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Di Bello F, Napolitano L, Abate M, Collà Ruvolo C, Morra S, Califano G, Capece M, Creta M, Scandurra C, Muzii B, Di Nola C, Bochicchio V, Nocini R, Abbate V, Maldonato NM, Dell'Aversana Orabona G, Longo N, Cantone E. "Nocturia and obstructive sleep apnea syndrome: A systematic review". Sleep Med Rev 2023; 69:101787. [PMID: 37167825 DOI: 10.1016/j.smrv.2023.101787] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
Lower urinary tract symptoms represent a significant public health problem worldwide, impairing patients' quality of life, especially in elderly people. Among LUTS, nocturia is assessed as the most experienced entity related to several disorders such as sleep disorders and/or obstructive sleep apnea syndrome (OSAS). Among OSAS patients, nocturia stands as a bothersome symptom that increases alongside with the OSAS severity. However, despite the nocturia and OSAS shared a long-acknowledged link, the causes, and the pathophysiology for development of nocturia in OSAS have remained largely unexamined. Generally, the patients with OSAS experienced nocturia due to easy waking or increased bladder filling. However, nor the effect of treatment on management of nocturia in OSAS patients are well-established.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy.
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Cristiano Scandurra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Benedetta Muzii
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Claudio Di Nola
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | | | - Riccardo Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vincenzo Abbate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Nelson Mauro Maldonato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | | | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Italy
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Nguyen LN, Randhawa H, Nadeau G, Cox A, Hickling D, Campeau L, Li J, Welk B, Carlson K. Canadian Urological Association best practice report: Diagnosis and management of nocturia. Can Urol Assoc J 2022; 16:E336-E349. [PMID: 35819914 PMCID: PMC9328849 DOI: 10.5489/cuaj.7970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Laura N. Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Geneviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec, QC, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Juliana Li
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kevin Carlson
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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Papworth E, Dawson S, Henderson EJ, Eriksson SH, Selsick H, Rees J, Gimson A, Strong E, Cotterill N, Huntley AL, Drake MJ. Association of Sleep Disorders with Nocturia: A Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. Eur Urol Focus 2022; 8:42-51. [PMID: 35027331 DOI: 10.1016/j.euf.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT Sleep disorders affect responsiveness to sensory information and can cause nocturnal polyuria and reduced sleep depth; hence, these are potentially influential in understanding the mechanism of nocturia. OBJECTIVE To report the systematic review (SR) and expert consensus for primary care management of nocturia in sleep disorders. EVIDENCE ACQUISITION Four databases were searched from January to April 2020. A total of 1658 titles and abstracts were screened, and 23 studies potentially applicable were included for full-text screening. The nominal group technique (NGT) was used to derive a consensus on recommendations for management using an expert panel with public involvement. EVIDENCE SYNTHESIS Thirteen studies met the SR inclusion criteria, all of which studied obstructive sleep apnoea (OSA), with ten evaluating the effect of continuous positive airway pressure. The NGT consensus discussed the assessment of OSA with other key sleep disorders, notably insomnia, restless legs syndrome/periodic limb movements of sleep, and parasomnias, including non-rapid eye movement (non-REM) parasomnias and REM sleep behaviour disorder (RBD). The NGT considered that the use of screening questions to reach a clinical diagnosis is a sufficient basis for offering conservative therapy within primary care. Reasons for referral to a sleep clinic are suspected sleep disorder with substantially impaired daytime function despite conservative treatment. Suspected RBD should be referred, and if confirmed, neurology opinion is indicated. Referrals should follow local guidelines. Persisting nocturia is not currently considered an indication for referral to a sleep clinic. CONCLUSIONS Sleep disorders are potentially highly influential in nocturia, but are often overlooked. PATIENT SUMMARY People with sleep disorders can experience nocturia due to easy waking or increased bladder filling. We looked at published research, and information was limited to one form of sleep disturbance-obstructive sleep apnoea. We assembled a group of experts, to develop practical approaches for assessing and treating nocturia in the potentially relevant sleep disorders.
