N, Hashim H. Desmopressin acetate the first sublingual tablet to treat nocturia due to nocturnal polyuria. Expert Rev Clin Pharmacol 2021; 14:939-954. [PMID: 33993824 DOI: 10.1080/17512433.2021.1931122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Desmopressin was widely used to treat nocturnal polyuria in adults under the age of 65 due to the well-established risk of hyponatremia. Since the prevalence of nocturia increases with age, and with an aging population, those most affected were excluded from treatment. Recently, a new lower dose sublingual tablet formulation that optimizes the balance between efficacy and tolerability has been licensed for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults of any age, with the caveat of regular serum monitoring for those over 65. This newer formulation aims to achieve the same clinical outcomes as previous formulations while reducing the risk of hyponatremia.Areas covered: This review will look at the pharmacology of the newly formulated desmopressin and examine the results of the clinical trials that would support its treatment of adult nocturia with idiopathic nocturnal polyuria.Expert opinion: When reporting on the clinical efficacy of desmopressin on nocturia, it is important for clinical trials to publish their complete data on nocturnal and 24-hour urine voided volumes. Further research examining the physiological reasoning behind this gender-specific dosing for desmopressin and the optimal recommended treatment duration of desmopressin for those over 65 is needed.
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Affiliation(s)
| | - Hashim Hashim
- University of Bristol, Bristol, UK.,Bristol Urological Institute, Southmead Hospital, Bristol, UK
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24
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Liu J, Yin J, Chen P, Liu D, He W, Li Y, Li M, Fu X, Zeng G, Guo Y, Wang X, DiSanto ME, Zhang X. Smoothened inhibition leads to decreased cell proliferation and suppressed tissue fibrosis in the development of benign prostatic hyperplasia. Cell Death Discov 2021; 7:115. [PMID: 34006832 PMCID: PMC8131753 DOI: 10.1038/s41420-021-00501-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common disease in aging males. It has been proven that the Hedgehog (HH) is implied as an effective and fundamental regulatory growth factor signal for organogenesis, homeostasis, and regeneration. Smoothened (SMO), as the major control point of HH signals, activates aberrantly in most human solid tumors. However, the specific function of SMO and its downstream glioma-associated oncogene (GLI) family in BPH has not been well understood. Here, we first revealed that the SMO cascade was upregulated in BPH tissues and was localized in both the stromal and the epithelium compartments of human prostate tissues. Cyclopamine, as a specific SMO inhibitor, was incubated with BPH-1 and WPMY-1, and intraperitoneally injected into a BPH rat model established by castration with testosterone supplementation. SMO inhibition could induce cell apoptosis, cell cycle arrest at the G0/G1 phase, and a reduction of tissue fibrosis markers, both in vitro and in vivo. Finally, a tissue microarray, containing 104 BPH specimens, was constructed to analyze the correlations between the expression of SMO cascade and clinical parameters. The GLI2 was correlated positively with nocturia and negatively with fPSA. The GLI3 was in a positive relationship with International Prostate Symptom Score and nocturia. In conclusion, our study suggested that SMO cascade could play important roles in the development of BPH and it might be rediscovered as a promising therapeutic target for BPH.
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Affiliation(s)
- Jianmin Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jing Yin
- Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ping Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Daoquan Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weixiang He
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mingzhou Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xun Fu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guang Zeng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuming Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Michael E DiSanto
- Department of Surgery and Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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25
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Barakat B, Franke K, May M, Gauger U, Vögeli TA. Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review. Asian J Urol 2021; 9:27-34. [PMID: 35198394 PMCID: PMC8841275 DOI: 10.1016/j.ajur.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/03/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Bara Barakat
- Hospital Viersen, Department of Urology and Pediatric Urology, Viersen, Germany
- Corresponding author.
| | - Knut Franke
- Hospital Viersen, Department of Urology and Pediatric Urology, Viersen, Germany
| | - Matthias May
- Hospital St. Elisabeth, Department of Urology, Straubing, Germany
| | | | - Thomas-Alexander Vögeli
- University Hospital RWTH Aachen, Department of Urology and Pediatric Urology, Aachen, Germany
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26
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Miyazato M, Ashikari A, Nakamura K, Nakamura T, Yamashiro K, Uema T, Uehara M, Masuzaki H, Saito S, Maeda S, Ishida H, Matsushita M. Effect of a mobile digital intervention to enhance physical activity in individuals with metabolic disorders on voiding patterns measured by 24-h voided volume monitoring system: Kumejima Digital Health Project (KDHP). Int Urol Nephrol 2021; 53:1497-1505. [PMID: 33909235 PMCID: PMC8280019 DOI: 10.1007/s11255-021-02867-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/17/2021] [Indexed: 11/09/2022]
Abstract
Purpose To evaluate the effect of a mobile digital intervention on voiding patterns, we performed 24-h voided volume monitoring in individuals with metabolic disorders. Methods Participants with metabolic disorders were grouped into either the intervention group (n = 17), who had access to a smartphone app (CARADA), or the non-intervention group (n = 11), who did not. Urine monitoring was conducted for 24 h using a novel digital self-health monitoring system for urine excretion (s-HMSU). Body weight, abdominal circumference, blood pressure, and biomarkers were measured. Results Physical findings and blood test results at baseline and 6 months indicated no significant between-group differences. Night-time frequency did not change between baseline and 6 months in the intervention group but significantly worsened at 6 months in the non-intervention group, as compared to baseline (1.0 ± 0.7 vs. 1.5 ± 0.5, p < 0.05). The change in night-time frequency over 6 months did not differ between the intervention and non-intervention groups. Furthermore, the change in hours of undisturbed sleep over 6 months did not differ between the two groups. However, compared with baseline, nocturnal polyuria index tended to worsen at 6 months in the non-intervention group. Conclusion Our study results suggest that mobile digital intervention might be useful for behavioral therapy to improve night-time frequency and urine production and that s-HMSU might be beneficial for confirming the prevention of progress in individuals with metabolic disorders, which can aid in modifying lifestyle.
