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Sleep and Quality of Life in Nocturia and Nocturnal Polyuria

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Sleep and Quality of Life in Clinical Medicine

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Summary

Nocturia, waking up at night to void, is a highly prevalent disorder in the elderly, with a profound impact on life expectancy, health, and quality of life (QoL). Elderly persons with nocturia are troubled by sleep impairment because of involuntary awakenings, increased nightmares, and a general feeling of insufficient and non-restorative sleep. Consequently, their daytime performance is impaired and they are more inclined to daytime sleepiness and napping than the elderly in general. Particularly, waking up three or more times a night to void is related to a steep increase in sleep disturbances. Giddiness both at night and during the daytime is another common consequence, since in three cases of four nocturia is due to nocturnal urine overproduction, causing a negative fluid balance. Nocturia may be attributable to nocturnal polyuria (nocturnal urine overproduction), a diminished nocturnal bladder capacity, or a combination of the two. In some elderly people, a disorder of the vasopressin system, with very low or undetectable levels of vasopressin at night and in some cases throughout the entire 24-h period may cause an increase in nocturnal urine output, which in most extreme cases will account for 85% of the 24-h diuresis. The increased urine output can be treated with desmopressin orally at bedtime, in generally low doses. Nocturia is also more prevalent in association with reduced bladder capacity. Antimuscarinic drugs may be administered to depress involuntary bladder contractions. This chapter emphasizes the importance of correctly diagnosing and treating nocturia in order to improve the patients’ sleep and, in turn, to reduce the risk of fall injuries and their detrimental consequences and to improve health and QoL.

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References

  1. Tikkinen KA, 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.

    Article  PubMed  Google Scholar 

  2. Coyne K-S, Zhou Z, Bhattacharyya S-K, Thompson C-L, Dhawan R, Versi E. The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA. BJU Int 2003; 92: 948–54.

    Article  PubMed  CAS  Google Scholar 

  3. Mortensen S, Nordling J, Munkgaard S. The Danish prostate Council. Elderly males and females do differ in urinary symptoms and bother. Br J Urol 1997; 80(Suppl. 2): 21.

    Google Scholar 

  4. Blandy J. Nocturia may be due to growing old. BMJ 1996 May 11; 312(7040): 1228–9.

    Google Scholar 

  5. Asplund R. The nocturnal polyuria syndrome (NPS). Gen Pharm 1995; 26: 1203–9.

    CAS  Google Scholar 

  6. Asplund R. Nocturia in the elderly in relation to thirst, dry mouth and dry eyes. Can J Urol 2004; 11: 1749–53.

    Google Scholar 

  7. Asplund R. Nocturnal giddiness in relation to nocturia and other symptoms and to medication in the elderly. Arch Gerontol Geriatr 2005; 40: 103–11.

    Article  PubMed  Google Scholar 

  8. Asplund R, Åberg H. Health of the elderly with regard to sleep and nocturnal micturition. Scand J Prim Health Care 1992; 10: 98–104.

    Article  PubMed  CAS  Google Scholar 

  9. Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S. Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project. Urology 2000;56 71–5.

    Article  PubMed  CAS  Google Scholar 

  10. Asplund R. Micturition habits and diuresis in relation to sleep and well-being in elderly subjects with emphasis on antidiuretic hormone. (Thesis) Stockholm 1992.

    Google Scholar 

  11. van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, Jennum P, Johnson T, Lose G, Mattiasson A, Robertson G, Weiss J. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 179–83.

    Article  PubMed  Google Scholar 

  12. Abrams P. Nocturia: the major problem in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO). Eur Urol 2005; Suppl 3(6) 8–16.

    Google Scholar 

  13. Chasens ER, Umlauf MG. Nocturia: a problem that disrupts sleep and predicts obstructive sleep apnea. Geriatr Nurs 2003; 24: 76–8.

    Article  PubMed  Google Scholar 

  14. van Dijk L, Kooij DG, Schellevis FG. Nocturia in the Dutch adult population. Br J Urol Int 2002;90644–8.

