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Diaconu Ş, Irincu L, Ungureanu L, Țînț D, Falup-Pecurariu C. Nocturia and Sleep in Parkinson's Disease. J Pers Med 2023; 13:1053. [PMID: 37511666 PMCID: PMC10381144 DOI: 10.3390/jpm13071053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Nocturia has a high prevalence in Parkinson's Disease (PD) and is known to be a bothersome symptom for people with Parkinson's disease (PwPD). OBJECTIVE to characterize nocturia in a sample of PwPD, in relation to sleep, fatigue and other non-motor symptoms (NMS). METHODS we assessed 130 PwPD using a comprehensive battery of scales, which includes the Non-Motor Symptoms Questionnaire (NMSQ), International Parkinson and Movement Disorder Society Non-Motor Rating Scale (MDS-NMS), Parkinson's Disease Sleep Scale version 2 (PDSS-2), Parkinson's Disease Questionnaire (PDQ-39), The Overactive Bladder Questionnaire-Short form (OABq-SF), and the Parkinson's Fatigue Scale (PFS-16). RESULTS according to the positive answers to the item of the NMSQ related to nocturia, patients were divided into PwPD + nocturia, and PwPD - nocturia. Nocturia was reported by 112 patients (86.15%). Quality of life in PwPD + nocturia was worse than in PwPD - nocturia, according to the PDQ-39 scores (13.32 ± 9.00 vs. 26.29 ± 14.55, p < 0.001). Sleep was significantly disturbed in PwPD + nocturia compared to PwPD - nocturia, according to the total scores of various scales, such as PDSS-2, PFS-16. PwPD who complained of nocturia presented higher scores of several NMS. CONCLUSIONS nocturia has a high prevalence in PwPD and it is associated with impaired sleep, fatigue, and reduced quality of life.
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Affiliation(s)
- Ştefania Diaconu
- Department of Neurology, County Clinic Hospital, 500365 Braşov, Romania
- Faculty of Medicine, Transilvania University, 500036 Braşov, Romania
| | - Laura Irincu
- Department of Neurology, County Clinic Hospital, 500365 Braşov, Romania
- Faculty of Medicine, Transilvania University, 500036 Braşov, Romania
| | - Larisa Ungureanu
- Department of Neurology, County Clinic Hospital, 500365 Braşov, Romania
- Faculty of Medicine, Transilvania University, 500036 Braşov, Romania
| | - Diana Țînț
- Faculty of Medicine, Transilvania University, 500036 Braşov, Romania
- Clinicco, 500059 Braşov, Romania
| | - Cristian Falup-Pecurariu
- Department of Neurology, County Clinic Hospital, 500365 Braşov, Romania
- Faculty of Medicine, Transilvania University, 500036 Braşov, Romania
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Hafner M, Andersson FL, Burtea T, van Stolk C, Whitmore M, Yerushalmi E, Troxel WM. Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity. J Med Econ 2020; 23:994-1003. [PMID: 32397770 DOI: 10.1080/13696998.2020.1767631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective well-being (SWB), work engagement and productivity.Methods: Using large-scale international workplace survey data, the associations between nocturia, SWB, work engagement (Utrecht Work Engagement Scale, UWES-9) and productivity (Work Productivity and Activity Impairment, WPAI) were assessed. Bivariate and multivariate regression analysis was used with adjustment for a large set of confounding factors, including sleep duration and sleep quality.Results: Across a study sample of 92,129 observations, aged 18-70, an average of 10% of the survey population reported ≥2 nocturnal voids (generally considered clinically significant nocturia), with prevalence of nocturia increasing with age. Individuals with nocturia reported a 35.7% (p < .001) higher relative sleep disturbance score and were 10.5 percentage points (pp) (p < .001) more likely to report short sleep. Adjusted for covariates, nocturia was associated with a 3.5% (p < .001) lower relative SWB score and a 2% (p < .001) lower relative UWES-9 work engagement score. Nocturia was associated with a 3.9 pp (p < .001) higher work impairment due to absenteeism and presenteeism (WPAI). Adjusting additionally for sleep disturbance and sleep duration reduced the magnitude of the estimated effects, suggesting a key role for poor sleep in explaining the relationship between nocturia and the outcomes (SWB, UWES-9, WPAI) assessed.Conclusions: A key contribution of this study is the assessment of the association between nocturia and a range of work performance outcomes in a sizeable study using validated instruments to measure work engagement and productivity. The study highlights the importance of taking sleep into account when assessing the relationship between nocturia and associated outcomes.