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Affiliation(s)
- Minoru Miyazato
- Department of Systems Physiology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Asuka Ashikari
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Koshi Nakamura
- Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takehiro Nakamura
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kiyoto Yamashiro
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsugumi Uema
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Moriyuki Uehara
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shiro Maeda
- Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, Okinawa, Japan
| | - Hajime Ishida
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masayuki Matsushita
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Deger M, Surmelioglu O, Kuleci S, Izol V, Akdogan N, Onan E, Tanrisever I, Aridogan IA. Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome. Int J Clin Pract 2021; 75:e13724. [PMID: 32959453 DOI: 10.1111/ijcp.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS Patients aged over 18 years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. RESULTS A total of 124 patients with a mean age of 49.9 ± 11.6 years (range: 25-81 years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4 ± 1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P < .05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P = .010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3 ± 1.4 before treatment and 1.7 ± 2.2 after treatment, showing a significant decrease (P = .032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P = .016 and P = .024, respectively). CONCLUSION The age and BMI score were the risk factors associated with nocturia in patients with OSAS.
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Affiliation(s)
- Mutlu Deger
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ozgur Surmelioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sedat Kuleci
- Department of Chest Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nebil Akdogan
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Elvan Onan
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Prevalence of Nocturia in United States Women: Results From National Health and Nutrition Examination Survey. Female Pelvic Med Reconstr Surg 2021; 27:e52-e58. [DOI: 10.1097/spv.0000000000000792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Konishi S, Hatakeyama S, Imai A, Kumagai M, Okamoto T, Okita K, Hamano I, Narita T, Kojima Y, Iwamura H, Yamamoto H, Yoneyama T, Yoneyama T, Hashimoto Y, Ohyama C. A Longitudinal Study of Bidirectional Relationships between Sleep Disorder and Frequency of Nocturia: Results from the Iwaki Health Promotion Project. Urol Int 2020; 105:232-239. [PMID: 33271539 DOI: 10.1159/000509976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The causal relationship between sleep disorder and frequency of nocturia remains unclear. METHODS We longitudinally evaluated sleep disorder and frequency of nocturia in 547 community-dwelling adults between baseline and 5-year follow-up. We included participants ≥50 years old who have no sleep disorder (the Pittsburgh Sleep Quality Index [PSQI] ≥ 5) nor nocturia (≥1). For 5 years, we evaluated the temporal changes in sleep disorder and nocturia and the bidirectional relationships between sleep disorder and nocturia. RESULTS Of the 547 participants, we included 268 adults with a median age of 61 years in this study. Median PSQI and nocturia were significantly increased for 5 years from 2 to 3 and from 1 to 2, respectively. New onset of sleep disorder (PSQI > 5) and nocturia >1 was observed in 42 (16%) and 137 (51%) participants, respectively. The cross-lagged panel analysis showed that the path coefficient from PSQI to nocturia (β = 0.22, p = 0.031) was significantly higher than that from nocturia to PSQI (β = 0.02, p = 0.941). CONCLUSIONS Our longitudinal study showed the effect of sleep disorder on nocturia was significant, although nocturia may not significantly worsen sleep disorder in community-dwelling adults.
