Urology

The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study

Shao IH, Wu CC, Hsu HS, Chang SC, Wang HH, Chuang HC, Tam YY. Clin Interv Aging 2016; 11: 879–885

Nocturia and sleep in patients with LUTS

Few studies have investigated the effect of nocturia on sleep quality and daytime functioning specifically in patients with lower urinary tract symptoms (LUTS).1 A recent study in China published in Clinical Interventions in Aging found patients with LUTS and nocturia experienced poor sleep quality.1

In the cross-sectional survey, Shao and colleagues investigated the effect of nocturia on sleep quality and daytime sleepiness.1 The study included 728 patients who presented to the Urology Department of the Lotung Poh-Ai Hospital in Taiwan with LUTS and at least one episode of nocturia per night, between 1^st March and 31^st December 2015.1 The patients had a mean age of 61.4±13.7 years and a male-to-female ratio of 2.7.1

In order to assess the effect of nocturia on sleep quality and daytime dysfunction, the investigators administered three surveys in face-to-face interviews prior to treatment for LUTS:1

• Pittsburgh Sleep Quality Index (PSQI)
• Epworth Sleepiness Scale (ESS)
• International Prostate Symptoms Score (IPSS).

The surveys assessed sleep quality, daytime sleepiness, and voiding problems, respectively.1 In addition, information on number of voids per night (nocturia episodes), age, sex, weight, height and body mass index was also collected.1

Results

The investigators found the mean number of nocturia episodes was 3.03 per night.1  101 (13.9%) patients reported one nocturia episode, 188 (25.8%) patients report two episodes, 170 (23.4%) patients reported three episodes, 124 (17%) patients reported four episodes, and almost one fifth of patients (145, 19.9%) reported nocturia five or more times per night.1

Results of a multivariate analysis using PSQI as the dependent variable revealed PSQI was significantly associated with the number of nocturia episodes per night and ESS score.1

Overall, the number of nocturia episodes increased with age and was significantly associated with sleep quality and daytime dysfunction.1

Subgroup analyses

The investigators also examined age- and sex-related differences.1 They found PSQI scores were higher in females than males.1 Females with LUTS reported worse sleep quality and a higher rate of sleeping pill use than men; however, they had comparable nocturia episodes and levels of daytime dysfunction.1

In addition, using Pearson’s correlation test, the researchers observed a significant correlation between number of nocturia episodes and daytime dysfunction in men, and between nocturia episodes and age <65.1

However, compared with patients <65 years of age, patients ≥65 years of age had more nocturia episodes, worse PSQI scores, worse IPSS scores and worse voiding-related quality of life; however, and notably, daytime dysfunction was comparable.1

Severity of nocturia increased with age in people with LUTS.1

The investigators also found that in the subgroups of patients ≥65/<65 years of age, and males/females, severity of nocturia was associated with higher PSQI total scores.1

Conclusions

The investigators concluded that the number of voids per night increased with age, and was significantly correlated with poor sleep quality.1 The results also indicated that nocturia plays an important role in daytime dysfunction in people under the age of 65, which should not be overlooked.1

The effect of nocturia on daytime dysfunction in people <65 years of age is also noteworthy.1

Whilst the researchers did not find a significant correlation between daytime sleepiness scores and nocturia episodes in patients ≥65 years of age, they proposed that the effect may have gone unnoticed.1 Daytime dysfunction is more apparent in employed people who require greater concentration and focus, whereas the population ≥65 years of age were retired from active work and did not need these abilities.1

They suggested that future prospective studies should include more accurate non-subjective measures of sleep quality, such as actigraphy and polysomnography.1

Report on: The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study. Shao IH, Wu CC, Hsu HS, Chang SC, Wang HH, Chuang HC, Tam YY. Clin Interv Aging 2016; 11: 879–885.