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Affiliation(s)
| | - Fredrik L Andersson
- International PharmaScience Center, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Teodor Burtea
- Ferring International Center S.A., Saint-Prex, Switzerland
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Cho JW, Duffy JF. Sleep, Sleep Disorders, and Sexual Dysfunction. World J Mens Health 2019; 37:261-275. [PMID: 30209897 PMCID: PMC6704301 DOI: 10.5534/wjmh.180045] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 12/16/2022] Open
Abstract
Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a 'third pillar of health', along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.
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Affiliation(s)
- Jae Wook Cho
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
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The Association Between Overactive Bladder and Falls and Fractures: A Systematic Review. Adv Ther 2018; 35:1831-1841. [PMID: 30255417 PMCID: PMC6223978 DOI: 10.1007/s12325-018-0796-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 11/18/2022]
Abstract
Introduction Urinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB. Methods Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB. Results Fifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups. Conclusions Evidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures. Funding Astellas. Electronic supplementary material The online version of this article (10.1007/s12325-018-0796-8) contains supplementary material, which is available to authorized users.
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Rogers TS, Blackwell TL, Lane NE, Tranah G, Orwoll ES, Cauley JA, Ancoli-Israel S, Stone KL, Cummings SR, Cawthon PM. Rest-activity patterns and falls and fractures in older men. Osteoporos Int 2017; 28:1313-1322. [PMID: 28013364 PMCID: PMC5533275 DOI: 10.1007/s00198-016-3874-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/06/2016] [Indexed: 01/11/2023]
Abstract
UNLABELLED Dysregulated rest-activity rhythm (RAR) patterns have been associated with several health conditions in older adults. This study showed that later acrophase was associated with a modestly greater risk of falls but not fractures in elderly men. Associations between dysregulated RAR patterns and osteoporosis risk warrant further investigation. PURPOSE The purpose of this study was to investigate the relationship between rest-activity rhythm (RAR) patterns and risk of falls/fractures in older men. We hypothesized that dysregulated RAR would be associated with incident falls/fractures. METHODS We used wrist-worn actigraphy to measure RAR over 4.8 ± 0.8 24-h periods in men (≥67 years) enrolled in the multicenter Outcomes of Sleep Disorders in Men (MrOS Sleep) Study (n = 3001). Men were contacted every 4 months to report occurrence of falls/fractures. RAR parameters included amplitude (difference between peak and nadir activity in counts/minute), mesor (activity counts/minute), acrophase (time of day of peak activity), and pseudo-F statistic (rhythm robustness) and were evaluated as continuous variables with associations reported per SD increase/decrease in models adjusted for confounders. Logistic regression was used to estimate the likelihood (odds ratio, OR) of recurrent falls in the year after the visit. Proportional hazards models were used to estimate the risk (hazard ratio, HR) of fractures. RESULTS One year after the visit, 417 men (14%) had recurrent (≥2) falls. Later acrophase (OR 1.18, 95% CI 1.06-1.32) was associated with a modestly greater likelihood of falls. In 8.6 years (SD 2.6 years) of >97% complete follow-up, 256 men (8.53%) had a major osteoporotic fracture, 85 (2.8%) had a clinical spine fracture, and 110 (3.7%) had a hip fracture. No consistent, significant associations were observed between RAR patterns and fractures. CONCLUSIONS Later acrophase was associated with a modestly greater risk of falls; this association did not translate into a higher fracture risk in this cohort of elderly men.
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Affiliation(s)
- Tara S Rogers
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California, Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
| | - Terri L Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Nancy E Lane
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California, Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA
| | - Greg Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
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Min Y, Slattum PW. Poor Sleep and Risk of Falls in Community-Dwelling Older Adults: A Systematic Review. J Appl Gerontol 2016; 37:1059-1084. [DOI: 10.1177/0733464816681149] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Concerns about sleep problems and falls in older adults are significant. This article reviews the association between sleep problems and falls in community-dwelling adults aged 65 years or older. Multiple databases were searched from inception until 2015 using sleep, sleep disorders, and falls as keywords, limiting to studies published in English in peer-reviewed journals. After screening and assessing for eligibility, 18 articles were selected based on the inclusion and exclusion criteria. Findings of an association between sleep problems and risk of falls are conflicting, but some specific sleep problems such as extremely short sleep duration, daytime sleepiness and naps appear to be significantly related to falls in older adults. Methodological limitations including variability in covariates included in the analyses and measurement of the exposure and outcome variables were identified. The results of this review identified the need to have comparable definitions, validated tools, and rigorous design of future studies.
