1
|
Fontanilles Arbones E, Salord Oleo N, Gasa Galmes M, Pérez Ramos S, Prado Gala E, Calvo Sánchez M, Pallarès Fontanet N, Santos Pérez S, Monasterio Ponsa C. Phenotypes of obstructive sleep apnea in women: A real-life cohort study. Sleep Med 2024; 121:295-302. [PMID: 39047303 DOI: 10.1016/j.sleep.2024.07.016] [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] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a complex, heterogeneous disease. Categorizing the disorder into phenotypes can help us better understand its pathology and guide us toward more personalized treatment approaches. Nevertheless, most of the previous cluster analysis (CA) studies in OSA predominantly included middle-aged to older men and may not adequately represent the heterogeneity of OSA phenotypes in women. Our aim is to identify these phenotypes in women using an extensive, exclusively female cohort. METHODS Cross-sectional study of 1886 women diagnosed with OSA (apnea-hypopnea index >5 events/h) by PSG (polysomnography) and RP (respiratory polygraphy) at a tertiary hospital Sleep Unit. A CA was performed including general data, clinical variables, comorbidities and sleep study results. RESULTS Four phenotypic subtypes were identified: Cluster 1 "Middle-aged paucisymptomatic women without cardiovascular risk factors" (507 patients, 27 %); Cluster 2 "Older paucisymptomatic women with established cardiovascular disease and severe OSA" (228 patients, 12 %); Cluster 3 "Middle-aged women with "classic" symptoms and cardiovascular risk factors" (892 patients, 47 %), and Cluster 4 ″Middle-aged women with mood disorders, nonrestorative sleep and cardiovascular risk factors" (259 patients, 14 %). CONCLUSIONS Conducting a CA exclusively within a female cohort reveals a heterogeneous presentation of OSA in women, similar to what has been previously reported in the literature for men. The "classical" presentation is notably the most prevalent, while the "atypical" presentation, which was previously more frequently associated with women, is less prevalent. Additionally, paucisymptomatic presentations, with or without associated comorbidities, are also present.
Collapse
Affiliation(s)
- Eva Fontanilles Arbones
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| | - Neus Salord Oleo
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Mercè Gasa Galmes
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Department of Medicine, Campus Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Sandra Pérez Ramos
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Eliseo Prado Gala
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Maria Calvo Sánchez
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Natàlia Pallarès Fontanet
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Salud Santos Pérez
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Department of Medicine, Campus Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carmen Monasterio Ponsa
- Sleep Unit. Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| |
Collapse
|
2
|
Tao M, Dong X, Tu J, Fang Q, Shao C. Symptom and comorbidity burden in hypertensive patients with obstructive sleep apnea. Front Endocrinol (Lausanne) 2024; 15:1361466. [PMID: 38501097 PMCID: PMC10944929 DOI: 10.3389/fendo.2024.1361466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is an important but frequently overlooked risk factor for hypertension (HTN). The prevalence of hypertension is high in patients with OSA, but the differences in clinical symptoms and comorbidities between patients with OSA with hypertension and those with normal blood pressure have not been fully defined. Methods This study retrospectively analyzed OSA patients diagnosed for the first time in Lihuili Hospital Affiliated to Ningbo University from 2016 to 2020. Patients were divided into an OSA group with hypertension and an OSA group without hypertension. The sociodemographic information, clinical symptoms, comorbidities, and polysomnography results of the two groups were compared. The independent risk factors associated with hypertension in patients with OSA were explored. Results A total of 1108 patients with OSA initially diagnosed were included in the study, including 387 with hypertension and 721 without. Compared with OSA patients without hypertension, OSA patients with hypertension were older; had a higher body mass index (BMI) and Epworth sleepiness score (ESS); a higher incidence of nocturia; and a higher proportion of diabetes mellitus, coronary heart disease, and cerebrovascular disease. Multivariate analysis showed age (odds ratio [OR]:1.06, 95% confidence interval [CI]:1.04-1.08), BMI (OR:1.17, 95% CI:1.11-1.23), ESS score (OR:0.97, 95%CI: 0.94-1.00) and nocturia symptoms (OR:1.64, 95% CI:1.19-2.27) was independently associated with hypertension in OSA patients, and comorbid diabetes (OR: 3.86, 95% CI: 2.31-6.45), coronary heart disease (OR: 1.90, 95% CI:1.15-3.16), and ischemic stroke (OR: 3.69,95% CI:1.31-10.40) was independently associated with hypertension in OSA patients. Conclusion Compared to OSA patients with normal blood pressure, OSA patients with hypertension had more significant daytime sleepiness, more frequent nocturnal urination, and a higher risk of diabetes, coronary heart disease, and cerebrovascular disease.
Collapse
Affiliation(s)
- MengShi Tao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Xiaoqi Dong
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jinjing Tu
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Qing Fang
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Chuan Shao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| |
Collapse
|
3
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Mello MF, Locali RF, Araujo RM, Reis JN, Saiovici S, Mello LF, Trigo Rocha FE. A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis. J Pediatr Urol 2023:S1477-5131(23)00008-6. [PMID: 36717289 DOI: 10.1016/j.jpurol.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vasopressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medications such as desmopressin and imipramine. OBJECTIVE To compare the effectiveness of different treatments of MNE. STUDY DESIGN Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. INCLUSION CRITERIA age between 5 and 16 years old, with MNE, evaluated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial responders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group - DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were monitored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE. RESULTS 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group - DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms. DISCUSSION Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study. CONCLUSION All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.
