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PubMed2006

Nocturnal polyuria and nocturia relief in patients treated with solifenacin for overactive bladder symptoms.

The objectives of this study are to determine whether patients with overactive bladder (OAB) and nocturia achieved relief of their nighttime voiding symptoms when treated with solifenacin and whether having nocturnal polyuria (NP) affected that response. The patients pooled from four phase III clinical trials were evaluated for reductions in nocturia episodes after treatment with solifenacin (5 or 10 mg) or placebo. A second analysis was performed in patients with and without NP. The patients treated with solifenacin experienced statistically significant reductions in nocturia episodes; median reductions were -35.5% for 5 mg of solifenacin and -36.4% for 10 mg of solifenacin compared with -25.0% for placebo, and significantly more patients treated with solifenacin vs placebo achieved a mean nocturic frequency of <or=1 episode/night. Solifenacin significantly reduced nocturia episodes only in patients without NP (mean change was -0.61 episodes/night for both doses compared with -0.43 episodes for placebo). Solifenacin significantly improved nocturia symptoms only in OAB patients without NP.

Female↗
PubMed2007

Prevalence and impact of nocturia in a urogynecologic population.

To determine the prevalence of nocturia and associated bother among patients presenting to a tertiary urogynecology clinic and to describe patient characteristics related to nocturic frequency and associated bother. Chart review of sequential new patients presenting to our clinic between June 2004 and May 2005. We recorded patients' response to a question about their frequency of nocturia, the level of associated bother, demographic data, history of chronic medical illness and clinical urogynecologic diagnosis. Seven hundred sixty patients were of mean age 56 (19-95) years. Eighty-seven percent of patients voided at least once nightly, and 60% usually voided at least twice nightly. Forty one percent of patients reported bother >or=5/10 from nocturia. High bother rating was associated with increasing number of nocturic episodes (p < 0.0005) and mixed incontinence (p = 0.012). Nocturia is common and bothersome to women presenting for urogynecologic care. Concomitant mixed incontinence significantly increases bother arising from nocturia.

Adult↗
PubMed2006

Nocturia in adults: draft New Zealand guidelines for its assessment and management in primary care.

Nocturia is a common bothersome condition. An ad hoc group of interested clinicians from a variety of backgrounds has developed draft guidelines for the assessment and management of this condition in primary care in New Zealand. The guidelines propose four steps in the assessment and management: clinical evaluation; simple investigations; assignment of a provisional diagnosis; and management based on the provisional diagnosis. For nocturnal polyuria-associated nocturia, the draft guidelines recommend that: lifestyle measures should be used as part of the management; if a patient complaining of nocturia has other features of overactive bladder, then bladder retraining and/or anticholinergics can be used; hypnosedatives should not be used to treat nocturia in older adults because of the increased risk of falls; loop diuretics given in the afternoon should be considered for the treatment; and desmopressin can be considered in the management of nocturnal polyuria associated nocturia but that it should be used cautiously in people aged over 65 because of the risk of hyponatraemia. A draft algorithm based on international guidelines is presented.

Adolescent↗
PubMedDate not supplied

Nocturnal problems in postpolio syndrome: sleep apnea symptoms and nocturia.

Nocturia, generally accepted as an inevitable consequence of aging, is also a symptom of a potentially lethal condition--obstructive sleep apnea (OSA). The descriptive study reported in this article examined nocturia and sleep-related breathing problems in persons with postpolio syndrome (PPS) and tested the Sleep Disordered Breathing--Nocturia Model. This model describes the cascade of events that results in polyuria in persons with sleep-related breathing disorders. Data were analyzed with descriptive and inferential statistics. A 34-item questionnaire was published in the newsletter of a national polio support group, and the 584 respondents constituted a convenience sample. The results showed statistically significant associations between OSA symptoms, nocturia, poor sleep quality, daytime sleepiness, lower urinary tract symptoms, naps, and decreased self-rated health. Study limitations were the use of a convenience sample and possible self-selection of persons with more severe sleep and bladder problems. The results support the model and document how nocturia and sleep disturbances negatively impact persons with PPS.

