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PubMed2004

The risk of hyponatremia in older adults using desmopressin for nocturia: a systematic review and meta-analysis.

AIMS: To estimate the incidence of hyponatremia in older adults who use nasal or oral desmopressin to treat nocturia. MATERIALS AND METHODS: A systematic review and meta-analysis of cohort studies and randomised controlled trials of the use of nasal or oral desmopressin for older adults with nocturia. The incidence of hyponatremia was estimated by a random effects model for binomial data. RESULTS: Seventy-five papers were identified by the literature review of which 14 were reports of randomised trials or cohort studies. Seven studies reported the incidence of hyponatremia. The pooled estimate for the incidence of hyponatremia was 7.6% (95% CI 3.7-15.1). CONCLUSIONS: Hyponatremia is a relatively common adverse effect of the use of desmopressin for the treatment of nocturia and caution and regular monitoring should be part of the use of this management option for nocturia in older adults.

Administration, Intranasal↗
PubMed2004

Nocturia, nocturnal polyuria, and sleep quality in the elderly.

Nocturia is a common symptom in the elderly, which profoundly influences general health and quality of life. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g., fall injuries, are increased both at night and in the daytime in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, a reduced bladder capacity, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. In the nocturnal polyuria syndrome (NPS), the 24-h diuresis is normal or only slightly increased, while there is a shift in diuresis from daytime to night. NPS is caused by a disturbance of the vasopressin system, with a lack of nocturnal increase in plasma vasopressin or, in some cases, no detectable levels of the hormone at any time of the 24-h period. The calculated prevalence of NPS is about 3% in an elderly population, with no gender difference. In NPS, there are serious sleep disturbances, partly due to the need to get up for micturition, but there is also increased difficulty in falling asleep after nocturnal awakenings and increased sleepiness in the morning. The treatment of NPS may include avoidance of excessive fluid intake, use of diuretics medication in the afternoon rather than the morning, and desmopressin orally at bedtime.

Aged↗
PubMed2006

Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea.

OBJECTIVES: To examine whether treatment with continuous positive airway pressure (CPAP) reduces nocturia in patients with obstructive sleep apnea (OSA). METHODS: This prospective clinical study recruited patients referred to the Rambam Sleep Laboratory with suspected OSA. After polysomnography, those found to have no OSA were excluded from the study, and the remainder were treated with CPAP. Nocturia was assessed at four time points: baseline (average number of awakenings to urinate per night during 1 week at home before polysomnography); diagnostic night in the laboratory; CPAP titration in the laboratory; and after 1 to 3 months of stable CPAP treatment at home (average number of awakenings to urinate per night for 1 week). RESULTS: Ninety-seven patients (75 men and 22 women) completed the study. The mean +/- SD age was 55 +/- 12 years, body mass index was 33 +/- 7 kg/m2, and respiratory disturbance index was 34 +/- 24/hr. The mean number of awakenings to void at home before CPAP was 2.5 +/- 2.4 times/night; during CPAP, it was 0.7 +/- 0.6 time/night (P < 0.001). A total of 73 patients reported improvement in nocturia. The mean number of awakenings to void in the laboratory was 1.1 +/- 0.9 before CPAP, with a decrease to 0.5 +/- 0.6 during CPAP (P < 0.001). Weak, but significant, correlations were found in the number of awakenings to void before treatment with the respiratory disturbance index (r = 0.25, P = 0.01) and with minimal oxygen saturation (r = -0.23, P = 0.02). CONCLUSIONS: CPAP appears to be an effective treatment for nocturia associated with OSA.

Adult↗
PubMed2000

Nocturia in the adult: classification on the basis of largest voided volume and nocturnal urine production.

PURPOSE: We propose a criterion to clarify the underlying etiologies of nocturia. MATERIALS AND METHODS: Frequency-volume charts were recorded for 24 hours by 35 men and 32 women who were subjectively free of lower urinary tract symptoms and had no evidence of voiding disorders. At least 5 subjects were included in each of 5 age groups of 20 to 49, 50 to 59, 60 to 69, 70 to 79, 80 to 89 years for both genders. The charts were used to make a tentative criterion, which was validated in 39 elderly individuals with nocturnal frequency. RESULTS: Correlation and regression analyses indicated that the quotients of nocturnal urine output divided by body weight (U(N)/BW) and largest voided volume divided by body weight (V(L)/BW) were useful classification factors. Cutoffs, which were set close to worst quartiles, were 10 ml./kg. for U(N)/BW and 4 ml./kg. for V(L)/BW, respectively. Correction by body weight made the same criterion applicable irrespective of weight. Symptomatic elderly patients were classified into 3 mutually exclusive groups of nocturnal polyuria (U(N)/BW greater than 10 ml./kg.), low bladder capacity (V(L)/BW less than 4 ml./kg.) and combined nocturia. Of 20 subjects who voided 2 times a night 11 (55%) were classified as having nocturnal polyuria and 15 of 19 who voided 3 or 4 times (79%) were classified as having low bladder capacity or combined nocturia. CONCLUSIONS: The criterion provides a reasonable distinction of etiologies of nocturia, and may be usefulness in examination and treatment.