Collapse
Affiliation(s)
- Marcos Figueiredo Mello
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.
| | - Rafael Fagionato Locali
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Rogerio Mattos Araujo
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Joceara Neves Reis
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Samuel Saiovici
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Luiz Figueiredo Mello
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Flavio Eduardo Trigo Rocha
- Pediatric Urology Unit, Division of Urology, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| |
Collapse
|
5
|
Ribeiro A, Bastos Netto JM, Figueiredo AAD, Cândido TC, Guércio WB, Zica BO. Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery. INTERNATIONAL BRAZ J UROL 2022; 48:937-943. [DOI: 10.1590/s1677-5538.ibju.2022.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, Brasil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Brasil
| | | | | | | | | |
Collapse
|
6
|
Chung YH, Kim JR, Choi SJ, Joo EY. Prevalence and predictive factors of nocturia in patients with obstructive sleep apnea syndrome: A retrospective cross-sectional study. PLoS One 2022; 17:e0267441. [PMID: 35476719 PMCID: PMC9045637 DOI: 10.1371/journal.pone.0267441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/09/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Many patients with obstructive sleep apnea syndrome (OSAS) have nocturia. However, the predictive index of nocturia in patients with OSAS is currently not well known. We aimed to investigate the prevalence of nocturia in patients with OSAS and determine the factors that could predict nocturia in these patients. Methods In this retrospective cross-sectional study, we enrolled 1,264 untreated patients with OSAS (Apnea-Hypopnea Index, AHI ≥5/h on polysomnography [PSG]) from January 2017 to January 2020. Participants completed the Beck Depression Inventory-II (BDI-II), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale. Participants were divided by sex and then subdivided into nocturia and non-nocturia groups according to the following question, “Do you go to the bathroom two times or more during your sleep?” Participants’ characteristics and underlying disease were investigated, and all information, including PSG data, was compared between the two groups using the t-test or chi-square test. Results Overall, 35.2% (337/958) of male participants with OSAS and 59.8% (183/306) of female participants with OSAS had nocturia. The nocturia group was older; scored higher on the BDI-II, PSQI, and ISI; and had more underlying disease in both sexes. There was no difference in the AHI between the two groups among both sexes, but the hypoxia-related PSG parameters and sleep quality parameters, such as higher 90% oxygen desaturation index (90% ODI), lesser N3 sleep, and higher wakefulness after sleep onset, were worse among male participants with OSAS in the nocturia group than in the non-nocturia group. In multivariate logistic analysis, 90% ODI was an independent risk factor associated with nocturia in male participants with OSAS. Conclusions Considerable number of patients with OSAS had nocturia and poor sleep quality. Nocturia should be evaluated in male OSAS patients with severe hypoxia observed during sleep.
Collapse
Affiliation(s)
- Yeon Hak Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Rim Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jung Choi
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
7
|
Matsushima E, Otsuka Y, Itani O, Matsumoto Y, Kaneita Y. Association between nighttime urinary frequency and sleep problems among Japanese adolescents. Int J Urol 2021; 29:152-157. [PMID: 34786770 DOI: 10.1111/iju.14744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To conduct a cross-sectional study to investigate the relationship between nighttime urinary frequency and sleep problems in Japanese adolescents. METHODS A self-administered questionnaire survey was conducted among 1757 adolescents (mean age 15.6 ± 1.1 years; 49.0% boys). The survey assessed sleep problems (sleep duration, sleep quality, and insomnia symptoms), nighttime urinary frequency, eating habits (breakfast, late-night eating, energy drink consumption), problematic internet use, engagement in club activities, and mental health. We analyzed the association between nighttime urinary frequency and sleep problems using descriptive statistics and logistic regression models. RESULTS The response rate was 99.6% (1699 students). The prevalence of nighttime urinary frequency ≥2 was 5.6% in boys and 4.6% in girls. The prevalence rates of sleep problems were: insomnia, 16.4%; difficulty initiating sleep, 11.8%; difficulty maintaining sleep, 5.9%; early-morning awakening, 5.4%; and poor sleep quality, 19.9%. Analysis of the relationship with sleep problems differentiating between zero, one, and two nighttime urinations showed that an increase in nighttime urinary frequency corresponded to an increase in the prevalence of insomnia, difficulty initiating sleep, and difficulty maintaining sleep. Logistic regression analysis also showed that insomnia, difficulty initiating sleep, and difficulty maintaining sleep had a linear, significant relationship with increased nighttime urinary frequency. CONCLUSION This study suggests that adolescents with high nighttime urinary frequency experience increased sleep problems. Consideration of urinary frequency is required when tackling adolescent sleep problems.
Collapse
Affiliation(s)
- Eriko Matsushima
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Di Carlo G, Zara F, Rocchetti M, Venturini A, Ortiz-Ruiz AJ, Luzzi V, Cattaneo PM, Polimeni A, Vozza I. Prevalence of Sleep-Disordered Breathing in Children Referring for First Dental Examination. A Multicenter Cross-Sectional Study Using Pediatric Sleep Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228460. [PMID: 33207543 PMCID: PMC7698058 DOI: 10.3390/ijerph17228460] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022]
Abstract
Background: Sleep-related breathing disorders (SRDB) are a group of pathological conditions characterized by a dysfunction of the upper airways. The value of SRDB's prevalence, in the pediatric population, ranges from 2 to 11% depending on the different methodologies used in measure and the difficulties in the diagnosis. The aim of this study was to assess the prevalence of SRDB using the Pediatric Sleep Questionnaire (PSQ). Methods: 668 patients were enrolled from the Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy and from the Unit of Integrated Pediatric Dentistry, University of Murcia, Spain. The questionnaires were administered to patients with no previous orthodontic and surgical treatment who attended on the first visit at the two units of pediatric dentistry. Data regarding general health status were extracted from the standard anamnestic module for first visit. Prevalence and logistic regression models were computed. Results: The ages ranged from 2 to 16 years old (average 7 years old). The prevalence of SRDB was 9.7% for the entire sample. The models showed a positive correlation between three variables (snoring, bad habits, and anxiety) and SRDB. Conclusions: The prevalence obtained demonstrates the relevance of sleep disorders in the pediatric population and highlights the central role of pediatric dentists in the earlier diagnosis of these disorders.
