Korean J Urol.  2010 Nov;51(11):757-762.

Correlation between Nocturia and Sleep: A Questionnaire Based Analysis

• Yoo SS
• Shim BS
• Lee DH
• Lee HW
• Yoon H

Abstract

PURPOSE
This study evaluated the effectiveness and quality of sleep (QoS) in adult patients with nocturnal lower urinary tract symptoms (LUTS) including nocturia and nocturnal polyuria.
MATERIALS AND METHODS
A total of 102 patients with nocturia and daytime LUTS were enrolled in this study. All patients completed a questionnaire that included the International Prostate Symptom Score (IPSS), quality of life score (QoL), overactive bladder questionnaire (OABq), and a sleepiness index. The sleepiness index was measured with the Korean Beck Depression Inventory (K-BDI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), and the International Restless Legs Syndrome Study Group (IRLSSG). Statistical analyses included the Student's t-test and chi-square test. Differences were considered significant at a p-value of less than 0.05.
RESULTS
Nocturia during sleep was experienced by 68 (66.7%) out of 102 patients. There was no significant association between the nocturia- and the sleep-related scales, but with multiple regression analysis for sex and age, the K-BDI score (p=0.05), IPSS score (p=0.05), and OABq (p=0.02) were significantly higher in patients who woke up to void during sleep. A total of 57 (55.9%) patients diagnosed with overactive bladder with nocturia had severe daytime sleepiness on the ESS questionnaire (p=0.019) and more urgency symptoms on the IPSS questionnaire (p=0.007).
CONCLUSIONS
Patients with nocturia had a greater risk of being depressive and felt sleepier during the daytime. LUTS including nocturia and sleep quality closely affected each other. Therefore, clinicians should consider patients' LUTS and sleep problems or QoS as well to provide more satisfying outcomes.

Keyword

Nocturia; Quality of life; Sleep disorders

MeSH Terms

Adult
Berlin
Depression
Humans
Lower Urinary Tract Symptoms
Nocturia
Polyuria
Prostate
Quality of Life
Restless Legs Syndrome
Sleep Wake Disorders
Sleep Initiation and Maintenance Disorders
Urinary Bladder, Overactive
Weights and Measures

Reference

1. Stewart RB, Moore MT, May FE, Marks RG, Hale WE. Nocturia: a risk factor for falls in the elderly. J Am Geriatr Soc. 1992. 40:1217–1220.

2. Hilton P, Stanton SL. The use of desmopression (DDAVP) in nocturnal urinary frequency in the female. Br J Urol. 1982. 54:252–255.

3. Tikkinen JA, Tammela TL, Huhtala H, Auvinen A. Is nocturia equally common among men and women? A population based study in Finland. J Urol. 2006. 175:596–600.

4. Shim JB, Lee SH, Kim H. A study of minimal change in nocturia affecting quality of life. Korean J Urol. 2009. 50:241–245.

5. Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003. 62:5 Suppl 2. 28–37.

6. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991. 14:540–545.

7. Rhee MK, Lee YH, Park SH, Son CH, Jeong YJ, Hong SK, et al. A standardization study of Beak Depression Inventory 1 - Korean version (K-BDI): reliability and factor analysis. Korean J Psychopathol. 1995. 4:77–95.

8. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999. 131:485–491.

9. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001. 2:297–307.

10. García-Borrequero D, Allen RP, Kohnen R, Högl B, Trenkwaider C, Oertel W, et al. Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute. Sleep Med. 2007. 8:520–530.

11. Barker JC, Mitteness LS. Nocturia in the elderly. Gerontologist. 1988. 28:99–104.

12. Sommer P, Nielsen KK, Bauer T, Kristensen ES, Hermann GG, Steven K, et al. Voiding patterns in men evaluated by a questionnaire survey. Br J Urol. 1990. 65:155–160.

13. Kim ET, Lee SI, Lee KS. The etiology and classification of nocturia in adults. Korean J Urol. 2001. 42:1075–1079.

14. Schneider T, de la Rosette JJ, Michel MC. Nocturia: a non-specific but important symptom of urological disease. Int J Urol. 2009. 16:249–256.

15. Asplund R, Aberg H. Nocturnal micturition, sleep and well-being in women of ages 40-64 years. Maturitas. 1996. 24:73–81.

16. Yoshimura K, Oka Y, Kamoto T, Yoshimura K, Ogawa O. Differences and associations between nocturnal voiding/nocturia and sleep disorders. BJU Int. 2010. 106:232–237.

17. Irwin DE, Abrams P, Milsom I, Kopp Z, Reilly K. Understanding the elements of overactive bladder: questions raised by the EPIC study. BJU Int. 2008. 101:1381–1387.

18. Middelkoop HA, Smilde-van den Doel DA, Neven AK, Kamphuisen HA, Springer CP. Subjective sleep characteristics of 1,485 males and females aged 50-93: effects of sex and age, and factors related to self-evaluated quality of sleep. J Gerontol A Biol Sci Med Sci. 1996. 51:M108–M115.

19. Diefenbach K, Donath F, Maurer A, Quispe Bravo S, Wernecke KD, Schwantes U, et al. Randomised, double-blind study of the effects of oxybutynin, tolterodine, trospium chloride and placebo on sleep in healthy young volunteers. Clin Drug Investig. 2003. 23:395–404.