Adult↗
PubMed2002

Efficacy of desmopressin in treatment of refractory nocturia in patients older than 65 years.

OBJECTIVES: To evaluate the efficacy of desmopressin treatment in patients 65 years old and older with nocturia and to determine whether baseline urodynamic characteristics influenced the outcome of treatment. METHODS: Patients with nocturia three or more times a night and nocturnal polyuria refractory to medication were treated with oral desmopressin 0.1 mg at bedtime for 4 weeks. Data from urodynamic studies and a voiding diary, nocturnal urine volume, urine specific gravity, serum sodium and potassium level, and quality of life index were measured at baseline, 4 weeks, and 4 weeks after discontinuation of treatment. RESULTS: A total of 30 patients (25 men and 5 women) were enrolled in the study. The mean age was 75.4 +/- 6.6 years. Five patients (16.7%) reported side effects, including hyponatremia in one. Twenty patients (66.7%) reported a good response with both reduced nocturnal frequency (5.2 +/- 1.16 times versus 2.24 +/- 1.12 times a night, P = 0.000) and urine volume (955.6 +/- 255.9 mL versus 522.8 +/- 210.5 mL, P <0.0001). Two patients (6.7%) had improved nocturnal frequency, and 3 patients (10%) reported no effect at all. After discontinuing the medication for 4 weeks, 13 patients (52%) had improved symptoms compared with baseline and 6 (24%) remained at their post-treatment frequency of nocturia. Urodynamic studies revealed that 15 patients had detrusor instability and 17 had a cystometric capacity of 250 mL or less. No significant difference was found in the success rate relative to the urodynamic results. CONCLUSIONS: Desmopressin is safe and effective in the treatment of severe nocturia in patients 65 years old and older.

Administration, Oral↗
PubMed2003

Nocturia and associated morbidity in a community-dwelling elderly population.

OBJECTIVE: To investigate the association between nocturia and selected concomitant diseases and medications in a community-dwelling elderly population. SUBJECTS AND METHODS: Data were obtained with a validated questionnaire mailed to all inhabitants aged >or= 65 years in Tierp, Sweden. Descriptive statistics on age, gender, concomitant diseases and medications were calculated for non-nocturics (subjects reporting a mean of < 1 void/night), intermediate (reporting a mean of 1-2 voids/night) and nocturics (reporting a mean of >or= 2 voids/night). Correlations between the number of nocturnal voids/week and concomitant diseases/medications were investigated with logistic regression, controlling for age and gender. RESULTS: Of the 4264 questionnaires sent, 67% (2866) were returned, of which 73% (2081) were fully evaluable on nocturia and incorporated in the analysis. Of these, 62% reported >or= 1 void/night and 29%>or= 2 voids/night. The median (range) age of the respondents was 74 (65-99) years. The prevalence of nocturia increased with age and men reported more nocturia than women. The nocturic group had the highest percentage of reported disease and medication on each question. In the logistic regression, controlling for age and gender, there was no significant correlation between the number of nocturnal voids and hypertension, angina pectoris or diabetes mellitus, nor with treatment of these diseases. Neither was there any correlation for congestive heart failure, snoring, use of diuretics or hypnotics. There were highly statistically significant correlations (P < 0.001) between the increase in number of nocturnal voids and incontinence, daytime urge and nocturnal thirst. The increase in number of nocturnal voids was negatively correlated with good sleep and with feeling in good health (P < 0.001). CONCLUSION: There was no correlation between the number of nocturnal voids and a known and treated hypertension, angina pectoris, congestive heart failure or diabetes mellitus. The number of nocturnal voids was highly correlated with urge and incontinence.

Age Distribution↗
PubMed2005

Incidence of nocturnal enuresis and nocturia in children with tuberculosis.