Collapse
Affiliation(s)
- Gabriele Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
- Correspondence:
| | - Francesca Zara
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Milena Rocchetti
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Angelica Venturini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Antonio José Ortiz-Ruiz
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, University of Murcia, 30008 Murcia, Spain;
| | - Valeria Luzzi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Paolo Maria Cattaneo
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Iole Vozza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| |
Collapse
|
9
|
Clerget A, Kanbar A, Abdessater M. [Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review]. Prog Urol 2020; 30:1069-1077. [PMID: 32830023 DOI: 10.1016/j.purol.2020.07.244] [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: 05/12/2019] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this work was to make a review of urinary tract symptoms and erectile dysfunction involved in obstructive sleep apnea (OSA) but also to study their physiopathology and potential treatments. METHODS We conducted a literature review in the Pubmed database using PRISMA guidelines and the MeSH terms: sleep apnea, urinary incontinence, erectile dysfunction, sexuality. All French and English articles published up to 2020 were evaluated. RESULTS The initial evaluation identified 240 articles from which 30 were included. References lists review allowed the inclusion of 26 additional articles. Nocturia, overactive bladder (OAB) and erectile dysfunction (ED) were associated with OSA. Increased levels of natriuretic peptides are behind nocturia. Nocturia is associated with higher Apnea/Hypopnea Index (AHI) (49±11 vs 24±8 episodes/hour with P=0.0001). The severity of nocturia is proportional to the severity of OSA with a positive predictive value of 71%. Intermittent nocturnal hypoxemia causes peripheral axonal damage with subsequent urgency incontinence. There is correlation between severity of OAB and the severity of OSA especially when the latter is moderate or severe. An odds ratio of 0.45 (CI95%: 0.18-0.71) is found for ED in patients who don't have OSA, associating the latter to an increased risk of ED. Intermittent nocturnal hypoxemia, the decrease in the levels of nitric oxide, and the increase in blood pressure and levels of endothelin 1 contribute to the development of ED. An early treatment of OSA with continuous positive airway pressure (CPAP) may allow a partial but significant control of urinary symptoms and erectile dysfunction associated with OSA. CONCLUSION OSA is associated with urinary tract symptoms (nocturia and OAB) and erectile dysfunction. The severity of associated symptoms is related to the severity of OSA. Urinary and sexual troubles are reversible after treatment of OSA by CPAP. OSA research is reasonable in case of pathologic nocturia or ED with loss of morning erections.
Collapse
Affiliation(s)
- A Clerget
- Sorbonne Université, 21, rue de l'École-de-Médecine, 75006 Paris, France
| | - A Kanbar
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Abdessater
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
| |
Collapse
|
10
|
Nevéus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, Raes A, Tekgül S, Yang SS, Rittig S. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol 2020; 16:10-19. [PMID: 32278657 DOI: 10.1016/j.jpurol.2019.12.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/30/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. AIM A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with enuresis. METHODS The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. RESULTS The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the enuresis alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
Collapse
Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, 75185, Sweden.
| | - Eliane Fonseca
- University of Rio de Janeiro State, Souza Marques School of Medicine, Pediatric Urodynamic Unit, Rio de Janeiro, Brazil
| | - Israel Franco
- Yale New Haven Children's Bladder and Continence Program, Yale-New Haven Hospital, New Haven, CT, 06520, USA
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Larisa Kovacevic
- Michigan State University, Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
| | - Anka Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - Ann Raes
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, Gent, 9000, Belgium
| | - Serdar Tekgül
- Hacettepe University, Department of Pediatric Urology, Ankara, Turkey
| | - Stephen S Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi University, New Taipei, Taiwan
| | - Søren Rittig
- Department of Pediatrics, Skejby Sygehus, Aarhus University Hospital, Aarhus N, 8200, Denmark
| |
Collapse
|
11
|
Alshehri MM, Alenazi AM, Hoover JC, Alothman SA, Phadnis MA, Rucker JL, Befort CA, Miles JM, Kluding PM, Siengsukon CF. Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14647. [PMID: 31855189 PMCID: PMC6940863 DOI: 10.2196/14647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results This study recruitment began in February 2019 and was completed in September 2019. Conclusions The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control. Trial Registration ClinicalTrials.gov NCT03713996; https://clinicaltrials.gov/ct2/show/NCT03713996 International Registered Report Identifier (IRRID) DERR1-10.2196/14647
Collapse
Affiliation(s)
- Mohammed M Alshehri
- University of Kansas Medical Center, Lenexa, KS, United States.,Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- University of Kansas Medical Center, Kansas City, KS, United States.,Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Jeffrey C Hoover
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Milind A Phadnis
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Jason L Rucker
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - John M Miles
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | | |
Collapse
|
12
|
Kass-Iliyya A, Hashim H. Nocturnal polyuria: Literature review of definition, pathophysiology, investigations and treatment. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818756792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nocturnal polyuria (NP) is characterised by increased urine production overnight in comparison to daytime. It has significant adverse events in adults including reduced quality of life, increased risk of falls and increased mortality.Although NP can be a manifestation of other significant conditions like heart failure and sleep apnoea, there are lots of unanswered questions about NP. What is the underlying pathophysiology? Is NP a physiological manifestation of ageing? Is the circadian change of vasopressin release the primary pathology? Or is it a secondary phenomenon to a low diurnal production of urine? Is the primary pathology at the kidney level or is there another humoral, cardiac, or endovascular element? In this article, we summarise the available English-language literature on the subject of NP, including its epidemiology, pathogenesis, diagnosis and treatment.Level of evidence: Not applicable for this multicentre audit.
Collapse
Affiliation(s)
- Antoine Kass-Iliyya
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Hashim Hashim
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
| |
Collapse
|
13
|
|
14
|
Doyle-McClam M, Shahid MH, Sethi JM, Koo P. Nocturia in Women With Obstructive Sleep Apnea. Am J Lifestyle Med 2018; 15:260-268. [PMID: 34025318 DOI: 10.1177/1559827618782657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is underdiagnosed in women compared with men. Women have a tendency to underreport or present with atypical symptoms such as behavior changes, insomnia, fatigue, and depression. Nocturia, waking up from sleep 2 times or more to void, has been shown to be associated with OSA, but it is not an included symptom in commonly used screening questionnaires in primary provider offices. About 50% of patients with OSA have nocturia, and treatment of OSA improves it. Recognition of nocturia as a relevant symptom of OSA is important for primary providers to provide timely referral for the diagnosis of OSA.