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Affiliation(s)
- Yaena Min
- Virginia Commonwealth University, Richmond, USA
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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.
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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
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Bower WF, Whishaw DM, Khan F. Nocturia as a marker of poor health: Causal associations to inform care. Neurourol Urodyn 2016; 36:697-705. [DOI: 10.1002/nau.23000] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/29/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Wendy F. Bower
- Department of Rehabilitation Services; The Royal Melbourne Hosital; Melbourne Victoria Australia
| | - D. Michael Whishaw
- Departments of Aged Care and Urology, Royal Park Campus; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Fary Khan
- Department of Rehabilitation Services; The Royal Melbourne Hosital; Melbourne Victoria Australia
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Hayley AC, Williams LJ, Kennedy GA, Holloway KL, Berk M, Brennan-Olsen SL, Pasco JA. Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample. BMC Geriatr 2015; 15:74. [PMID: 26141865 PMCID: PMC4491238 DOI: 10.1186/s12877-015-0068-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/03/2015] [Indexed: 01/11/2023] Open
Abstract
Background Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95 % CI 1.03-1.10). Conclusions For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.
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Affiliation(s)
- Amie C Hayley
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Lana J Williams
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Gerard A Kennedy
- School of Psychology, Counselling & Psychotherapy, Cairnmillar Institute, 993 Burke Road, Camberwell, Australia. .,Institute for Breathing and Sleep, Bowen Centre, Austin Health, PO Box 5555, Heidelberg, Melbourne, Australia.
| | - Kara L Holloway
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Michael Berk
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Department of Psychiatry, The University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, Australia. .,Orygen, the National Centre of Excellence for Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia. .,Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, Melbourne, Australia.
| | - Sharon L Brennan-Olsen
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
| | - Julie A Pasco
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
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Abstract
Nocturia is a bothersome symptom that increases with age, resulting in sleep disruption, an increased risk of falls, and a greater likelihood of rating one's health as poor. It is often a symptom of conditions that cause low volume voiding, overproduction of urine across the day or only at night and a symptom of a sleep disorder. Nocturia affects quality of life and has an impact on aging in place, thus assessment and treatment are essential. Behavioral treatments should be explored first, keeping in mind what the affected older adult defines as the desired outcomes of treatment.
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Johnson TM, Markland AD, Goode PS, Vaughan CP, Colli JL, Ouslander JG, Redden DT, McGwin G, Burgio KL. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU Int 2013; 112:100-8. [PMID: 23448285 DOI: 10.1111/j.1464-410x.2012.11736.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | | | - Joseph G. Ouslander
- Charles E. Schmidt College of Biomedical Science; Florida Atlantic University; Miami; FL; USA
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Weiss JP, Blaivas JG, Blanker MH, Bliwise DL, Dmochowski RR, Drake M, DuBeau CE, Hijaz A, Rosen RC, Van Kerrebroeck PEV, Wein AJ. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int 2013; 111:700-16. [PMID: 23360086 DOI: 10.1111/j.1464-410x.2012.11749.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A consensus statement published in 2011 summarised current research, clinical approaches, and treatment options for nocturia. Since that time, new research has refined our understanding of nocturia in clinically important ways and new evidence has been presented on the efficacy and outcomes of several treatment methods for this underreported, infrequently recognised, and undertreated problem in adults. This paper provides updated guidance to clinicians in light of recent advances in the field.
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Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA.