Circadian Rhythm↗
PubMed2005

Nocturnal polyuria in women with overactive bladder symptoms and nocturia.

OBJECTIVE: This study was undertaken to determine the prevalence of nocturnal polyuria in women complaining of nocturia and overactive bladder (OAB) symptoms and to identify clinical and health characteristics associated with nocturnal polyuria. STUDY DESIGN: Women presenting to a urogynecology clinic with complaints of nocturia and OAB symptoms were asked to participate. They completed a health characteristic summary, 3-day voiding diary, Nordic sleep questionnaire, urinary distress inventory (UDI), and a nocturia distress visual log (NDVL). The 24-hour urine production, nighttime urine volume, and maximum bladder capacity were calculated from the bladder diary. Nocturnal polyuria was defined as production of greater than 33% of the 24-hour urine volume during an 8-hour sleep period. A histogram was performed to analyze at what age the prevalence of nocturnal polyuria increased. Women were then divided by presence or absence of nocturnal polyuria and compared by the health and clinical characteristics. RESULTS: Fifty-five women met the qualifications and participated in the study. Average age of the cohort was 65.8 +/- 13.5 years. The risk of nocturnal polyuria increased with age 65 years or older (prevalence for age 65-74 = 0.86 [0.62-1.00]) and with white race. On the basis of the mean population values for UDI, NDVL, sleepiness scores, and insomnia scores, all women were bothered by their nocturia. Median number of nighttime voids, 24-hour urine production, maximum bladder capacity, nocturnal index, UDI, NDVL, sleepiness scores, and insomnia scores did not differ, based on presence or absence of nocturnal polyuria. CONCLUSION: Among women complaining of nocturia and overactive bladder symptoms, age 65 years or older and white race appear to be risk factors for nocturnal polyuria.

Aged↗
PubMed2006

Nocturia in sleep-disordered breathing.

BACKGROUND AND PURPOSE: Nocturia is a common complaint in sleep-disordered breathing (SDB), but there is no study demonstrating the prevalence and frequency of nocturnal urination in a large number of SDB patients. To determine the prevalence and frequency of nocturnal urination among patients with SDB of different severities and to discover the factors related to nocturia. METHOD: A retrospective chart review was conducted among 1970 SDB patients. Nocturia was assessed using a standard questionnaire. Four groups of SDB patients were compared with regard to frequency of nocturnal urination and additional demographic, clinical, and polysomnographic (PSG) variables, by analysis of variance (ANOVA) with Tukey's honest significant difference (HSD) post-hoc comparisons. Partial correlation analysis was performed to detect the relationships between frequency of nocturnal urination and PSG and demographic variables. Logistic regression analysis was employed to examine the independent predictors of nocturia. RESULTS: Significant correlations were found between the frequency of nocturnal urination and mean age, body mass index (BMI), respiratory disturbance index (RDI), apnea-hypopnea index (AHI), respiratory effort index (REI) and lowest oxygen saturation. The frequency of nocturnal urination showed significant differences between four groups of individuals with SDB (P<0.001). Nocturnal urination of more than three episodes per night was reported significantly more by severe SDB patients (P<0.001). CONCLUSION: Age, BMI, hypertension (HT), AHI, and REI were found to be significantly associated with nocturia.

Body Mass Index↗
PubMed2002

Nocturnal polyuria versus overactive bladder in nocturia.