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Affiliation(s)
- Sakae Konishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan,
| | - Atsushi Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Mika Kumagai
- Department of Active Life Promotion Sciences, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Okita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Palmieri B, Iannitti T, Morales-Medina JC, Vadalà M. Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly. Int J Clin Pract 2020; 74:e13612. [PMID: 32668490 DOI: 10.1111/ijcp.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022] Open
Abstract
AIM OF THE STUDY We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. METHODS USED TO CONDUCT THE STUDY The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. RESULTS OF THE STUDY We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
| | - Tommaso Iannitti
- Charles River Discovery Research Services UK Limited, Portishead, UK
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala CP 90000, AP 62, Tlaxcala, México
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
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Okumura K, Obayashi K, Tai Y, Yamagami Y, Negoro H, Kataoka H, Kurumatani N, Saeki K. Association between NT-proBNP and nocturia among community-dwelling elderly males and females: A cross-sectional analysis of the HEIJO-KYO study. Neurourol Urodyn 2020; 40:112-119. [PMID: 33085835 DOI: 10.1002/nau.24550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate the association between B-type natriuretic peptide (BNP) and nocturia among community-dwelling males and females. METHODS A total of 1096 participants (mean age 71.9 ± 7.1 years, 518 [47.2%] males) were included in the study. The number of nocturnal voids was recorded in a self-reported urination diary, and nocturia was defined as two or more voids per night. Daytime serum concentration of the N-terminal fragment of BNP precursor (NT-proBNP) was measured. Multivariable logistic regression analysis was performed to determine the association between NT-proBNP and nocturia. RESULTS Nocturia was observed in 23.5% of females and 37.1% of males. Higher NT-proBNP (log pg/ml) was associated with nocturia in both gender groups (females: odds ratio [OR]: 1.67, 95% confidence interval [95% CI], 1.21-2.34, p = .002; males: OR: 1.26, 95% CI, 1.01-1.59, p = .046), independent of confounding variables including night-time blood pressure, mean voided volume, and chronic kidney disease. Although the increase in prevalence of nocturia with higher NT-proBNP was equivalent in both genders, some effect of gender on the relationship between NT-proBNP and nocturia was observed (p = .037). Nocturnal urine volume was also significantly and independently associated with NT-proBNP level (females: β = 32.9 ml, 95% CI, 5.63-60.2, p = .018; males: β = 34.6 ml, 95% CI, 9.40-59.9, p = .007). CONCLUSIONS This study revealed higher serum NT-proBNP is significantly and independently associated with the prevalence of nocturia in both males and females. This is an exploratory cross-sectional study and the analyses are post hoc, so further research works are needed to clarify the causality and clinical value.
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Affiliation(s)
- Kazuki Okumura
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Yoshiaki Tai
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan.,Department of General Medicine, Nara Medical University School of Medicine, Nara, Japan
| | - Yuki Yamagami
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | | | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Norio Kurumatani
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
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32
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Weiss JP, van der Meulen EA, Juul KV. Low-dose Desmopressin Orally Disintegrating Tablet: Suggested Clinically Meaningful Benefit in Patients with Nocturia Due to Nocturnal Polyuria. Eur Urol Focus 2020; 6:1006-1012. [DOI: 10.1016/j.euf.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/24/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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Hafner M, Andersson FL, Burtea T, van Stolk C, Whitmore M, Yerushalmi E, Troxel WM. Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity. J Med Econ 2020; 23:994-1003. [PMID: 32397770 DOI: 10.1080/13696998.2020.1767631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective well-being (SWB), work engagement and productivity.Methods: Using large-scale international workplace survey data, the associations between nocturia, SWB, work engagement (Utrecht Work Engagement Scale, UWES-9) and productivity (Work Productivity and Activity Impairment, WPAI) were assessed. Bivariate and multivariate regression analysis was used with adjustment for a large set of confounding factors, including sleep duration and sleep quality.Results: Across a study sample of 92,129 observations, aged 18-70, an average of 10% of the survey population reported ≥2 nocturnal voids (generally considered clinically significant nocturia), with prevalence of nocturia increasing with age. Individuals with nocturia reported a 35.7% (p < .001) higher relative sleep disturbance score and were 10.5 percentage points (pp) (p < .001) more likely to report short sleep. Adjusted for covariates, nocturia was associated with a 3.5% (p < .001) lower relative SWB score and a 2% (p < .001) lower relative UWES-9 work engagement score. Nocturia was associated with a 3.9 pp (p < .001) higher work impairment due to absenteeism and presenteeism (WPAI). Adjusting additionally for sleep disturbance and sleep duration reduced the magnitude of the estimated effects, suggesting a key role for poor sleep in explaining the relationship between nocturia and the outcomes (SWB, UWES-9, WPAI) assessed.Conclusions: A key contribution of this study is the assessment of the association between nocturia and a range of work performance outcomes in a sizeable study using validated instruments to measure work engagement and productivity. The study highlights the importance of taking sleep into account when assessing the relationship between nocturia and associated outcomes.