Collapse
Affiliation(s)
- Megan Doyle-McClam
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Muhammad H Shahid
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Jigme M Sethi
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Patrick Koo
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| |
Collapse
|
15
|
Finamore P, Scarlata S, Laudisio A, Galdi F, Pipita M, Chiarella I, Giua R, Cortese L, Rivera C, Antonelli Incalzi R. Occurrence of nocturia is not mediated by nocturnal hypoxia length and severity in patients with sleep-disordered breathing. Sleep Med 2018; 45:69-73. [DOI: 10.1016/j.sleep.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/12/2018] [Accepted: 01/31/2018] [Indexed: 01/23/2023]
|
16
|
Does continuous positive airway pressure treatment affect autonomic nervous system in patients with severe obstructive sleep apnea? Sleep Med 2018; 42:68-72. [DOI: 10.1016/j.sleep.2017.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022]
|
17
|
Lee YJG, Lee YJ, Jeong DU. Differential Effects of Obesity on Obstructive Sleep Apnea Syndrome according to Age. Psychiatry Investig 2017; 14:656-661. [PMID: 29042891 PMCID: PMC5639134 DOI: 10.4306/pi.2017.14.5.656] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/19/2016] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the effect of obesity on obstructive sleep apnea syndrome (OSAS) by age in relation to anthropometric measurements. METHODS The medical records of 1,110 participants diagnosed with OSAS were analyzed according to age. All participants underwent nocturnal polysomnography and had their body mass index, waist circumference, neck circumference (NC), and waist-to-hip ratio measured. RESULTS According to the multiple linear regression analysis model for the natural logarithm of the apnea-hypopnea index treating all four anthropometric measurements and gender as covariates, the final stepwise model accounted for an increasing percentage of the variability in the severity of OSAS as a function of age: 7.0, 9.1, 14.5, and 25.6% for those aged <30, 30-39, 40-49, and 50-59 yrs, respectively. It accounted for a decreased percentage among those 60-69 (20.3%) and 70 yrs or older (3.9%). The correlation between NC and the severity of OSAS linearly increased as a function of age for those aged 30-59 yrs, peaked among those in their 60s, and dramatically decreased thereafter. CONCLUSION Middle-aged patients with OSAS were more likely to be obese, as measured by anthropometric measurements, than were younger or older OSAS patients. In particular, the predictive value of NC was significantly lower for younger and older OSAS patients.
Collapse
Affiliation(s)
- Yu-Jin G. Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Do-Un Jeong
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| |
Collapse
|
18
|
Johnson TM, Vaughan CP, Goode PS, Bliwise DL, Markland AD, Huisingh C, Redden DT, McGwin G, Eisenstein R, Ouslander JG, Issa M, Burgio KL. Pilot Results from a Randomized Trial in Men Comparing Alpha-Adrenergic Antagonist versus Behavior and Exercise for Nocturia and Sleep. Clin Ther 2016; 38:S0149-2918(16)30742-1. [PMID: 28029383 DOI: 10.1016/j.clinthera.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/06/2016] [Accepted: 10/01/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Nocturia and sleep problems are common in older adults. We developed and tested a novel intervention, multicomponent behavioral treatment and exercise therapy (M-BET), that may reduce nocturia and improve sleep in men. We compared reductions in nocturia and improvement in sleep in men with M-BET versus an active drug comparator (α-blocker) used alone or in combination (M-BET + α-blocker) METHODS: This randomized, controlled trial was conducted in the ambulatory setting in 2 US Department of Veterans Affairs medical centers in men at least 40 years of age with nocturia (defined as ≥2 nightly episodes). Participants were randomized to receive either M-BET, including pelvic floor muscle training, urge-suppression techniques, delayed voiding, fluid management, sleep hygiene, and peripheral edema management; an active comparator of known efficacy (the α-blocker tamsulosin, one 0.4-mg tablet nightly); or both therapies combined. Participants received interventions over 12 weeks. Outcomes were assessed via voiding diaries, wrist actigraphy, and validated questionnaires. The primary outcome was change in diary-recorded nocturia, assessed using ANCOVA for the between-group changes and paired t tests for within-group changes. FINDINGS A total of 72 men with a mean age of 65.8 years participated. At 12 weeks, mean diary-recorded nocturia changed with M-BET by -1.39 episodes/night (P < 0.001), with α-blocker therapy by -0.59 episodes/night (P < 0.01), and with combination therapy by -1.03 episodes/night (P < 0.01). Reductions were not statistically different across treatment groups (P = 0.41). M-BET also showed statistically significant improvements in sleep quality, bother from nocturia, and nocturia-specific quality of life. All treatment groups indicated global satisfaction with treatment. IMPLICATIONS Behavioral therapy in men, alone or combined with α-blocker therapy, consistently showed large and statistically significant nocturia reductions and favorable effects on sleep and quality of life. Based on these findings, behavioral therapy, while not statistically superior to α-blocker therapy, may provide a meaningful treatment option for men with nocturia. Future research should include the development of behavioral treatment and exercise therapy interventions that could be more easily deployed. ClinicalTrials.gov identifier: NCT00824200.
Collapse
Affiliation(s)
- Theodore M Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta VAMC, Decatur, Georgia; Department of Medicine, Emory University, Atlanta, Georgia.
| | - Camille P Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta VAMC, Decatur, Georgia; Department of Medicine, Emory University, Atlanta, Georgia
| | - Patricia S Goode
- Birmingham/Atlanta GRECC, Birmingham VAMC, Birmingham, Alabama; Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | - Donald L Bliwise
- Program in Sleep, Aging and Chronobiology, Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Birmingham/Atlanta GRECC, Birmingham VAMC, Birmingham, Alabama; Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | | | - David T Redden
- Birmingham/Atlanta GRECC, Birmingham VAMC, Birmingham, Alabama; Biostatistics, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Gerald McGwin
- Birmingham/Atlanta GRECC, Birmingham VAMC, Birmingham, Alabama; Departments of Epidemiology, Birmingham, Alabama
| | - Rina Eisenstein
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta VAMC, Decatur, Georgia; Department of Medicine, Emory University, Atlanta, Georgia
| | - Joseph G Ouslander
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Atlanta VAMC, Decatur, Georgia; Department of Medicine, Emory University, Atlanta, Georgia
| | - Muta Issa
- Department of Urology, Atlanta Veterans Affairs Medical Center (VAMC), Decatur, Georgia
| | - Kathryn L Burgio
- Birmingham/Atlanta GRECC, Birmingham VAMC, Birmingham, Alabama; Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| |
Collapse
|
19
|
Obstructive Sleep Apnea: A Cluster Analysis at Time of Diagnosis. PLoS One 2016; 11:e0157318. [PMID: 27314230 PMCID: PMC4912165 DOI: 10.1371/journal.pone.0157318] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/29/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The classification of obstructive sleep apnea is on the basis of sleep study criteria that may not adequately capture disease heterogeneity. Improved phenotyping may improve prognosis prediction and help select therapeutic strategies. OBJECTIVES This study used cluster analysis to investigate the clinical clusters of obstructive sleep apnea. METHODS An ascending hierarchical cluster analysis was performed on baseline symptoms, physical examination, risk factor exposure and co-morbidities from 18,263 participants in the OSFP (French national registry of sleep apnea). The probability for criteria to be associated with a given cluster was assessed using odds ratios, determined by univariate logistic regression. RESULTS Six clusters were identified, in which patients varied considerably in age, sex, symptoms, obesity, co-morbidities and environmental risk factors. The main significant differences between clusters were minimally symptomatic versus sleepy obstructive sleep apnea patients, lean versus obese, and among obese patients different combinations of co-morbidities and environmental risk factors. CONCLUSIONS Our cluster analysis identified six distinct clusters of obstructive sleep apnea. Our findings underscore the high degree of heterogeneity that exists within obstructive sleep apnea patients regarding clinical presentation, risk factors and consequences. This may help in both research and clinical practice for validating new prevention programs, in diagnosis and in decisions regarding therapeutic strategies.