The purpose of this article is to review the current state of knowledge on contributions of nocturnal urine overproduction and overactive bladder to the syndrome of nocturia. We review the recent literature and current state of the art in differential diagnosis, pathophysiology, and classification of nocturia. We found that multiple pathologic factors may result in nocturia, including cardiovascular disease, diabetes mellitus or insipidus, third spacing of fluid, sleep apnea, lower urinary tract obstruction, primary sleep disorders, and behavioral and environmental factors. Thus, nocturia may be attributed to nocturnal polyuria (nocturnal urine overproduction), diminished nocturnal bladder capacity, or both. Distinction between these conditions is made by a simple arithmetic analysis of the 24-hour voiding diary. Understanding the manifold origins of nocturia will lead to rational treatment of specific contributing pathophysiologic factors.

Aged↗
PubMedDate not supplied

Nocturia: a problem that disrupts sleep and predicts obstructive sleep apnea.

Nocturia frequently is considered a benign problem that results from aging. Nocturia can result from poorly controlled diabetes, congestive heart failure, or urinary dysfunction. Also a symptom of obstructive sleep apnea (OSA), nocturia is a significant source of sleep disruption that may result in excessive daytime sleepiness. This article examines variables that contribute to nocturia, its effect on health, and the physiological mechanisms in OSA that evoke nocturia. Evaluation requires differentiation of the underlying causes that result in either increased frequency or increased nocturnal urine production, including symptoms of OSA.

Aged↗
PubMed1998

Circadian antidiuretic hormone variation in elderly men complaining of persistent nocturia after urinary flow obstruction removal.

Persistence of nocturia after prostatic resection in healthy patients without symptoms referred to residual bladder instability and to pathological polyuria seems to be caused by an increased urine production at night. The more accreditate mechanism involved is the relevant decreased ADH secretion pattern which occurs at night. In our study, patients with nocturnal poliuria showed significantly low plasmatic vasopressin levels compared with a control group. The aim of this study was to evaluate whether the persistence of nocturia after prostatic resection in healthy patients, without symptoms referred due to residual bladder instability and important polyuria, could be due to a decrease or a lack of increase in antidiuretic hormone (ADH) nocturnal levels following increased urine production at night. Serum ADH, atrial natriuretic peptide (ANP) and osmolality were assessed at 4-h intervals in 12 patients complaining of residual nocturia (group A) and in a control group of 13 patients who had undergone a complete resolution of nocturia after prostate ablation (group B). In the 25 patients involved in the study (mean age 65.8 years), no significant differences were observed in the two groups concerning mean age (67.5 years for group A, 64 years for group B). Mean nocturnal urine volume (1080 +/- 490 ml) in group A patients was significantly higher than in group B (500 +/- 100 ml) (p < 0.001), while no significant differences were found in diurnal diuresis. Mean plasma vasopressin levels of the 12 patients showing an increased nocturnal micturition were found to be significantly lower at all 4-h intervals when compared with the control group (p < 0.05). Individual fluctuations in serum osmolality were slight and insignificant within the normal range in all patients. The diurnal variation of plasma atrial natriuretic peptide was within the reference limits for all subjects during the 24-h period. Our results lead us to believe that residual nocturia after prostatic resection seems to be caused by an increased urine production at night due to a decreased ADH secretion pattern.

Aged↗
PubMed2005

Classification and distribution of symptomatic nocturia with special attention to duration of time in bed: a patient-based study.

OBJECTIVE: To classify the night-time urinary frequency of patients with symptomatic nocturia by urine volume produced, nocturnal bladder capacity and time spent in bed. PATIENTS, SUBJECTS AND METHODS: In all, 110 patients whose principal complaint was nocturia were enrolled in the study; 32 age- and gender-matched subjects were recruited as controls. From studies of the controls, 190 mL and 510 min were identified as the normal limits for mean nocturnal urine voided volume and time spent in bed. The 110 patients were classified into eight categories based on urine volume, nocturnal bladder capacity and time spent in bed. RESULTS: There were abnormalities of urine volume produced, bladder capacity and time spent in bed in 72%, 50% and 54% of the patients, respectively. Patients with severe nocturia (> or =4 voids/night) tended to have more complex pathophysiology than those with mild nocturia (< or =3 voids/night). CONCLUSION: Time spent in bed, urine volume produced and bladder capacity should be used to assess patients with symptomatic nocturia.