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Affiliation(s)
| | - Fredrik L Andersson
- International PharmaScience Center, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Teodor Burtea
- Ferring International Center S.A., Saint-Prex, Switzerland
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34
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The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms. Int Urogynecol J 2020; 32:919-928. [PMID: 32778918 PMCID: PMC8009795 DOI: 10.1007/s00192-020-04440-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis To evaluate whether nocturia and coexisting pelvic floor symptoms in women with pelvic organ prolapse (POP) can be improved by ligamentous fixation of apical vaginal prolapse to the sacrospinous ligament. Methods We evaluated the PROPEL study data from 281 women with pelvic organ prolapse stage > 2. Bothersome nocturia and coexisting pelvic floor symptoms were assessed with the Pelvic Floor Disorder Inventory (PFDI) questionnaire preoperatively and at 6, 12 and 24 months after successful vaginal prolapse repair. Women with successful reconstruction (POP-Q stage < 1 at all compartments throughout the 2-year follow-up), defined as anatomical “responders,” were compared to the anatomical “non-responders.” Results Among the patients completing all PFDI questions (N = 277), anatomical responders and non-responders were the groups of interest for our analysis. We found the occurrence rates of “moderate” or “quite a bit” of nocturia was significantly reduced after surgery in all subgroups (48.7% at baseline vs. 19.5% after 24 months). The occurrence of nocturia was halved for responders compared to non-responders (45.4% and 48.3% at baseline vs. 14% and 29.5% after 24 months). Anatomical non-responders still had a relevant improvement of POP-Q stages, especially in the apical compartment. Prevalence rates of co-existing over- and underactive bladder, fecal incontinence, defecation disorders and pain symptoms were also significantly reduced postoperatively. Conclusion Nocturia can be associated with symptomatic POP, with improvements seen following vaginal ligamentous prolapse repair. We caution providers, however, when advising patients of the possible resolution of nocturia following POP reconstruction, that all other traditional etiologies of nocturia must first be ruled out.
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Olesen T, Paul J, Gramme P, Drake MJ, Vandewalle J, Everaert K. Assessment of the Most Impactful Combination of Factors Associated with Nocturia and to Define Nocturnal Polyuria by Multivariate Modelling. J Clin Med 2020; 9:jcm9072262. [PMID: 32708764 PMCID: PMC7408683 DOI: 10.3390/jcm9072262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nocturia is common and associated with multiple disease states. Many potential mechanisms have been proposed for nocturia, which also remains challenging to manage. PURPOSE To use multivariate analysis to determine which combinations of factors can accurately discriminate clinically significant nocturia in patients to facilitate clinical management and treatment decisions. PATIENTS AND METHODS Data analysis was based on frequency volume charts from three randomized controlled trials. There were 1479 patients included, of which 215 patients had no/mild nocturia and 1264 had clinically significant nocturia with at least two voids per night. Factors studied that may influence nocturia were demographics, sleep duration, functional bladder capacity, 24 h urine volume and literature-suggested definitions of nocturnal polyuria. We used univariate analysis and cross-validated multivariate modelling to assess association between factors and nocturia status, redundancy between factors and whether the combined use of factors could explain patients' nocturia status. RESULTS The multivariate analyses showed that the most useful definitions of nocturia are 'Nocturia Index' (NI) and 'Nocturnal Urine Production per hour' (NUPh) in combination with functional bladder capacity and sleep duration. Published definitions providing binary nocturnal polyuria outcomes had lower performance than continuous indices. These analyses also showed that NI was not specific to nocturnal polyuria as it also captured nocturia due to low functional bladder capacity. By contrast, NUPh was demonstrated to be specific to nocturnal polyuria. CONCLUSION NUPh has previously been shown among elderly males to be essential in nocturia and a very valid measure of nocturnal polyuria. However, the current, large and independent dataset now confirms that it can be applied in an adult population with a complaint of nocturia covering both males and females.
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Affiliation(s)
- Tine Olesen
- Urology Department, Ghent University Hospital, 9000 Ghent, Belgium;
- Correspondence: ; Fax: +49-15155385918
| | - Jerome Paul
- DNAlytics, 1348 Louvain-la-Neuve, Belgium; (J.P.); (P.G.)
| | - Pierre Gramme
- DNAlytics, 1348 Louvain-la-Neuve, Belgium; (J.P.); (P.G.)
| | - Marcus J. Drake
- Bristol Urological Institute, University of Bristol, Bristol BS105NB, UK;
| | - Johan Vandewalle
- Department of Pediatric Nephrology, Safepedrug, University Hospital Ghent, 9000 Ghent, Belgium;
| | - Karel Everaert
- Urology Department, Ghent University Hospital, 9000 Ghent, Belgium;
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Emeruwa CJ, Epstein MR, Michelson KP, Monaghan TF, Weiss JP. Prevalence of the nocturnal polyuria syndrome in men. Neurourol Urodyn 2020; 39:1732-1736. [PMID: 32501556 DOI: 10.1002/nau.24403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 11/11/2022]
Abstract
AIMS Nocturnal polyuria (NP) is caused by a wide array of factors, including genitourinary and systemic comorbidities, modifiable behavior, and pharmaceuticals. When an identifying factor is absent, NP may be purely a symptom of the nocturnal polyuria syndrome (NPS) and secondary to blunting of normal arginine vasopressin action within the circadian rhythm. The purpose of this study is to determine the prevalence of NPS in male patients attending a Veterans Affairs outpatient urology clinic. METHODS Retrospective database analysis was performed of voiding diaries from men who had established care for lower urinary tract symptoms from 2007 to 2018. Patients were excluded if they reported fewer than two nocturnal voids on voiding diary analysis or had comorbidity associated with NP. Distinct cutoffs were separately employed to identify NP: nocturnal polyuria index (NPi; calculated as nocturnal urine volume divided by 24-hour urine volume) greater than 0.33; and nocturnal urine production (NUP) greater than 90 mL/h. RESULTS A total of 283 completed voiding diaries were evaluated and 202 patients had ≥2 nocturnal voids. After exclusions, at NPi greater than 33, the floor and ceiling NPS prevalence values were 21% and 41%, respectively. At NUP greater than 90 mL/h, the floor and ceiling NPS prevalence values were 17% and 32%, respectively. CONCLUSIONS The prevalence of NPS in patients with nocturia in the present study lies between 17% and 41%. NPS constitutes a clinically relevant subgroup of nocturia among male patients in the Veterans Affairs outpatient urology setting.