Collapse
|
20
|
Goessaert AS, Walle JV, Bosch R, Hoebeke P, Everaert K. Nocturnal Polyuria: Excess of Nocturnal Urine Production, Excess of Definitions—Influence on Renal Function Profile. J Urol 2016; 195:670-6. [DOI: 10.1016/j.juro.2015.09.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Johan Vande Walle
- Pediatric Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | - Ruud Bosch
- Urology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Piet Hoebeke
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
21
|
Chen JL, Chen SF, Jiang YH, Kuo HC. Practical points in the medical treatment of overactive bladder and nocturia in the elderly. Tzu Chi Med J 2016; 28:1-5. [PMID: 28757708 PMCID: PMC5509172 DOI: 10.1016/j.tcmj.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022] Open
Abstract
The prevalence of overactive bladder (OAB) increases with age. Degeneration of the central nervous system in the elderly has been proposed as one of the pathogenic factors of OAB. Antimuscarinic therapy is effective in the treatment of OAB; however, intolerable systemic adverse events and cognitive dysfunction during treatment with nonselective antimuscarinic agents is of growing concern in elderly patients. The newly developed beta-3 adrenoceptor agonist mirabegron does not adversely affect flow rate and detrusor pressure, and its therapeutic efficacy and tolerability are similar in patients aged > 65 years and > 75 years, suggesting it might be the therapeutic choice in older patients with OAB. Nocturia can cause sleep deprivation at night and increase daytime sleepiness and loss of energy in the elderly. Desmopressin add-on therapy is effective in improving nocturia and storage symptoms. However, elderly patients with a baseline serum sodium level below the normal range are at high risk of developing significant hyponatremia.
Collapse
Affiliation(s)
- Jing-Liang Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Sheng-Fu Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
22
|
Madhu CK, Hashim H, Enki D, Drake MJ. Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women. Neurourol Urodyn 2015; 36:188-191. [DOI: 10.1002/nau.22912] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Chendrimada K. Madhu
- Department of Women's Health and Bristol Urological Institute; Southmead Hospital; Bristol England
| | - Hashim Hashim
- Urodynamics Unit; Bristol Urological Institute; Southmead Hospital; University of Bristol; Bristol England
| | - Doyo Enki
- Plymouth University Peninsula Schools of Medicine and Dentistry; Plymouth England
| | - Marcus J. Drake
- Bristol Urological Institute; Southmead Hospital; University of Bristol; Bristol England
| |
Collapse
|
23
|
Kovacevic L, Lu H, Wolfe-Christensen C, Abdulhamid I, Thottam PJ, Lulgjuraj M, Madgy DN, Lakshmanan Y. Adenotonsillectomy Normalizes Hormones and Urinary Electrolytes in Children With Nocturnal Enuresis and Sleep-Disordered Breathing. Urology 2015; 86:158-61. [PMID: 26142600 DOI: 10.1016/j.urology.2015.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess (1) plasma levels of antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) and urinary levels of electrolytes in children with sleep disordered breathing (SDB), with or without nocturnal enuresis (NE), and (2) the effect of adenotonsillectomy (T&A) on urinary electrolytes and the secretion of ADH and BNP in children with NE and SDB. We previously reported post-T&A improvements in plasma levels of BNP and ADH in children with SDB and NE. However, the differences in plasma concentration of these hormones in SDB children with and without NE, and their relationships with urinary electrolytes, have not yet been addressed. METHODS This prospective study compared concentrations of urinary electrolytes and plasma ADH and BNP in (1) children with SDB and NE (study group) and an age- and sex-matched control group of children with SDB without NE, and (2) the study group before and 1-month after T&A. RESULTS Compared with the control group (n = 31), the study group (n = 37) exhibited significantly lower ADH (P = .04) and higher BNP (P = .009) plasma levels. The differences in urinary electrolytes were not significant. Post-T&A, the study group showed significantly decreased BNP (P = .018), urinary sodium-to-creatinine ratio (P = .02), and urinary calcium-to-creatinine ratio (P = .007) compared with the pre-T&A values. Post-T&A changes in urinary calcium were significantly correlated with changes in sodium excretion (P = .002) and in plasma levels of BNP (P <.001). CONCLUSION The presence of NE is associated with altered ADH and BNP levels in children with SDB. T&A led to normalization of ADH and BNP, probably through a calcium- and sodium-dependent mechanism.
Collapse
Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI.
| | - Hong Lu
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI
| | | | - Ibrahim Abdulhamid
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Prasad J Thottam
- Department of Otolaryngology, Children's Hospital of Michigan, Detroit, MI
| | - Mark Lulgjuraj
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI
| | - David N Madgy
- Department of Otolaryngology, Children's Hospital of Michigan, Detroit, MI
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI
| |
Collapse
|
24
|
|
25
|
Park EK, Park JH, Kim JH, Choi JI, Kim K, Lee H, Yoon H, Lee HW. Relationships between Nocturia, Obstructive Sleep Apnea, and Quality of Sleep. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Bladder Oxidative Stress in Sleep Apnea Contributes to Detrusor Instability and Nocturia. J Urol 2015; 193:1692-9. [DOI: 10.1016/j.juro.2014.11.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/21/2022]
|
27
|
Zebede S, Lovatsis D, Alarab M, Drutz H. Prevalence of obstructive sleep apnea detected by the Berlin Questionnaire in patients with nocturia attending a urogynecology unit. Int Urogynecol J 2015; 26:881-5. [DOI: 10.1007/s00192-014-2618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/19/2014] [Indexed: 12/20/2022]
|
28
|
Abstract
Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.