Nocturnal enuresis is a common problem and occurs in 15 to 20 percent of 5-year-old children. The etiology of nocturnal enuresis remains unknown and is probably multifactorial. In this study 52 children aged between 6-17 years with tuberculosis were questioned for nocturia and nocturnal enuresis, retrospectively. Nocturnal, enuresis was found in 12 (23%) and nocturia in 22 (42%) of the children, respectively. After specific treatment with antituberculosis drugs nocturnal enuresis and nocturia were improved in 5 and 21 children, respectively. However, it could not be explained why these disorders were much higher in children with tuberculosis than healthy children. The findings suggest that nocturnal enuresis and nocturia may be in a high frequency in children with tuberculosis; however, the authors think that prospective and more extensive studies should be performed to clarify these preliminary findings.

Adolescent↗
PubMed2005

Effectiveness of an anti-inflammatory drug, loxoprofen, for patients with nocturia.

AIM: There is increasing evidence that non-steroidal anti-inflammatory drugs are effective for the treatment of nocturia. In this study, we attempted to investigate the role of loxoprofen sodium (loxoprofen) in the therapeutic management of patients with nocturia. METHODS: Fifteen benign protastatic hyperplasia and/or overactive bladder patients (13 males and 2 females, 71.1 +/- 1.5 years old) with three or more voids per night were involved. These patients had received standard drug therapy. Although these patients had received standard drug therapy for more than half a year, they had still three or more episodes of nocturia. The patients took a single dose of 60 mg of loxoprofen at night prior to sleep. Before and 1 week after the initiation of this therapy, the effects of this treatment were assessed by frequency volume chart and a questionnaire. RESULTS: In the questionnaire, seven patients answered as excellent, six patients demonstrated improvement of their symptoms, two patients did not show a significant change in their symptoms and no patients demonstrated a deterioration in the symptoms. In frequency volume chart, total void per day, total void per night, total urine volume per day, total night urine volume per day and single voided volume in the night before and after this treatment were 9.97 +/- 0.81 and 8.99 +/- 0.74 per day, 3.82 +/- 0.25 and 1.82 +/- 0.27 per night, 1349 +/- 81 and 1258 +/- 91 mL per day, 567 +/- 46 and 325 +/- 51 mL per night, and 143 +/- 13 and 149 +/- 10 mL, respectively. CONCLUSION: Loxoprofen can be effective and useful for patients with nocturia. Our data suggest that the main mechanism of this effect is to decrease urine production during a night's sleep.

Aged↗
PubMed1988

Prophylactic treatment of adult nocturia with bumetanide.

The efficacy of 1 mg bumetanide on nocturia was compared with placebo in a randomised double-blind cross-over study in general practice. Twenty-eight patients, 13 females and 15 males, completed two treatment periods of 2 weeks' duration. During the placebo period the weekly number of nocturia episodes was 13.8 and during bumetanide treatment the number was reduced by 3.8. Ten males had a history of prostatic hypertrophy and in these patients treatment with bumetanide was not beneficial. In the remaining 18 patients the weekly number of nocturia episodes was reduced by 4 during bumetanide treatment compared with the placebo period. Of these patients, 3 preferred treatment with placebo, 11 preferred bumetanide and 4 gave no preference. These results suggest that bumetanide offers an alternative in the treatment of adult nocturia not connected with enlargement of the prostate.

Aged↗
PubMed2004

Antidiuretic hormone in elderly male patients with severe nocturia: a circadian study.

OBJECTIVE: To investigate the circadian variation of plasma antidiuretic hormone (ADH) and urine output in patients with severe nocturia (> three times per night) and to assess the effect of oral desmopressin on nocturnal urine output in these patients. PATIENTS AND METHODS: Twelve patients with severe nocturia and five age-matched controls without were assessed over 24 h (circadian sampling) during a 72-h hospital admission. Blood levels of ADH and changes of urine output were measured in the patients before and after the oral administration of desmopressin (0.2 mg, at 22.00 hours in the second day), and in the controls not treated with desmopressin. RESULTS: Compared with the normal control, the patients had no diurnal variation in urine output and greater nocturnal urine production, associated with a lack of nocturnal increase in ADH level. Compared with the baseline urine output, desmopressin significantly decreased night-time (23.00-08.00 hour) urine output in the patients (P < 0.05). Desmopressin significantly increased the osmolality of night-time urine (P < 0.05), and there was no systemic adverse reaction. CONCLUSIONS: Severe nocturia in a large proportion of elderly men with lower urinary tract symptoms is caused by nocturnal polyuria and natriuresis, because they have no nocturnal increase in ADH. These results suggest that desmopressin may be effective in decreasing nocturnal urine production in patients with severe nocturia who do not respond to conventional treatment.

Aged↗
PubMed1997

A population study of urinary incontinence and nocturia among women aged 20-59 years. Prevalence, well-being and wish for treatment.