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Affiliation(s)
- Curran J Emeruwa
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Matthew R Epstein
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Kyle P Michelson
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
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[Diagnostic and therapeutic approach to nocturia in Primary Care]. Semergen 2020; 46:487-496. [PMID: 32467014 DOI: 10.1016/j.semerg.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022]
Abstract
Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin.
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Monaghan TF, Bliwise DL, Denys MA, Goessaert AS, Decalf V, Kumps C, Vande Walle J, Weiss JP, Epstein MR, Weedon J, Lazar JM, Everaert K. Phenotyping nocturnal polyuria: circadian and age-related variations in diuresis rate, free water clearance and sodium clearance. Age Ageing 2020; 49:439-445. [PMID: 32043123 DOI: 10.1093/ageing/afz200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/10/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND this study compares diuresis rate, sodium clearance and free water clearance (FWC) by age and time of day (nighttime vs. daytime) in subjects with and without nocturnal polyuria (NP) to determine whether these variables affect the phenotype of NP. METHODS post hoc analysis of two prospective observational studies. Eight urine samples collected at 3-h intervals and a single blood sample were used to calculate daytime (10a/1p/4p/7p/10p) and nighttime (1a/4a/7a) diuresis rates, sodium clearance and FWC. Three mixed linear models were constructed for diuresis rate, sodium clearance and FWC using four predictor variables: NP status (present [nocturnal urine production >90 ml/h] vs. absent [≤90 ml/h]), time of day, age and study identification. RESULTS subjects with NP experienced higher nighttime versus daytime diuresis rates, sodium clearance and FWC. Regardless of NP status, increased age was accompanied by an increase in the ratio of nighttime/daytime diuresis rate, nighttime sodium clearance and daytime sodium clearance. FWC showed a complex age effect, which was independent of time of day or NP status. CONCLUSIONS age-related increases in nighttime/daytime diuresis rate, 24-h sodium clearance and 24-h FWC are not specific to subjects with NP. The age-related surge in either nocturnal sodium clearance or nocturnal FWC may represent the relevant substrate for behavioural or pharmacologic interventions targeting sodium diuresis or free water diuresis, respectively. Increases in FWC in older age groups may reflect impaired circadian rhythmicity of endogenous AVP or changes in responsiveness of the aged nephron to water clearance.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Veerle Decalf
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Candy Kumps
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Matthew R Epstein
- Department of Urology, Temple University Hospital, Philadelphia, PA, USA
| | - Jeremy Weedon
- Research Division, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jason M Lazar
- Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Clemens JQ, Wiseman JB, Smith AR, Amundsen CL, Yang CC, Bradley MS, Kirkali Z, Agochukwu NQ, Cameron AP. Prevalence, subtypes, and correlates of nocturia in the symptoms of Lower Urinary Tract Dysfunction Research Network cohort. Neurourol Urodyn 2020; 39:1098-1107. [PMID: 32249998 PMCID: PMC7238757 DOI: 10.1002/nau.24338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
Abstract
AIMS We determined the prevalence, severity, and correlates of nocturia in a large clinical cohort of patients. METHODS Patients presenting with lower urinary tract symptoms (LUTS) completed 3-day bladder diaries. Nocturia was quantified based on the mean number of nighttime voids documented over the 3 days. Nocturia subtypes (global polyuria, nocturnal polyuria [NP], reduced global bladder capacity, and reduced nocturnal bladder capacity) were assessed. Bother due to nocturia was measured by the LUTS Tool. Sleep quality was assessed with the Patient-Reported Outcomes Measurement Information System Sleep Scale. Multivariable multinomial regression was used to explore patient characteristics associated with nocturia. RESULTS In 502 participants with analyzable diaries (285 men and 217 women), the mean number of nocturia episodes over 3 days was 0 in 103 (20.5%), >0 to <1 in 151 (20.1%), 1 to <2 in 165 (32.9%), and ≥2 in 83 (16.5%). Sixty-seven percent of the participants with nocturia ≥1 reported significant bother from their nocturia. NP was the most common nocturia subtype and was present in 17% of those with nocturia = 0, 40% of those with nocturia >0 to <1, 65% of those with nocturia 1 to <2%, and 77% with nocturia 2+. Higher degrees of nocturia were associated with male sex, greater sleep disturbance, and a higher likelihood of exhibiting multiple nocturia subtypes. CONCLUSIONS Nocturia ≥1 occurred in 49% of LUTS patients and caused significant bother in the majority of them. The most common subtype was NP, but a substantial proportion of patients exhibited additional characteristics.