Aged↗
PubMed2005

Nocturia in relation to sleep, health, and medical treatment in the elderly.

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24-h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3-4% in those aged >or= 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.

Age Factors↗
PubMed2004

Sleep-disordered breathing and nocturia in older adults.

OBJECTIVES: To investigate the relationship between sleep-disordered breathing (SDB) and nocturia episodes in community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: Community. PARTICIPANTS: Community-dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia. MEASUREMENTS: Three-day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale. RESULTS: Fifty-eight of the 72 subjects completed the study. The mean age+/-standard deviation was 77.7+/-6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea-hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7+/-1.1, 1.6+/-0.9, and 2.6+/-1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI. CONCLUSION: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.

Aged↗
PubMed2005

Effects of behavioral and drug therapy on nocturia in older incontinent women.

OBJECTIVES: To examine changes in nocturia from a multicomponent behavioral training program or drug therapy in older women with urge or mixed (urge-predominant) urinary incontinence. DESIGN: A secondary analysis of data from a prospective, randomized clinical trial. SETTING: Parent trial was an outpatient research protocol in Alabama. PARTICIPANTS: One hundred ninety-seven women (aged 55-92) with incontinence and urodynamic evidence of bladder dysfunction. At baseline, 131 women (66% of participants) had nocturia. INTERVENTION: In the parent study, participants received behavioral training, including four sessions of biofeedback-assisted pelvic floor muscle exercises, drug treatment (oxybutynin IR titrated from 2.5 mg per day to 5.0 mg three times a day), or placebo. MEASUREMENTS: Participant-completed bladder diaries were used to calculate changes in nocturia. RESULTS: Behavioral training reduced nocturia by a median 0.50 episodes per night and was significantly more effective than drug treatment (median reduction=0.30 episodes; P=.02) and placebo (median reduction=0.00 episodes; P<.001). Also, drug treatment was more effective than control (P=.007). CONCLUSION: Both behavioral training and drug treatment reduced nocturia more than placebo, but behavioral training was the most effective.

Aged↗
PubMedDate not supplied

Gabapentin for overactive bladder and nocturia after anticholinergic failure.

INTRODUCTION: We reviewed our experience with the use of gabapentin to treat symptoms of overactive bladder (OAB) and nocturia in patients who have failed conventional anticholinergic therapy. METHODS: Thirty-one patients referred to us with refractory (OAB) and/or nocturia were treated with oral gabapentin. All the patients had tried or remained on antimuscarinic drugs during treatment. Twenty-four of 31 complained of bothersome symptoms during day and night and the other seven had primary complaints of nocturia. Initial gabapentin doses ranged from 100-300 mg at bedtime. Dose was slowly titrated up to 3,000 mg based on patients' symptomatology and tolerability. RESULTS: The mean age was 51 years old (range 27-78). There were 13 men and 18 women. The median steady state dose chosen by the patient after initial titration was 600 mg/day. Fourteen of 31 patients reported subjective improvement of their frequency and 8 have been on the medication for over 12 months with persistent efficacy. For the 14 improved patients, mean frequency/24 hours decreased from 14.1 +/- 2.2 to 10.0 +/- 2.1. Three patients with primary nocturia reported improvement from a mean of 4.0 +/- 1.3 to 1.0 +/- 0.3 episodes/night. Six patients stopped taking the drug within one month due to side effects mostly described as drowsiness or lethargy. CONCLUSIONS: Fourteen of 31 patients with refractory (OAB) and nocturia improved with oral gabapentin. Gabapentin was generally well tolerated and can be considered in selective patients when conventional modalities have failed.

Adult↗
PubMed1999

Treatment of nocturia in the elderly.