BACKGROUND: The aim was to study urinary incontinence (UI) and nocturia in a female population; prevalence, effect on well-being, wish for treatment and result of treatment in primary health care. METHODS: A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor. RESULTS: Of the included 641 women, 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%), 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type. CONCLUSIONS: Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it, only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.

Adult↗
PubMed1993

[The effect of desmopressin (DDAVP) in patients complaining of nocturia].

The mechanism of increased nocturnal urine production in adult patients complaining of nocturia has seldom been reported. The objective of this clinical study is to investigate the circadian rhythm of both urine production and plasma arginine-vasopressin (AVP) level, and the efficacy of intranasal instillation of 1-deamino-8-D-arginine-vasopressin (DDAVP) in adult patients complaining of nocturia. Eight patients (seven men, one woman) who ranged in age from 44 to 77 years (mean 64.1 years) were examined. Three of them suffered from Shy-Drager syndrome, and no patient had shown any improvement of symptoms in spite of administration of anti-cholinergic agents and restriction of water intake. Nocturnal urine volume was more than bladder capacity in all patients, and no patient showed normal elevation of nocturnal plasma AVP level. Intranasal administration of DDAVP of 5 or 10 micrograms revealed marked decrease in nocturia, and nocturnal urine volume (p < 0.01). There were mild side effects (headache, nasal obstruction, and hyponatremia) not requiring any treatment. In conclusion, DDAVP is a safe and effective treatment for adult patients complaining of nocturia due to hyperproduction of nocturnal urine and inappropriate nocturnal secretion of AVP.

Administration, Intranasal↗
PubMed2000

Sleep apnea symptoms, nocturia, and diabetes in African-American community dwelling older adults.

The primary aim of this exploratory study was to examine the association between obstructive sleep apnea (OSA) symptoms, nocturia and diabetes in African-American community-dwelling older adults. A pencil and paper survey was used to collect symptoms of OSA, nocturia, excessive daytime sleepiness (EDS), lower urinary tract symptoms (LUT), and self-rated health. The convenience sample of community dwelling African-Americans (n = 87) included a majority of women (61%) and obese persons (60% with BMI > 30). The mean age was 64 years (range 50-91), and 40% were self reported Type 2 diabetics. Diabetics had significantly more OSA symptoms, more nocturia, and decreased self-rated health. Results of a stepwise logistic regression showed that persons with diabetes and those who reported EDS experienced significant three to four-fold risks for OSA. Similarly, diabetics, women, persons with LUT symptoms and those reporting EDS, had significant three to six-fold risks for nocturia > or = 2/night.

Age Distribution↗
PubMed2002

[Nocturia and nocturnal polyuria in the elderly. Treatment essential for increasing patients' quality of life and decreasing the risk of injury].

Nocturia, i.e. nocturnal voiding episodes, is a symptom which can occur at all ages, but there is an age-related increase in both men and women. Both health and quality of life are deteriorated by nocturia. Sleep is disturbed, with daytime sleepiness and reduced well-being as consequences. The risk of fall injuries is increased among elderly persons who need to get up several times at night for toilet visits. Nocturia is associated with an increase in nocturnal urine output, and an increased number of nocturnal voids indicates a shift of urine output from the daytime to the night. One of the aims of the treatment of nocturia is therefore to normalise the circadian rhythm of diuresis.

Aged↗
PubMed2005

[Efficacy of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria].

Older adults often cite nocturia as one of the most bothersome lower urinary tract symptoms (LUTS). We investigated the efficacy and safety of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria on 12 patients (ten men, two women) ranging in age from 53 to 77 years (mean 67 years). All patients experienced more than two episodes of nocturia per night, and had a nocturnal urine volume greater than 35% of the daily voided volume, measured using a 3-day voiding diary with a frequency-volume chart. They began taking intranasal desmopressin (10 microg) at bedtime. When compared with the baseline data, the nocturnal urine volume, (928 +/- 307 versus 469 +/- 251 ml, p = 0.0007) and nocturnal frequency (4.8 +/- 2.0 versus 2.8 +/- 1.8, p = 0.0009) were significantly decreased. The daytime urine volume (1,008 +/- 458 versus 930 +/- 419 ml, p = 0.49) did not change significantly. The unine osmolarity (420 +/- 143 versus 598 +/- 158 mOsm/kg, p = 0.0065), and urine sodium levels (100 +/- 32 versus 140 +/- 60 mEq/l, p = 0.007) increased significantly, whereas the serum sodium levels (141 +/- 3 versus 135 +/- 7 mEq/l, p = 0.048) decreased significantly. Among the 12 patients, 5 (41.6%) patients reported side effects, including headache in 1, edema in 1 and hyponatremia in 3. The patient with edema discontinued medication, but the other 4 patients continued their medication and the side effects subsided. In conclusion, desmopressin is an effective treatment for adult patients complaining of nocturia due to nocturnal polyuria. One should be aware of the potential side effects including hyponatremia.