    Google Scholar 

  15. Weiss JP, Blaivas JG. Nocturia. Curr Urol Rep 2003;4362–6.

    Google Scholar 

  16. Poulton EM. Relative nocturnal polyuria as a factor in enuresis. Lancet 1952; 2: 906–7.

    Article  PubMed  CAS  Google Scholar 

  17. Kirkland JL, Lye M, Levy DW, Banerjee AK. Patterns of urine flow and electrolyte excretion in healthy elderly people. Br Med J 1983; 287: 1665–7.

    CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Mitropoulos D, Anastasiou I, Giannopoulou C, Nikolopoulos P, Alamanis C, Zervas A, Dimopoulos C. Symptomatic benign prostate hyperplasia: impact on partners’ quality of life. Eur Urol 2002; 41: 240–5.

    Article  PubMed  Google Scholar 

  20. Gentili A, Weiner DK, Kuchibhatil M, Edinger JD. Factors that disturb sleep in nursing home residents. Aging (Milano) 1997; 9: 207–13.

    CAS  Google Scholar 

  21. Kobelt G, Borgstrom F, Mattiasson A. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. BJU Int 2003; 91: 190–5.

    Article  PubMed  CAS  Google Scholar 

  22. Asplund R, Marnetoft SU, Selander J, Akerstrom B. Nocturia in relation to somatic health, mental health and pain in adult men and women. BJU Int 2005; 95: 816–9.

    Article  PubMed  Google Scholar 

  23. Asplund R. Sleep and hypnotic use in relation to perceived somatic and mental health among the elderly. Arch Gerontol Geriatr 2000; 31: 199–205.

    Article  PubMed  Google Scholar 

  24. Swithinbank LV, Donovan JL, Rogers CA, James MC, Yang Q, Abrams P. Urinary symptoms and incontinence in women; relationships between occurrence, age and troublesomeness. Br J Gen Pract 1999; 49: 879–900.

    Google Scholar 

  25. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002; 59: 131–6.

    Article  PubMed  Google Scholar 

  26. Hasler G, Buysse DJ, Klaghofer R, Gamma A, Ajdacic V, Eich D, Rossler W, Angst J. The association between short sleep duration and obesity in young adults: A 13-year prospective study. Sleep 2004; 27: 661–6.

    PubMed  Google Scholar 

  27. Asplund R, Henriksson S, Johansson S, Isacsson G. Nocturia and depression. BJU Int 2004; 93: 1253–6.

    Article  PubMed  CAS  Google Scholar 

  28. Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication. BJU Int 2005; 95: 816–9.

    Article  PubMed  Google Scholar 

  29. Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 2001; 66: 159–64.

    Article  PubMed  CAS  Google Scholar 

  30. Muller MB, Landgraf R, Keck ME. Vasopressin, major depression, and hypothalamic-pituitary-adrenocortical desensitization. Biol Psychiatry 2000; 48: 330–3.

    Article  PubMed  CAS  Google Scholar 

  31. Zhou JN, Riemersma RF, Unmehopa UA, et al. Alterations in arginine vasopressin neurons in the suprachiasmatic nucleus in depression. Arch General Psychiatry 2001; 58: 655–62.

    Article  CAS  Google Scholar 

  32. Rusak B, Zucker I. Neural regulation of circadian rhythms. Physiol Rev 1979; 59: 449–526.

    PubMed  CAS  Google Scholar 

  33. Asplund R, Åberg H. Diurnal variation in the levels of antidiuretic hormone in the elderly. J Intern Med 1991; 229: 131–4.

    PubMed  CAS  Google Scholar 

  34. Asplund R, Åberg H. Diurnal rhythm of antidiuretic hormone in elderly subjects with nocturia. Med Sci Res 1991; 19:765–6.

    Google Scholar 

  35. Lucassen PJ, Van Heerikhuize JJ, Guldenaar SE, Pool CW, Hofman MA, Swaab DF. Unchanged amounts of vasopressin mRNA in the supraoptic and paraventricular nucleus during aging and in Alzheimer’s disease. J Neuroendocrinol 1997; 9: 297–305.