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Affiliation(s)
| | | | | | - Cindy L. Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Claire C. Yang
- Department of Urology, University of Washington, Seattle, Washington
| | - Megan S. Bradley
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Bladder sensations in women with nocturia due to overactive bladder syndrome. Int Urogynecol J 2020; 31:1041-1048. [PMID: 32146520 DOI: 10.1007/s00192-020-04257-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
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.
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What Is the Most Effective Treatment for Nocturia or Nocturnal Incontinence in Adult Women? Eur Urol Focus 2020; 7:453-463. [PMID: 32061540 DOI: 10.1016/j.euf.2020.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 01/23/2023]
Abstract
CONTEXT Nocturia is a prevalent symptom with varied aetiology and no consensus on treatment options. OBJECTIVE We systematically reviewed evidence comparing the benefits and harms of various treatment options for nocturia or nocturnal incontinence in women. EVIDENCE ACQUISITION Literature search was performed using Embase, Medline, and Cochrane databases (from 1 January 1946 to 26 September 2017), following the methods detailed in the Cochrane Handbook. The protocol was registered with PROSPERO. Certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. EVIDENCE SYNTHESIS The literature search identified 3573 citations, of which 11 full-text articles were included. Three studies on desmopressin and four on antimuscarinics provided evidence of improving nocturia symptoms. Four studies on behavioural treatment provided limited evidence and controversial results. One study on oestrogen did not prove the benefit of any mode of administration, and one small study on functional magnetic stimulation provided some evidence of effectiveness in nocturia. One randomised controlled trial (RCT; 141 participants) reported a statistically significant difference between the desmopressin and placebo groups (desmopressin patients experienced 0.75 [95% confidence interval {CI} 0.47-1.03] nocturia episodes less than those experience by the placebo group; certainty of evidence = low). The only RCT on antimuscarinics in women with nocturia reported that oxybutynin reduced the number of nocturia episodes by 0.3 (95% CI -0.02 to 0.62) versus placebo. In one RCT comparing tolterodine with the combination of tolterodine with behavioural therapy, there was significant change from baseline nocturnal incontinence episodes in both groups. CONCLUSIONS There is some evidence that desmopressin and antimuscarinics are effective treatment options for nocturia; however, there is very limited evidence for other treatment options. The findings should be interpreted with caution as there were some methodological flaws in the included studies, particularly outcome heterogeneity. PATIENT SUMMARY This review identified several medical treatments for nocturia in women, such as desmopressin and antimuscarinics, which appear to improve the severity of the condition.
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Lee DS, Kim SW, Sohn DW. Association between Nocturnal Frequency and Erectile Function in Eugonadal Men with Benign Prostatic Obstruction: A Cross Sectional Study. World J Mens Health 2020; 39:338-345. [PMID: 32202080 PMCID: PMC7994652 DOI: 10.5534/wjmh.190146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/29/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose We aimed to evaluate the association between nocturnal frequency and erectile dysfunction in patients with benign prostatic obstruction. Materials and Methods To evaluate the association, we simultaneous evaluated urodynamic study, prostate ultrasound, nocturnal tumescence test (nocturnal penile tumescence) for sleep-related erection (SRE) and two questionnaires, international prostate symptom score (IPSS) and 5-item version of the international index of erectile function (IIEF-5). Patients with hypogonadism or nocturnal polyuria were excluded. Results Forty-six patients were registered over 4 years. The mean age, prostate size, IPSS score, and IIEF-5 score were 67.65±5.51 years, 65.10±22.12 mL, 24.67±7.89, and 9.50±7.01, respectively. Among the IPSS subscores, nocturia was most significantly related to the total IIEF-5 score (p<0.001). More severe nocturia was associated with less frequent SRE (p=0.003) and shorter total duration of SRE (p=0.002), which in turn elucidated that nocturia was significantly related to the total amount of rigidity signals (rigidity activity unit, RAU) or tumescence signals (tumescence activity unit, TAU). Among objective urodynamic parameters, bladder compliance also correlated to RAU and TAU. Individual subjective erectile function (IIEF-5) was significantly related to both RAU and TAU. Conclusions Sleep fragmentation due to benign prostate obstruction related nocturnal frequency caused by reduced bladder compliance could decrease the frequency and duration of SRE, which decreases the total amount of SRE and reflects the patient's relevant erectile function.