Collapse
Affiliation(s)
- Andrew Chang
- Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA,
| | | | | |
Collapse
|
29
|
Destors M, Tamisier R, Sapene M, Grillet Y, Baguet JP, Richard P, Girey-Rannaud J, Dias-Domingos S, Martin F, Stach B, Housset B, Levy P, Pepin JL. Nocturia is an independent predictive factor of prevalent hypertension in obstructive sleep apnea patients. Sleep Med 2015; 16:652-8. [PMID: 25862119 DOI: 10.1016/j.sleep.2014.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/14/2014] [Accepted: 10/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether nocturia is an independent predictor for prevalent hypertension in obstructive sleep apnea (OSA). METHODS We analyzed data from a national prospective clinical cohort of OSA patients participating in the French national prospective registry. Anthropometric data, comorbidities, OSA severity, and number of voids/night were included in multivariate analyses to determine the independent variables associated with prevalent hypertension. RESULTS A total of 22,674 OSA patients were included, of which 11,332 were hypertensive. The prevalence of hypertension among OSA patients was about 1.3 times higher in patients suffering from nocturia at 61.45% versus 46.52% in hypertensive and non-hypertensive OSA patients (p <0.001). There was a significant positive relationship between hypertension and the severity of nocturia beyond two voids/night: two voids/night versus none: odds ratio (OR) = 1.270 (95% confidence interval (CI) = 1.175; 1.372), three voids/night versus none: OR = 1.422 (95% CI = 1.293; 1.565), and four voids/night versus none: OR = 1.575 (95% CI = 1.394; 1.781). The strength of the association was enhanced in patients over 64 years of age. CONCLUSIONS Nocturia is a strong independent predictor of prevalent hypertension in OSA. This association exhibited a "dose-response" relationship beyond two voids/night. The resolution of nocturia after continuous positive airway pressure (CPAP) treatment might be an important outcome to consider for the response of hypertension to CPAP.
Collapse
Affiliation(s)
- Marie Destors
- HP2 Laboratory, INSERM U 1042, University Grenoble Alpes, Grenoble, France; Service de Pneumologie, CHU Grenoble, Grenoble, France.
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U 1042, University Grenoble Alpes, Grenoble, France; Pôle Locomotion, Rééducation et Physiologie, CHU Grenoble, Grenoble, France
| | - Marc Sapene
- Unité Sommeil et Vigilance, Polyclinique Bordeaux Caudéran, Bordeaux, France
| | | | - Jean-Philippe Baguet
- Unité d'Hypertension artérielle, Clinique de cardiologie, CHU de Grenoble, Grenoble, France
| | | | | | - Sonia Dias-Domingos
- HP2 Laboratory, INSERM U 1042, University Grenoble Alpes, Grenoble, France; Pôle Locomotion, Rééducation et Physiologie, CHU Grenoble, Grenoble, France
| | - Francis Martin
- Unité des pathologies du sommeil, Centre hospitalier de Compiègne, Compiègne, France
| | - Bruno Stach
- Pneumologie, Cabinet Médical Saint Michel, Valenciennes, France
| | - Bruno Housset
- Service de Pneumologie, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Patrick Levy
- HP2 Laboratory, INSERM U 1042, University Grenoble Alpes, Grenoble, France; Pôle Locomotion, Rééducation et Physiologie, CHU Grenoble, Grenoble, France
| | - Jean-Louis Pepin
- HP2 Laboratory, INSERM U 1042, University Grenoble Alpes, Grenoble, France; Pôle Locomotion, Rééducation et Physiologie, CHU Grenoble, Grenoble, France
| |
Collapse
|
30
|
Van Kerrebroeck P, Andersson KE. Terminology, epidemiology, etiology, and pathophysiology of nocturia. Neurourol Urodyn 2015; 33 Suppl 1:S2-5. [PMID: 24729150 DOI: 10.1002/nau.22595] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/20/2014] [Indexed: 01/13/2023]
Abstract
Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia affects men and women and is more prevalent among the elderly. More than two nocturnal voids is considered to be a clinically meaningful threshold associated with significant negative outcomes for health and well-being, and the timing of awakening has a significant bearing on the negative consequences of nocturia. Several serious underlying pathophysiologic conditions may be associated with nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient's nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient's nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturnal polyuria is defined as more than 20% of daily urine output at night in young patients and more than 33% in elderly patients. Reduced bladder capacity may be a result of idiopathic or neurogenic detrusor overactivity, bladder outlet obstruction, or reduced nocturnal bladder capacity. The pathophysiology underlying the findings of the FVC falls into five main categories: global polyuria, nocturnal polyuria, reduced bladder capacity, sleep disorders, and circadian clock disorders. This review discusses the epidemiology, etiology, and pathophysiology of nocturia.
Collapse
Affiliation(s)
- Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | |
Collapse
|
31
|
Jeong JI, Kim SJ, Hong SD, Chung SK, Dhong HJ, Kim HY. Differences of Short-Term Systemic Responses in Obstructive Sleep Apnea Patient by Compliance of Continuous Positive Airway Pressure. JOURNAL OF RHINOLOGY 2015. [DOI: 10.18787/jr.2015.22.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jong In Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Nevéus T, Leissner L, Rudblad S, Bazargani F. Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis. Acta Paediatr 2014; 103:1187-91. [PMID: 25040246 DOI: 10.1111/apa.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/12/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022]
Abstract
AIM According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions. METHODS Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5 cm. The dental appliance was removed after 6 months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1 year post-treatment. RESULTS Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.48 ± 1.48, 5.12 ± 1.73, 3.09 ± 2.49 and 2.63 ± 2.81; p < 0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p = 0.001) and to have larger nasal airway dimensions (p = 0.01). CONCLUSION Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.
Collapse
Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | - Farhan Bazargani
- Department of Orthodontics; Postgraduate Dental Education Center; Örebro Sweden
| |
Collapse
|
33
|
dos Santos MA, Guedes EDS, Barbosa RL, da Cruz DDALM. Sleeping difficulties reported by patients with heart failure. Rev Lat Am Enfermagem 2013; 20:644-50. [PMID: 22990148 DOI: 10.1590/s0104-11692012000400003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 04/19/2012] [Indexed: 01/11/2023] Open
Abstract
The study aimed to describe the reports of heart failure patients on the factors that cause difficulties to sleep and the association of these factors with the quality of sleep. This cross-sectional study involved a non-probabilistic sample of 400 patients (mean age 57.8 years, 64.8% were men, average education of 6.1 years, 82.5% in functional class II or III) with heart failure. The main factors associated with sleeping difficulty were: nocturia, interrupted sleep at night and breathing difficulty. Sleeping difficulties in heart failure patients are diverse and there is an association between these difficulties and quality of sleep. Most of these disorders warrant professional nursing interventions.