Administration, Intranasal↗
PubMed2006

Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia.

AIMS: To explore the incidence, severity, time course, and risk factors of clinically significant hyponatremia in desmopressin treatment for nocturia. METHODS: Data from three multi-center phase III trials were pooled. Hyponatremia was categorised as borderline (134-130 mmol/L) or significant (<130 mmol/L). Risk factors were explored with logistic regression and subgroup analysis performed to explore threshold values for contra-indication. RESULTS: In total 632 patients (344 men, 288 women) were analyzed. During dose-titration, serum sodium concentration below normal range was recorded in 95 patients (15%) and 31 patients (4.9%) experienced significant hyponatremia. The risk increased with age, lower serum sodium concentration at baseline, higher basal 24-hr urine volume per bodyweight and weight gain at time of minimum serum sodium concentration. Age was the best single predictor. Elderly patients (>or=65 years of age) with a baseline serum sodium concentration below normal range were at high risk (75%). Limiting treatment in elderly with normal basal serum sodium concentration to those below 79 years and with a 24-hr urine output below 28 ml/kg would reduce the risk from 8.1% to 3.0% at the cost of 34% fulfilling the contra-indication. CONCLUSIONS: The majority of nocturia patients tolerate desmopressin treatment without clinically significant hyponatremia. However, the risk increases with increasing age and decreasing baseline serum sodium concentration. Treatment of nocturia in elderly patients with desmopressin should only be undertaken together with careful monitoring of the serum sodium concentration. Patients with a baseline serum sodium concentration below normal range should not be treated.

Adult↗
PubMed2005

Hyponatremia in elderly patients treated with desmopressin for nocturia: a review of a case series.

OBJECTIVE: Lately, desmopressin (dDAVP) administered orally has been demonstrated to be an effective alternative in the management of nocturia in adults. Although the safety profile of dDAVP is well known, much of the experience originates from studies in enuretic children and younger adults, and it may not be readily extrapolated to elderly patients. In order to identify factors associated with an increased risk of hyponatremia in elderly patients treated with dDAVP for nocturia, we analysed spontaneous reports accrued from clinical practice in Denmark and Sweden. METHOD: Following a selection procedure, the study base comprised 15 case reports. From the included reports, information was sought on concurrent diseases, concomitant medications and other factors that may predispose elderly patients to hyponatremia when treated with desmopressin. RESULTS: The median age amongst the cases was 81 years (range 61-93 years) and 80% were females. For seven of the patients, the hyponatremia occurred during the first 3 weeks of treatment. The symptoms presented by the patients led to hospitalisation in all but one case. Among patients with information available on concomitant medication, half of them were treated with cyclooxygenase inhibitors. An excessive fluid intake could only be ascertained in one case; all 15 patients eventually recovered. CONCLUSION: In elderly patients treated with dDAVP for nocturia, an increased risk of hyponatremia exists in the first weeks of treatment. Compared with younger subjects, risk factors other than excessive intake of fluid appear to contribute to this adverse drug reaction.

Age Factors↗
PubMed2005

Oral dryness, nocturia and the menopause.

OBJECTIVE: To analyse the relationship between oral dryness (OD), nocturia, the menopausal transition and some medical conditions and medications in women. METHODS: A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about occurrence of somatic diseases and symptoms, nocturia, nocturnal thirst and drinking, and the use of drugs. RESULTS: The occurrence of oral dryness was 17.8% in women before the menopause, 23.3% during the first 5 years after, 29.2% 5-9 years after and 34.5% 10 or more years after the menopause (P < 0.0001). In a multiple logistic regression analysis independent correlates for oral dryness were: nocturnal micturition, one episode versus none 1.7 (1.4-2.1); two versus none 2.4 (1.7-3.2); > or = 3 versus none 3.3 (2.1-5.2); menopausal state: <5 years after the menopause versus before 1.2 (0.9-1.6); 5-9 years after the menopause versus before 1.6 (1.2-2.1); > or = 10 years after the menopause versus before 1.7 (1.3-2.2); musculo-skeletal pain 1.6 (1.3-2.1) being on one or more prescribed drugs 1.8 (1.5-2.1). CONCLUSION: The present data show that OR is a common and disregarded symptom in women with nocturia independent of menopausal state, musculo-skeletal symptoms and medication with analgesics, diuretics, hypnotics and hormonal replacement therapy (HRT).

Adult↗