The aging process, behavioural habits and a multitude of pathological conditions are the main contributors to the development of nocturia in the elderly. Age-related physiological changes can alter the regular pattern of urine excretion and lead to increased nocturnal frequency of voiding. In addition, aging is associated with anatomical and physiological changes of the urinary tract itself that predispose to increased urinary frequency without affecting urine volume. Several urinary and extra-urinary tract conditions may have nocturia as a prominent symptom. These conditions can be grouped as those associated with bladder overactivity, bladder outlet obstruction, bladder hypotonicity and an increased urine volume. A detailed assessment that gathers clues from the medical history, physical examination and laboratory is of utmost importance in identifying the specific causes. Overactive bladder can be idiopathic or associated with different triggers such as UTI, bladder stones, bladder tumours and CNS diseases that disrupt the normal inhibitory signals to the bladder. It may be cured by the successful elimination of the trigger conditions. Therapeutic modalities include behavioural therapies with scheduled voiding, anticholinergic drugs and in women the use of transvaginal electrical stimulation. Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction in men. Different drug classes (e.g. peripheral alpha-adrenoceptor blockers and 5 alpha-reductase inhibitors) are now available for the treatment of mild to moderate symptoms. Surgery is reserved for patients with severe symptoms or with complications, with new and less invasive surgical techniques being preferred. Bladder hypotonicity is usually caused by peripheral neuropathies, spinal cord lesions and the indiscriminate use of drugs with anticholinergic actions. Treatment involves discontinuation of implicated drugs, short term use of cholinergic drugs and urinary catheterisation. Increased urine volumes and nocturia are frequently seen in hyperosmolar and oedematous states. Excessive ingestion of fluids, caffeinated or alcoholic beverages are habits that commonly produce nocturia. Although more definitive studies are awaited, low dose loop diuretics given a few hours prior to bedtime and desmopressin nasal spray or tablets may be useful alternatives for the control of nocturic symptoms in elderly patients with nocturnal polyuria syndrome. Whenever nocturia is present, clinicians should try to identify its causes by means of a thorough history, physical examination and pertinent complimentary tests. Once the specific cause or causes are found, most cases can be satisfactorily managed with behavioural, pharmacological or surgical therapies.

Aged↗
PubMed2005

Desmopressin: in adults with nocturia.

Desmopressin, a synthetic antidiuretic hormone analogue, is the only drug currently approved for the treatment of nocturia associated with nocturnal polyuria or multiple sclerosis (MS). Compared with vasopressin, desmopressin has a longer lasting and more potent antidiuretic effect and is devoid of vasopressor and uterotonic effects. In two large, randomised, double-blind phase III trials in adults with nocturia associated with nocturnal polyuria, 3 weeks of oral desmopressin therapy was significantly more effective than placebo in reducing the mean number of nocturnal voids and in normalising the rate of nocturnal urine production. Beneficial effects of desmopressin on nocturia were maintained and increased in patients completing 10 or 12 months of further treatment in a nonblind extension of short-term trials. In randomised, double-blind trials in MS patients with nocturia, nasal desmopressin reduced the mean number of nocturnal voiding episodes by 31-54%. In both patient populations, desmopressin increased the initial sleep period or mean maximum period of uninterrupted sleep by approximately 2 hours, an outcome significantly greater than that achieved with placebo. In trials of < or =6 weeks duration in adults with nocturia, desmopressin was generally well tolerated. Most desmopressin-related adverse events were transient and mild or moderate in severity. Clinically significant hyponatraemia was reported in approximately 5% and required withdrawal from studies in < or =3% of patients.

Adult↗
PubMed2003

Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women.

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women. STUDY DESIGN: Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks. RESULTS: In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug. CONCLUSION: Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Adult↗
PubMed2004

Degree of bother caused by nocturia in women.

AIMS: The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. MATERIALS AND METHODS: The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. RESULTS: Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). CONCLUSIONS: As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Adolescent↗