Collapse
|
34
|
Affiliation(s)
- Raymond C Rosen
- Chief Scientist, New England Research Institutes, Watertown, MA, USA.
| | | | | | | |
Collapse
|
35
|
Effect of adenotonsillectomy on nocturnal enuresis in children with OSA. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
36
|
Ozben S, Guvenc TS, Huseyinoglu N, Sanivar HS, Hanikoglu F, Cort A, Ozben T. Low serum copeptin levels in patients with obstructive sleep apnea. Sleep Breath 2013; 17:1187-92. [PMID: 23407918 DOI: 10.1007/s11325-013-0822-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group. METHODS A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method. RESULTS Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409). CONCLUSIONS Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.
Collapse
Affiliation(s)
- Serkan Ozben
- Department of Neurology, Medical Faculty, Kafkas University, 36100, Kars, Turkey,
| | | | | | | | | | | | | |
Collapse
|
37
|
Bing MH, Jennum P, Moller LA, Mortensen S, Lose G. Obstructive sleep apnea in a Danish population of men and women aged 60-80 years with nocturia. J Clin Sleep Med 2012; 8:515-20. [PMID: 23066362 PMCID: PMC3459196 DOI: 10.5664/jcsm.2144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea, in men and women who had nocturia ≥ 2 per night (nocturics) compared to those without nocturia (controls). METHODS Participants were randomly selected among respondents in a population study of 4000 elderly individuals. Nocturia was assessed using the validated Nocturia, Nocturnal Enuresis, and Sleep-interruption Questionnaire (NNES-Q). Nocturia (≥ 2 voids/night) or control (< 1 void/night) status was assessed by a 3-day frequency volume chart (FVC). Furthermore, all participants completed an overnight ambulatory polygraphic recording to identify obstructive sleep apnea (OSA). RESULTS Of 1111 eligible individuals, a total of 75 nocturics and 75 controls (13.5%) were included. Overall, the prevalence and severity of OSA among nocturics and controls was not significantly different. In a sub-analysis we found that 22 nocturics with OSA (69%) had nocturnal polyuria. This led to a significantly increased risk of having OSA (OR 2.8, 95% CI: 1.1-7.3, p < 0.05) when having nocturnal polyuria compared to other pathophysiological causes of nocturia (polyuria, low bladder capacity, a combination of nocturnal polyuria/low bladder capacity, and neither nocturnal polyuria/low bladder capacity). CONCLUSIONS Nocturia twice or more was not significantly associated with OSA. However, nocturics with nocturnal polyuria had a significantly higher risk of having OSA than nocturics with other pathophysiologies.
Collapse
Affiliation(s)
- Mette Hornum Bing
- Department of Obstetrics and Gynaecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | | | | | | | | |
Collapse
|
38
|
Kang SH, Yoon IY, Lee SD, Kim JW. The impact of sleep apnoea syndrome on nocturia according to age in men. BJU Int 2012; 110:E851-6. [PMID: 22958406 DOI: 10.1111/j.1464-410x.2012.11342.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Study Type--Symptom prevalence (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? Sleep apnoea syndrome (SAS) can be a risk factor for nocturia, although whether the relationship between nocturia and SAS changes according to age remains to be addressed. SAS has a modest impact on nocturia frequency and the prevalence of pathological nocturia in young adults and middle-aged men. However, SAS may not be a risk factor for nocturia in the elderly, and age-related urinary diseases and voiding dysfunctions could over-ride the influence of SAS on nocturia in the elderly. OBJECTIVE • To assess the association between nocturia and sleep apnoea syndrome (SAS) according to age, as well as to determine the factors related to nocturia. PATIENTS AND METHODS • A total of 1757 men who had been referred to a sleep laboratory underwent polysomnography. • Nocturia frequency was assessed using a questionnaire, and pathological nocturia was defined as the need to void two or more times per night. • The Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI) were applied to all study subjects. RESULTS • Nocturia frequency was significantly correlated with age (r = 0.405, P < 0.001) and the apnoea-hypopnoea index (AHI) (r = 0.065, P < 0.01). • In those men aged <65 years, significant correlations were found between nocturic frequency and age, AHI, BDI and PSQI. • Multiple regression analysis showed that age (β = 0.303, P < 0.001), AHI (β = 0.107 P < 0.001) and benign prostatic hypertrophy (BPH; β = 0.069, P < 0.01) were associated with nocturia, and that the presence of pathological nocturia was predicted by BPH (odds ratio [OR], 2.77; P < 0.01), age (OR, 1.09; P < 0.001) and AHI (OR, 1.02; P < 0.001). • However, in men aged >65 years, nocturia frequency was significantly associated with BDI and PSQI, although no relationship was found between nocturia frequency and SAS parameters. • BPH was more frequently observed in elderly men with pathological nocturia than in those without pathological nocturia (OR, 2.18; P < 0.05). CONCLUSIONS • In the elderly, SAS may not be a risk factor for nocturia. • Age-related urinary diseases and voiding dysfunction may over-ride the influence of SAS.
Collapse
Affiliation(s)
- Suk-Hoon Kang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | | | | | | |
Collapse
|
39
|
Johansson P, Riegel B, Svensson E, Broström A, Alehagen U, Dahlström U, Jaarsma T. The contribution of heart failure to sleep disturbances and depressive symptoms in older adults. J Geriatr Psychiatry Neurol 2012; 25:179-87. [PMID: 23124012 DOI: 10.1177/0891988712458366] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF). METHODS A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506). RESULTS Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (β = 0.64 vs β = 0.45, P = .006). CONCLUSION In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms.
Collapse
Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden.
| | | | | | | | | | | | | |
Collapse
|
40
|
VALENZA MC, VALENZA G, MUÑOZ-CASAUBON T, BOTELLA-LÓPEZ M, PUENTEDURA EJ, ARROYO-MORALES M, FERNÁNDEZ-DE-LAS-PEÑAS C. Epidemiology of sleep-related complaints associated with obstructive sleep apnea, insomnia and non-restorative sleep in an at-risk population in Granada, Spain. Sleep Biol Rhythms 2012. [DOI: 10.1111/j.1479-8425.2012.00565.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
41
|
Schuman CC, Attarian HP. Integrating Sleep Management into Clinical Practice. J Clin Psychol Med Settings 2012; 19:65-76. [DOI: 10.1007/s10880-012-9297-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
42
|
Nevéus T. Nocturnal enuresis-theoretic background and practical guidelines. Pediatr Nephrol 2011; 26:1207-14. [PMID: 21267599 PMCID: PMC3119803 DOI: 10.1007/s00467-011-1762-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/24/2010] [Accepted: 01/04/2011] [Indexed: 02/07/2023]
Abstract
Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment-often combined with desmopressin-can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account.