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Vaughan CP, Juncos JL, Trotti LM, Johnson TM, Bliwise DL. Nocturia and overnight polysomnography in Parkinson disease. Neurourol Urodyn 2013; 32:1080-5. [PMID: 23359220 DOI: 10.1002/nau.22365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023]
Abstract
AIM Characterize clinical factors related to nocturia and sleep disruption in Parkinson disease (PD) using polysomnography (PSG). METHODS Sixty-three PD patients were recruited regardless of sleep or voiding complaints from a university-based movement disorders clinic for a 48 hr inpatient PSG protocol. Nocturia frequency and bother related to urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) and were corroborated by measurements of PSG-defined sleep made immediately preceding and subsequent to each in-lab voiding episode. PSG measures included whole-night total sleep time (TST), sleep efficiency (SE), apnea/hypopnea index (AHI), and time to PSG-defined sleep following nocturia episodes. Differences between groups were assessed using Mantel-Haenszel chi-square, t-tests, or Wilcoxon signed rank tests. Linear regression was used to assess factors associated with reported nocturia frequency. RESULTS Sixty patients completed the IPSS. Thirty-seven (61%) reported at least two nocturia episodes nightly; those individuals demonstrated lower PSG-defined SE (P = 0.01) and TST (P = 0.02) than patients with 0-1 episodes. Participants reporting 2-3 episodes of nocturia with high bother on the IPSS (n = 12) demonstrated lower whole-night TST (280.5 ± 116.1 min vs. 372.5 ± 58.7 min, P = 0.03) and worse SE (59.2 ± 22.7% vs. 75.9 ± 11.2%, P = 0.04) when compared to participants with 2-3 episodes of nocturia with low bother (n = 13). CONCLUSIONS These results verify objectively that PD patients with nocturia have poor sleep. Furthermore, among individuals with comparable levels of reported nocturia, higher bother is associated with poorer sleep as defined on PSG. Neurourol. Urodynam. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Camille P Vaughan
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia; Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
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Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, Tubaro A, Madersbacher S. A Contemporary Assessment of Nocturia: Definition, Epidemiology, Pathophysiology, and Management—a Systematic Review and Meta-analysis. Eur Urol 2012; 62:877-90. [DOI: 10.1016/j.eururo.2012.07.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/06/2012] [Indexed: 01/19/2023]
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Redeker NS, Adams L, Berkowitz R, Blank L, Freudenberger R, Gilbert M, Walsleben J, Zucker MJ, Rapoport D. Nocturia, sleep and daytime function in stable heart failure. J Card Fail 2012; 18:569-75. [PMID: 22748491 PMCID: PMC3389347 DOI: 10.1016/j.cardfail.2012.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/01/2012] [Accepted: 05/04/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate nocturia severity and nocturia-related differences in sleep, daytime symptoms and functional performance among patients with stable heart failure (HF). METHODS AND RESULTS In this cross-sectional observational study, we recruited 173 patients [mean age 60.3 ± 16.8 years; female n = 60 (35%); mean left ventricular ejection fraction 32 ± 14.6%] with stable chronic HF from HF disease management programs in the northeastern United States. Participants reported nocturia and completed a 6-minute walk test (6MWT), 1 night of ambulatory polysomnography, and the SF-36 Medical Outcomes Study, Epworth Sleepiness, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Fatigue, and Centers for the Epidemiological Studies of Depression scales. Participants reported 0 (n = 30; 17.3%), 1-2 (n = 87; 50.2%), and ≥3 (n = 56; 32.4%) nightly episodes of nocturia. There were decreases in sleep duration and efficiency, REM and stage 3-4 sleep, physical function, and 6MWT distance and increases in the percentage of wake time after sleep onset, insomnia symptoms, fatigue, and sleepiness across levels of nocturia severity. CONCLUSIONS Nocturia is common, severe, and closely associated with decrements in sleep and functional performance and increases in fatigue and sleepiness in patients with stable HF.
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Affiliation(s)
- Nancy S Redeker
- Yale University School of Nursing, 100 Church Street South, New Haven, CT 06536-07040, USA.
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Vaughan CP, Eisenstein R, Bliwise DL, Endeshaw YK, Nagamia ZJ, Wolf RA, Johnson TM. Self-rated sleep characteristics and bother from nocturia. Int J Clin Pract 2012; 66:369-73. [PMID: 22356249 DOI: 10.1111/j.1742-1241.2011.02868.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate if men with varying degrees of bother from a similar number of nocturia episodes differ with respect to self-rated sleep characteristics and fatigue. MATERIALS AND METHODS As part of the baseline assessments during a nocturia treatment trial, 55 participants reported frequency and bother of nocturia using the AUA Symptom Inventory and completed 7-day sleep diaries prior to treatment. Participants who reported moderate nocturia (either two or three episodes nightly) were further grouped into categories of LOW (nocturia is no problem or a very small problem) or HIGH bother (nocturia is a big problem). Information from the participant completed sleep diaries was abstracted, including information on daytime napping, total sleep time, mean time needed to return to sleep, nighttime ratings of fatigue, and daytime ratings of fatigue. RESULTS Of the 55 individuals who completed the pilot study, 24 study participants reported two or three episodes of nocturia and had either HIGH (n = 11) or LOW (n = 13) bother. Participants categorised with HIGH bother were significantly more likely than those with LOW bother to report difficulty initiating sleep (47.7 ± 34.4 vs. 23.5 ± 13.6 min, p = 0.05), difficulty returning to sleep after an awakening (28.9 ± 16.1 vs. 15.4 ± 9.6 min, p = 0.03) and greater morning fatigue (3.3 ± 0.7 vs. 2.5 ± 1.0, p = 0.04 on a 7-point scale). CONCLUSIONS Since bother related to nocturia is linked to sleep quality, interventions targeting fatigue and sleep maintenance may provide useful targets in the management of nocturia in men.