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Affiliation(s)
- Emma Papworth
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, University College London Hospitals, London, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, North Somerset, Bristol, UK
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Apergis N, Gounidis A, Filippou DK, Papadopoulos VP. The Use of CPAP Independently Improves Nocturia, Erectile Function, and Depression Symptoms in Obstructive Sleep Apnea Male Patients: an Observational Study. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1575-1585. [DOI: https:/doi.org/10.1007/s42399-021-00916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 08/30/2023]
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Chen CY, Chen CL, Yu CC. Trazodone improves obstructive sleep apnea after ischemic stroke: a randomized, double-blind, placebo-controlled, crossover pilot study. J Neurol 2021; 268:2951-2960. [PMID: 33625584 DOI: 10.1007/s00415-021-10480-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low arousal threshold plays a part in the pathogenesis of obstructive sleep apnea (OSA) and may be improved by sedatives. Sedative antidepressants are frequently prescribed for stroke patients due to their high prevalence of insomnia and depression. However, the effect of sedative antidepressants on the severity of OSA in stroke patients has not been studied well. METHODS In a double-blinded randomized crossover pilot study, 22 post-acute ischemic stroke patients (mean age, 61.7 ± 10.6 y) with OSA received 100 mg of trazodone or a placebo just before polysomnography, with approximately 1 week between measures. The study also measured baseline heart rate variability and 24-h ambulatory blood pressure. RESULTS Administration of trazodone significantly increased the percentage time of slow-wave sleep (31.5 ± 13.2 vs. 18.4 ± 8.7%; P < 0.001) and improved almost all the parameters of OSA severity, including the apnea-hypopnea index (AHI, 25.4 ± 15.4 vs. 39.1 ± 18.4 events/h; P < 0.001), the respiratory arousal index (9.8 (5.8-11.95) vs. 14.1 (11.3-18.7) events/h; P < 0.001), and the minimum oxygen saturation (80.2 ± 9.1 vs. 77.1 ± 9.6%; P = 0.016). Responders to therapy (AHI reduced by > 50%; n = 7/22) had predominant OSA during rapid-eye-movement sleep and decreased sympathetic tone, as reflected in significantly lower mean blood pressure, diastolic blood pressure, and normalized low-frequency power. CONCLUSIONS Obstructive sleep apnea with comorbid ischemic stroke may be a distinctive phenotype which responds quite well to trazodone, decreasing OSA severity without increasing nocturnal hypoxia. TRIAL REGISTRATION Clinicaltrials.gov: NCT04162743, 2019/11/10.
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Affiliation(s)
- Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chieh Yu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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Papadopoulos VP, Apergis N, Filippou DK. Nocturia in CPAP-Treated Obstructive Sleep Apnea Patients: a Systematic Review and Meta-Analysis. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2799-2807. [DOI: https:/doi.org/10.1007/s42399-020-00584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 08/30/2023]
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Celikhisar H, Dasdemir Ilkhan G. Comparison of clinical and polysomnographic characteristics in young and old patients with obstructive sleep apnea syndrome. Aging Male 2020; 23:1202-1209. [PMID: 32103694 DOI: 10.1080/13685538.2020.1730789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM This study aimed to determine the differences in the clinical, demographic and polysomnographic characteristics of OSAS between patients older than and younger than 65 years of age. METHODS Two groups of OSAS patients under 65 years of age and older who underwent PAP treatment in our sleep center were included in the study. Demographic, clinical, and polysomnographic variables of patients were compared as well as the PAP device usage compliance. RESULTS The study was conducted with 183 patients (81 females and 102 males) having the diagnosis of OSAS. The ages of the patients ranged from 37 to 85 years (mean: 58.77 ± 12.59). The incidence of apnea, chest pain, arrhythmia, headache, non-concentration, forgetfulness, psychiatric disorders, motor activity, enuresis, libido and impotence complaints as well as the sedative usage rates and incidence of additional diseases were higher in elderly patients. Apnea hypopnea index, inspiratory positive airway pressure, and expiratory positive airway pressure measurements were significantly higher in the elderly group. The rates of NREM2 (%) and NREM3 (%) were lower in elderly patients. CONCLUSION Many comorbid medical conditions, concomitant drug use, and age-related physiological changes in sleep architecture and circadian rhythm and their effects on sleep should be considered in the elderly sleep.
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Affiliation(s)
- Hakan Celikhisar
- Department of Chest Diseases, Izmir Metropolitan Municipality Hospital, Izmir, Turkey
| | - Gulay Dasdemir Ilkhan
- Okmeydani Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
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[Diagnostic and therapeutic approach to nocturia in Primary Care]. Semergen 2020; 46:487-496. [PMID: 32467014 DOI: 10.1016/j.semerg.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022]
Abstract
Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin.
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Haddad R, Denys P, Arlandis S, Giannantoni A, Del Popolo G, Panicker JN, De Ridder D, Pauwaert K, Van Kerrebroeck PE, Everaert K. Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature. Eur Urol Focus 2020; 6:922-934. [PMID: 32192920 DOI: 10.1016/j.euf.2020.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. OBJECTIVE To systematically review the literature about nocturia in neurological patients. EVIDENCE ACQUISITION Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. EVIDENCE SYNTHESIS A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. CONCLUSIONS Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. PATIENT SUMMARY In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
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Affiliation(s)
- Rebecca Haddad
- Urology Department, Ghent University Hospital, Ghent, Belgium.
| | - Pierre Denys
- Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Giulio Del Popolo
- Neuro-Urology & Spinal Unit Department, Careggi University Hospital, Firenze, Italy
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Dirk De Ridder
- Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - Kim Pauwaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
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Sharma A, Muresanu DF, Ozkizilcik A, Tian ZR, Lafuente JV, Manzhulo I, Mössler H, Sharma HS. Sleep deprivation exacerbates concussive head injury induced brain pathology: Neuroprotective effects of nanowired delivery of cerebrolysin with α-melanocyte-stimulating hormone. PROGRESS IN BRAIN RESEARCH 2019; 245:1-55. [DOI: 10.1016/bs.pbr.2019.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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