    Article  PubMed  CAS  Google Scholar 

  36. van Londen L, Goekoop JG, van Kempen GM, et al. Plasma levels of arginine vasopressin elevated in patients with major depression. Neuropsychopharmacology 1997; 17: 284–92.

    Article  PubMed  Google Scholar 

  37. Chartier-Kastler E, Andrea Tubaro A. Expert Opinion on Hours of Undisturbed Sleep (HUS): A new tool to evaluate the impact of nocturia on LUTS/BPH patients. Eur Urol 2006; Suppl (5, 1); 3–11.

    Google Scholar 

  38. Curcio G, Ferrara M, De Gennaro L. Sleep loss, learning capacity and academic performance. Sleep Med Rev 2006; 10: 323–7.

    Article  PubMed  Google Scholar 

  39. Hornung OP, Danker-Hopfe H, Heuser I. Age-related changes in sleep and memory: commonalities and interrelationships. Exp Gerontol 2005; 40(4): 279–85.

    Article  PubMed  Google Scholar 

  40. Greenberg R, Pearlman C, Schwartz WR, Grossman HY. Memory, emotion, and REM sleep. J Abnorm Psychol 1983; 92: 378–81.

    Article  PubMed  CAS  Google Scholar 

  41. Grieser C, Greenberg R, Harrison RH. The adaptive function of sleep: the differential effects of sleep and dreaming on recall. J Abnorm Psychol 1972; 80: 280–6.

    Article  PubMed  CAS  Google Scholar 

  42. Wagner U, Gais S, Born J. Emotional memory formation is enhanced across sleep intervals with high amounts of rapid eye movement sleep. Learn Mem 2001; 8: 112–9.

    Article  PubMed  CAS  Google Scholar 

  43. Asplund R, Åberg HE. Oral dryness, nocturia and the menopause. Maturitas 2005; 50: 86–90.

    Article  PubMed  Google Scholar 

  44. Pajukoski H, Meurman JH, Halonen P, Sulkava R. Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 641–9.

    Article  PubMed  CAS  Google Scholar 

  45. Nederfors T. Xerostomia and hyposalivation. Adv Dent Res 2000; 14: 48–56.

    PubMed  CAS  Google Scholar 

  46. Ikebe K, Nokubi T, Sajima H, Kobayashi S, Hata K, Ono T, Ettinger RL. Perception of dry mouth in a sample of community-dwelling older adults in Japan. Spec Care Dentist 2001; 21:52–9.

    PubMed  CAS  Google Scholar 

  47. Schein OD, Hochberg MC, Munoz B, Tielsch JM, Bandeen-Roche K, Provost T, Anhalt GJ, West S. Dry eye and dry mouth in the elderly: a population-based assessment. Arch Intern Med 1999; 159: 1359–63.

    Article  PubMed  CAS  Google Scholar 

  48. Lamey PJ, Freeman R, Eddie SA, Pankhurst C, Rees T. Vulnerability and presenting symptoms in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 48–54.

    Article  PubMed  Google Scholar 

  49. Grushka M, Epstein JB, Gorsky M. Burning mouth syndrome. Am Fam Physician 2002; 65: 615–20.

    PubMed  Google Scholar 

  50. Bergdahl M, Bergdahl J. Burning mouth syndrome: prevalence and associated factors. J Oral Pathol Med 1999; 28: 350–4.

    Article  PubMed  CAS  Google Scholar 

  51. Riley JL 3rd, Gilbert GH, Heft MW. Health care utilization by older adults in response to painful orofacial symptoms. Pain 1999; 81: 67–75.

    Article  Google Scholar 

  52. Asplund R. Nocturia and the burning mouth syndrome in elderly men and women. Arch Gerontol Geriatr 2005; 41: 255–60.

    Article  PubMed  CAS  Google Scholar 

  53. Asplund R. Sleep, nocturia and the burning mouth syndrome (BMS) in the elderly. Sleep Hypnosis 2006; 8: 7–12.

    Google Scholar 

  54. Kita H, Ohi M, Chin K, Noguchi T, Otsuka N, Tsuboi T, Itoh H, Nakao K, Kuno K. The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure. J Sleep Res 1998; 7: 199–207.