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Affiliation(s)
- C P Vaughan
- Birmingham/Atlanta GRECC, Atlanta VA Medical Center, Decatur, GA, USA.
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Lightner DJ, Krambeck AE, Jacobson DJ, McGree ME, Jacobsen SJ, Lieber MM, Roger VL, Girman CJ, St Sauver JL. Nocturia is associated with an increased risk of coronary heart disease and death. BJU Int 2012; 110:848-53. [PMID: 22233166 DOI: 10.1111/j.1464-410x.2011.10806.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Nocturia has been associated with multiple chronic conditions, however, previous studies have been conducted only at a single time. We found that nocturia preceded the development CHD in young men. Moderate nocturia may be an early marker of CHD in young men. OBJECTIVE To determine whether nocturia is associated with the development of diabetes mellitus, hypertension, coronary heart disease (CHD) and occurrence of death. MATERIALS AND METHODS We studied data obtained from a retrospective cohort of randomly selected men, aged 40-79 years in 1990, from Olmsted County, MN, USA. Moderate nocturia was defined as waking to urinate ≥2 times per night. Men were followed every 2 years through repeated questionnaires and community medical records to assess development of diabetes mellitus and hypertension, and occurrence of death. CHD was ascertained through ongoing surveillance of heart disease in Olmsted County. Cox proportional hazard models were used to estimate associations between baseline nocturia and each of the outcomes. RESULTS A total of 2447 men were followed for a median of 17.1 years (25th and 75th percentiles: 15.0, 17.4 years). Moderate nocturia was not significantly associated with the later development of diabetes mellitus or hypertension in this study. Younger men (<60 years of age) with moderate nocturia were more likely to develop CHD later in life than younger men without nocturia (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.13, 2.49). This association was no longer significant when adjusted for age, body mass index (BMI) and urological medications (HR: 1.36; 95% CI: 0.87, 2.12). Older men (≥60 years of age) with moderate nocturia were more likely to die than older men without moderate nocturia, even after adjusting for age, BMI, urological medications and CHD (HR: 1.48; 95% CI: 1.15, 1.91). CONCLUSION Nocturia may be a marker for increased risk of CHD in younger men, and death in older men.
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Harel M, Weiss JP. Evaluation and Management of Nocturia in Older Men. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nocturia × disturbed sleep: a review. Int Urogynecol J 2011; 23:255-67. [DOI: 10.1007/s00192-011-1525-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/21/2011] [Indexed: 11/24/2022]
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Weiss JP, Blaivas JG, Bliwise DL, Dmochowski RR, Dubeau CE, Lowe FC, Petrou SP, Van Kerrebroeck PEV, Rosen RC, Wein AJ. The evaluation and treatment of nocturia: a consensus statement. BJU Int 2011; 108:6-21. [PMID: 21676145 DOI: 10.1111/j.1464-410x.2011.10175.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
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Scheuermaier K, Meyers M, Surprise M, Loughlin KR, Duffy JF. Reciprocal relationship between age-related sleep disruption and urological symptoms. BJU Int 2011; 107:871-3. [PMID: 21392205 DOI: 10.1111/j.1464-410x.2011.10121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karine Scheuermaier
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Pereira AA, Ceolim MF. Relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2011. [DOI: 10.1590/s1809-98232011000400016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Esta revisão objetivou sistematizar estudos que avaliam a relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade. MÉTODO: Realizou-se revisão bibliográfica entre 21 e 30 de setembro de 2009, no idioma Inglês, com as seguintes palavras-chave: "sleep" AND "falls" AND "functional performance" AND "elderly". Foram utilizadas as bases de dados PubMed, Ageline e Scielo. Foram critérios de inclusão: artigos publicados de janeiro de 2006 a setembro de 2009; artigos completos; estudos transversais, retrospectivos, prospectivos; estudos realizados com idosos da comunidade. RESULTADOS: Foram encontrados 52 estudos, dos quais foram avaliados dez que preencheram os critérios de inclusão. CONCLUSÕES: Os estudos mostraram que os distúrbios do sono podem piorar o desempenho funcional, além de representarem fator de risco independente para quedas em idosos.
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