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Affiliation(s)
- Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Wan Sohn
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Thölking TW, Lamers ECT, Olde Rikkert MGM. A Guiding Nightlight Decreases Fear of Falling and Increases Sleep Quality of Community-Dwelling Older People: A Quantitative and Qualitative Evaluation. Gerontology 2020; 66:295-303. [PMID: 31914450 DOI: 10.1159/000504883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Even though poor lighting at nighttime is an important risk factor for falls (and most falls occur during the night), lighting interventions to improve nightly lighting from bed to bathroom are rarely evaluated for fall prevention. OBJECTIVE We tested the hypothesis that an automated guiding light would reduce nightly fear of falling (FOF) and increase sleep quality of community-dwelling older people. METHODS This study had a pragmatic uncontrolled before-after design, including participants during a period of 8 months if they (i) were aged at least 65 years, (ii) ambulated independently at night, and (iii) had no cognitive or audiovisual impairments obstructing outcome measurement. Automated LED strips (GightTM) were installed in the participants' homes. The primary outcome measure was overnight FOF on a scale of 0-10. Secondary outcome measures included sleep quality on a scale of 0-10 and fall rate. Additionally, a sample of participants was interviewed about their experiences with Gight. RESULTS Sixty-four participants were included (mean age: 80.8 ± 8.1 years; 89% living independently). Mean study length was 118 days (range: 30-231). In the intention-to-treat analysis, overnight FOF declined from 5.5 ± 3.0 to 3.8 ± 3.2 (p = 0.001), and sleep quality increased from 6.7 ± 2.4 to 7.4 ± 1.7 (p = 0.012). The fall rate during the study was too low to detect changes. Participants appreciated Gight (8.4 ± 0.8 on a scale of 10), and the majority (57%) reported a subjective decrease in FOF. CONCLUSION Gight shows promising results for overnight FOF and sleep quality, but the effect of lighting interventions on fall rate should be evaluated further before widespread implementation.
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Affiliation(s)
- Thessa W Thölking
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Gight-BV, Nijmegen, The Netherlands
| | | | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands,
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Jhaveri J, Gauthier-Loiselle M, Gagnon-Sanschagrin P, Wu EQ. The Economic Burden of Nocturia on the U.S. Health Care System and Society: A National Health and Nutrition Examination Survey Analysis. J Manag Care Spec Pharm 2019; 25:1398-1408. [PMID: 31566054 PMCID: PMC10397598 DOI: 10.18553/jmcp.2019.19191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nocturia, characterized as waking during the main sleep period to urinate, is a common condition. Persistent nocturia results in sleep fragmentation with deleterious effects on health and well-being. Yet, there are limited data on the economic burden of nocturia in the United States. OBJECTIVE To assess the association of nocturia with health care resource utilization (HRU), work productivity, and self-rated health while estimating the societal costs of nocturia in the United States in 2017. METHODS A retrospective cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES; 2005-2006 to 2013-2014). Adults aged ≥ 18 years (excluding pregnant women) were stratified into individuals with nocturia (≥ 2 voids/night) and individuals without nocturia (< 2 voids/night), based on the threshold for clinically significant nocturia. Outcomes were self-reported and included HRU (hospitalizations, outpatient visits); work productivity (weekly hours worked, employment); and current health status. Multivariable regression analyses adjusting for age, race, sex, body mass index, insurance status, education level, alcohol use, smoking status, and self-reported comorbid conditions were used to compare the 2 cohorts, overall and stratified by age group (20-44 years, 45-64 years, and 65+ years) to distinguish the effects on different age groups including the Medicare-aged population. Excess direct health care costs and indirect productivity costs associated with nocturia in the United States were then calculated using a prevalence-based approach and available literature (i.e., nocturia prevalence estimates, aggregated unit costs by HRU type, and average hourly earnings in the United States). RESULTS 22,300 individuals were identified, and 24% had nocturia (≥ 2 voids/night). Median age was 55.2 and 43.2 years among individuals with and without nocturia, respectively, and the proportion of males was 43.3% and 51.3%, respectively. Individuals with nocturia had significantly more HRU, including hospitalizations and outpatient visits, worked significantly fewer hours weekly, and were significantly less likely to be employed when compared with those without nocturia. They were also significantly less likely to report being in very good/excellent health. These comparisons remained statistically significant across age groups. Total excess direct health care costs were $62.9 billion (hospitalization: $47.6 billion; outpatient: $15.3 billion). Total excess indirect productivity costs were $151.7 billion. Altogether, costs were estimated at $214.5 billion, equivalent to $3,491 per individual with nocturia. Individuals aged 20-44 years incurred 23.5% of total excess costs, while those aged 45-64 and 65+ years incurred 48.2% and 28.3%, respectively. Sensitivity analyses based on lower prevalence estimates resulted in costs of $94.0 billion, while those based on higher prevalence estimates reached up to $231.1 billion. CONCLUSIONS Nocturia is associated with a substantial economic burden in the United States even when evaluated based on lower prevalence estimates. This study underscores the importance of timely diagnosis and management of nocturia patients to alleviate health-related and economic consequences to patients and society. DISCLOSURES This work was supported by Ferring Pharmaceuticals, which contributed to and approved the study design and participated in the interpretation of data, review, and approval of the manuscript. Gauthier-Loiselle, Gagnon-Sanschagrin, and Wu are employees of Analysis Group, which received consultancy fees from Ferring Pharmaceuticals for work on this study. Jhaveri is a full-time employee of Ferring Pharmaceuticals. Parts of this work were presented as a poster presentation at AMCP Nexus 2018; October 22-25, 2018; Orlando, FL.