Collapse
Affiliation(s)
- Tryggve Nevéus
- Uppsala University Children's Hospital, 751 85 Uppsala, Sweden.
| |
Collapse
|
43
|
Abstract
Parasomnias are undesirable physical or experiential events that occur in and around sleep. Treatments include reassurance in some cases, various forms of cognitive-behavioral therapy (CBT), and pharmacologic agents. Cognitive restructuring, imagery rehearsal, relaxation, hypnosis, desensitization, and anticipatory awakenings are some of the common CBT and nonpharmacologic interventions. Medications that are used belong to a wide variety of pharmacologic classes, such as alpha-blockers (prazosin), tricyclic antidepressants (imipramine and clomipramine), selective serotonin reuptake inhibitors, benzodiazepines (diazepam and clonazepam), anticonvulsants (topiramate and gabapentin), desmopressin acetate, and anticholinergic agents (oxybutynin and tolterodine). Data on efficacy are only available from randomized trials on CBT and prazosin for nightmares and on pharmacologic and alarm therapy for enuresis. No large-scale randomized trials are available to assess the efficacy of the other treatments, and most data come from anecdotal case reports, case series, or small open-label trials.
Collapse
Affiliation(s)
- Hrayr Attarian
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maguire Building, Room 2700, 2160 South First Avenue, Maywood, IL 60153, USA.
| |
Collapse
|
44
|
Abstract
Sleep has long been considered as a passive phenomenon, but it is now clear that it is a period of intense brain activity involving higher cortical functions. Overall, sleep affects every aspect of a child's development, particularly higher cognitive functions. Sleep concerns are ranked as the fifth leading concern of parents. Close to one third of all children suffer from sleep disorders, the prevalence of which is increased in certain pediatric populations, such as children with special needs, children with psychiatric or medical diagnoses and children with autism or pervasive developmental disorders. The paper reviews sleep physiology and the impact, classification, and management of sleep disorders in the pediatric age group.
Collapse
Affiliation(s)
- Hanan M El Shakankiry
- King Fahd University Hospital, Al Dammam University, Al Khobar, Kingdom of Saudi Arabia
| |
Collapse
|
45
|
Chasens ER, Twerski SR, Yang K, Umlauf MG. Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll. Behav Sleep Med 2010; 8:157-71. [PMID: 20582759 DOI: 10.1080/15402002.2010.487462] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.
Collapse
Affiliation(s)
- Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | | | | | | |
Collapse
|
46
|
Tsujimura A, Takao T, Miyagawa Y, Yamamoto K, Fukuhara S, Nakayama J, Kiuchi H, Suganuma N, Nakamura T, Kumano-Go T, Sugita Y, Nonomura N, Okuyama A. Urgency Is an Independent Factor for Sleep Disturbance in Men with Obstructive Sleep Apnea. Urology 2010; 76:967-70. [PMID: 20381845 DOI: 10.1016/j.urology.2010.01.070] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 01/19/2010] [Accepted: 01/27/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Akira Tsujimura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Daniel LC, Grant M, Kothare SV, Dampier C, Barakat LP. Sleep patterns in pediatric sickle cell disease. Pediatr Blood Cancer 2010; 55:501-7. [PMID: 20658622 DOI: 10.1002/pbc.22564] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research examining sleep in children with sickle cell disease (SCD) has focused on the increased occurrence of specific sleep disorders (i.e., sleep-disordered breathing, hypoxemia, nocturnal enuresis), but no research exists describing general sleep behaviors of children with SCD. The purpose of the current study was to compare sleep patterns and sleep behaviors in children with SCD and healthy controls and examine the associations of demographic and disease factors with sleep in the SCD group. PROCEDURE The Children's Sleep Habits Questionnaire was completed by parents of 4- to 10-year-old children with SCD (n = 54) and children attending well-care clinics in the same urban hospital (n = 52). Within the SCD group, demographic and disease factors [i.e., genotype, healthcare utilization, SCD complications, and socioeconomic status (SES)] were determined by medical chart review. RESULTS Parents of children with SCD reported significantly more behaviors associated with night waking and sleep-disordered breathing than the control group. Within the SCD group, parasomnias were related to SES, enuresis, more severe genotypes, SCD complications, and healthcare utilization. Sleep-disordered breathing was also related to SES, enuresis, and SCD complications. CONCLUSIONS Results indicate the importance of routinely assessing sleep in children with SCD as they are more likely to exhibit disrupted sleep than children with similar demographic backgrounds. Given significantly higher rates of parent reported sleep-disordered breathing and night waking in this population, it is important to consider interventions to minimize disruptions to overnight sleep and improve daytime functioning for quality of life in children with SCD.
Collapse
Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | |
Collapse
|
48
|
Bourey R, Bourey J, Habbal N, Balaa A. Early gain in body mass with continuous positive airway pressure therapy for obstructive sleep apnea. SOMNOLOGIE 2010. [DOI: 10.1007/s11818-010-0483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
49
|
Guimarães GM. História clínica e exame físico em SAOS: clinical history and physical examination. J Bras Pneumol 2010; 36 Suppl 2:10-2. [DOI: 10.1590/s1806-37132010001400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Embora SAOS seja uma patologia comum, é frequentemente subdiagnosticada. Seus sinais e sintomas são, na sua maioria, subjetivos e, portanto, deve haver suspeição diagnóstica quando existir roncos, sonolência diurna, cansaço, desânimo e alteração de humor. Escalas e tabelas com boa sensibilidade, que incluem os sintomas clínicos mais relevantes e dados do exame físico, podem indicar o diagnóstico de SAOS. A confirmação diagnóstica é realizada através de polissonografia, considerada o método padrão ouro.
Collapse
|
50
|
Yoshimura K, Oka Y, Kamoto T, Yoshimura K, Ogawa O. Differences and associations between nocturnal voiding/nocturia and sleep disorders. BJU Int 2009; 106:232-7. [DOI: 10.1111/j.1464-410x.2009.09045.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|