Clinical review
The effect of nocturia on sleep

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Summary

Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant ‘bother’. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

Introduction

The importance of good sleep has only begun to be understood. It has been known for many years that a good night's sleep is important, with 7–8 h endorsed for adults. New data reinforce the increased risks associated with insufficient sleep. In a series of studies by Stone and associates in older men and women,1, 2, 3, 4, 5 less sleep at night and lower sleep efficiency (defined as the amount of sleep given the amount of time in bed) were both associated with increased risk of poor physical function, decreased cognitive function, falls and mortality. There are many reasons why sleep can be disrupted or shortened at night, including primary sleep disorders, changes in circadian rhythms, or just not spending enough time in bed. In addition, both exogenous and endogenous factors can disrupt sleep, such as too much light or noise in the bedroom. The sensation of a full bladder may also cause awakening and ultimately lead to the conscious decision to get out of bed to go to the bathroom; when this happens multiple times during the night, it is defined as nocturia.

Section snippets

What is ‘disturbed sleep’?

Disturbed sleep can mean many things but it is often equated with insomnia, which is clinically defined as persistent difficulty in initiating or maintaining sleep, or non-restorative sleep, that causes significant daytime distress and impaired social or occupational functioning.6 Insomnia affects around 15% of adults and is among the most prevalent chronic disorder in the general population.7 Three types of insomnia have been characterized: sleep onset insomnia (difficulty falling asleep),

Insomnia co-morbid with nocturia

Disturbed sleep, or insomnia, is often co-morbid with nocturia, i.e., the sensation of a full bladder leading to the need to get up to urinate at night.*10, *11 Three-quarters of participants in a survey of US residents aged 18 years or over cited the need to go to the bathroom as the most frequent reason for nocturnal awakenings.8 Indeed, going to the toilet was the primary reason for night-time awakening across all age groups, and the proportion affected increased with age: 39.9% in those

Quality of life

Chronic lack of sleep can have a great impact on ability to function. Sleep disturbances which result in sleep deprivation can also exact an immense personal toll, as evidenced by the adverse impact of disturbed sleep on physical and emotional health as well as overall quality of life (QoL). Sleep disruption among insomnia sufferers has been associated with impairments in daytime functioning and cognition, and with increased medical illnesses, hospitalizations and work absences due to sickness.7

Clinical evaluation of nocturia

Nocturia is multifactorial and can be associated with serious medical conditions such as diabetes mellitus, diabetes insipidus and congestive heart failure. Once such underlying illnesses have been excluded through thorough history-taking and patient evaluation, other possible contributory factors need to be explored. A fundamental issue in most patients is that the amount of urine produced overnight exceeds the capacity of the bladder. This may be due to an overproduction of urine (nocturnal

Treatment of nocturia

Before entering into discussion of available therapies for nocturia and their effect on subsequent sleep, it should first be highlighted that the question of which sleep endpoints are most relevant is as yet unresolved. Efficacy in nocturia trials is generally reported as the reduction in number of voids per night, or percentage reduction in voids per night, and QoL studies indicate that those people with fewer than two voids/night experience minimal impact on their daytime functioning.*15, 21

Conclusions

Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that poor sleep quality is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the primary causes of sleep disturbance and has been shown to impair functioning, QoL, health and productivity, with those experiencing two or more voids per night reporting significant ‘bother’. Many urologists have

Conflict of interest

Sonia Ancoli-Israel, Ph.D: Consultant/Scientific Advisory Board: Ferring Pharmaceuticals Inc., GlaxoSmithKline, Merck, Orphagen Pharmaceuticals, Pfizer, Philips-Respironics, sanofi-aventis, Schering-Plough. Grants/Contracts: Litebook, Inc.

Donald L. Bliwise, PhD: Consultant, New England Research Institute.

Jens Peter Nørgaard MD DMSC: Full time employee at Ferring Pharmaceuticals in Copenhagen, Denmark. Ferring is the manufacturer of several desmopressin formulations (rhinyle, spray, tablets and

References* (62)

  • H. Nakagawa et al.

    Association between nocturia and mortality in a community-dwelling elderly population aged 70 years and over: results of a 3-year prospective cohort study in Japan

    J Urol

    (2009)
  • D. Margel et al.

    Predictors of nocturia quality of life before and shortly after prostatectomy

    Urology

    (2007 Sep)
  • B. Djavan et al.

    The impact of tamsulosin oral controlled absorption system (OCAS) on nocturia and the quality of sleep

    Eur Urol Suppl

    (2005)
  • P.E. van Kerrebroeck et al.

    Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study

    Eur Urol

    (2007 Jul)
  • A.J. Wein

    How much is enough and who says so? The case of the King's Health Questionnaire and overactive bladder

    J Urol

    (2005 Mar)
  • J. Weiss

    Prevalence of nocturnal polyuria in nocturia

    J Urol

    (2009)
  • D. Margel et al.

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

    Urology

    (2006 May)
  • M.P. FitzGerald et al.

    Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment

    Am J Obstet Gynecol

    (2006 May)
  • G. Lose et al.

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

    Am J Obstet Gynecol

    (2003 Oct)
  • G. Lose et al.

    Clinical experiences with desmopressin for long-term treatment of nocturia

    J Urol

    (2004 Sep)
  • K.L. Stone et al.

    Sleep, insomnia and falls in elderly patients

    Sleep Med

    (2008 Sep)
  • T. Holm-Larsen et al.

    Desmopressin is more cost effective than behavioural treatment in adults suffering from nocturia when applying a societal perspective

    J Urol

    (2008)
  • T. Blackwell et al.

    Poor sleep is associated with impaired cognitive function in older women: the study of osteoporotic fractures

    J Gerontol A Biol Sci Med Sci

    (2006 Apr)
  • K.L. Stone et al.

    Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures

    J Am Geriatr Soc

    (2006 Aug)
  • T.T. Dam et al.

    Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study

    J Am Geriatr Soc

    (2008 Sep)
  • K.L. Stone et al.

    Actigraphy-measured sleep characteristics and risk of falls in older women

    Arch Intern Med

    (2008 Sep 8)
  • K.L. Stone et al.

    Self-reported sleep and nap habits and risk of mortality in a large cohort of older women

    J Am Geriatr Soc

    (2009 Apr)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders – text revision

    (2000)
  • L. Culpepper

    Secondary insomnia in the primary care setting: review of diagnosis, treatment, and management

    Curr Med Res Opin

    (2006 Jul)
  • National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13–15, 2005

    Sleep

    (2005 Sep 1)
  • D.L. Bliwise et al.

    Nocturia and disturbed sleep in the elderly

    Sleep Med

    (2008 Aug 12)
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