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Affiliation(s)
- Jay Jhaveri
- Ferring Pharmaceuticals, Parsippany, New Jersey
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Emeruwa CJ, Gordon DJ, Weiss JP. Nocturia: Evaluation and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for nocturia and summarize the existing evidence for treatment of nocturia across the condition's broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria. RECENT FINDINGS Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of nocturia remains limited. Treatment options for nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.
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Affiliation(s)
- Danielle J Gordon
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA.
| | - Curran J Emeruwa
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Box 79, Brooklyn, NY, 11203, USA
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Weiss JP, Everaert K. Management of Nocturia and Nocturnal Polyuria. Urology 2019; 133S:24-33. [DOI: 10.1016/j.urology.2019.09.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023]
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Hwang TY, Kim SK, Kim KH, Kim JY. Association Between Lower Urinary Tract Symptoms and Falls in Adults Males: Based on the Korean Community Health Survey. Asia Pac J Public Health 2019; 31:643-651. [PMID: 31561710 DOI: 10.1177/1010539519878361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the correlation between lower urinary tract symptoms (LUTSs) and falls considering places where falls can occur in adult males. We analyzed 101 862 males in the 2011 Korean Community Health Survey. LUTSs were assessed using the International Prostate Symptom Score system. The rate of total and indoor falls significantly increased with the LUTS severity, respectively. After adjusting for age and other confounding variables, the odds ratios (ORs) for total falls were significantly high for the mild (OR = 1.63, 95% confidence interval [CI] = 1.54-1.71), moderate (OR = 2.35, 95% CI = 2.16-2.56), and severe groups (OR = 2.83, 95% CI = 2.49-3.22), relative to the normal group. Indoor fall experience was the same for the mild (OR = 1.56, 95% CI = 1.36-1.79), moderate (OR = 2.37, 95% CI = 1.97-2.85), and severe groups (OR = 3.77, 95% CI = 3.00-4.72). Nocturia, hesitancy, and urgency were significantly associated with indoor falls. The association between falls and the degree of LUTS was observed in both the young and the elderly. Therefore, further studies are needed to determine the effects of treatment of LUTS on the risk of falls and the effectiveness of the fall prevention program.
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Affiliation(s)
| | - Sang-Kyu Kim
- Dongguk University, Gyeongsangbuk-do, Republic of Korea
| | - Ki Ho Kim
- Dongguk University, Gyeongsangbuk-do, Republic of Korea
| | - Jong-Yeon Kim
- Catholic University of Daegu, Daegu, Republic of Korea
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Li ESW, Flores VX, Weiss JP. Current guidelines and treatment paradigms for nocturnal polyuria: A "NEW" disease state for US physicians, patients and payers. Int J Clin Pract 2019; 73:e13337. [PMID: 30810265 DOI: 10.1111/ijcp.13337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Nocturia is one of the most bothersome symptoms encountered in urology, and its prevalence rises with age. Causes include both urological and non-urological aetiologies, often in combination. The effects of nocturia on a patient's quality of life can be detrimental. The initial approach to managing this condition includes appropriately classifying nocturia based on the results of a 24-hour bladder diary. Broadly, the categories under which nocturia can be classified include: low nocturnal or global bladder capacity, nocturnal polyuria, global polyuria and mixed.Based on the type of nocturia and possible underlying causes, clinicians can appropriately discuss with patients the treatment plans that may include a combination of behavioural, pharmacologic, and invasive therapy. The available literature on the management of nocturia was reviewed. Findings were incorporated into a practice-based approach for its workup and treatment.
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Affiliation(s)
- Eric S W Li
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Viktor X Flores
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Medical Center, Brooklyn, New York
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Rose G, Decalf V, Everaert K, Bower WF. Toileting-related falls at night in hospitalised patients: The role of nocturia. Australas J Ageing 2019; 39:e70-e76. [PMID: 31321899 DOI: 10.1111/ajag.12696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/21/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the prevalence and characteristics of toileting-related falls in hospitalised older people. METHODS Retrospective analysis of falls related to night-time toileting in patients 60 years or over in a tertiary hospital during a one-year period. RESULTS Overall 34% of falls were related to toileting with at least 44% of these falls occurring during the night. Toilet-related falls peaked between 11 pm and 1 am, a period that coincides with maximum supine-induced diuresis. Almost half of night falls occurred at the bedside. In 80% of night toileting-related falls, patients were mobilising without the recommended level of assistance. Half of all patients had no strategies for toileting documented in their care plan. CONCLUSION Findings support screening for nocturia in older inpatients and implementation of strategies to reduce both the need for toileting at night and risk factors for falling.
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Affiliation(s)
- Georgie Rose
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Veerle Decalf
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wendy F Bower
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
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