    Article  PubMed  CAS  Google Scholar 

  55. Asplund R. Sleep and hypnotics among the elderly in relation to body weight and somatic disease. J Intern Med 1995; 238:65–70.

    Article  PubMed  CAS  Google Scholar 

  56. Asplund R. Sleep and hypnotic use in relation to perceived somatic and mental health among the elderly. Arch Gerontol Geriatr 2000; 31: 199–205.

    Article  PubMed  Google Scholar 

  57. Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003; 327: 712–7.

    Article  PubMed  Google Scholar 

  58. Avidan AY, Fries BE, James ML, Szafara KL, Wright GT, Chervin RD. Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc 2005; 53:955–62.

    Article  PubMed  Google Scholar 

  59. Asplund R. Hip fractures, nocturia and nocturnal polyuria in the elderly. Arch Gerontol Geriatr 2006; 43(3): 319–26 [Epub ahead of print 2006 Jan 30].

    Article  PubMed  CAS  Google Scholar 

  60. Stalenhoef PA, Diederiks JP, Knottnerus JA, de Witte LP, Crebolder HF. The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Fam Pract 2000; 17: 490–6.

    Article  PubMed  CAS  Google Scholar 

  61. 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: 1217–20.

    PubMed  CAS  Google Scholar 

  62. Donmez L, Gokkoca Z. Accident profile of older people in Antalya City Center, Turkey. Arch Gerontol Geriatr 2003; 37: 99–108.

    Article  PubMed  Google Scholar 

  63. Asplund R. Sleep, health and visual impairment in the elderly. Arch Gerontol Geriatr 2000; 30: 7–15.

    Article  PubMed  CAS  Google Scholar 

  64. Asplund R. Visual impairment, sleep and nocturia in the elderly. Arch Gerontol Geriatr 2005; 4: 61–7.

    Article  Google Scholar 

  65. Lockley SW, Skene DJ, Tabandeh H, Bird AC, Defrance R, Arendt J. Relationship between napping and melatonin in the blind. J Biol Rhythms 1997; 12: 16–25.

    Article  PubMed  CAS  Google Scholar 

  66. Andersson KE. Treatment of the overactive bladder syndrome and detrusor overactivity with antimuscarinic drugs. Continence 2005; 1: 1–8.

    Google Scholar 

  67. Elhilali M, Emberton M, Matzkin H, et al. Long-term efficacy and safety of alfuzosin 10 mg once daily: a 2-year experience in ‘real-life’ practice. BJU Int 2006; 97: 513–9.

    Article  PubMed  CAS  Google Scholar 

  68. Asplund R. Sleep disorders in the elderly. Drugs Ageing 1999; 14: 91–103.

    Article  CAS  Google Scholar 

  69. Rembratt A, Norgaard JP, Andersson KE. Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output, sleep and voiding patterns. BJU Int 2003; 9: 642–6.

    Article  CAS  Google Scholar 

  70. Asplund R, Sundberg B, Bengtsson P. Desmopressin for the treatment of nocturnal polyuria in elderly subjects: a dose titration study. Br J Urol 1998; 82: 642–6.

    PubMed  CAS  Google Scholar 

  71. Asplund R, Sundberg B, Bengtsson P. Oral desmopressin for nocturnal polyuria in 60–74 year old subjects: a double-blind, placebo-controlled and randomised exploratory study. Br J Urol 1999; 83: 591–5.

    CAS  Google Scholar 

  72. Abrams P, Mattiasson A, Lose GR, Robertson GL. The role of desmopressin in the treatment of adult nocturia. BJU Int 2002; 90(Suppl 3): 32–6.

    Article  PubMed  CAS  Google Scholar 

  73. Lose G, Mattiasson A, Walter S, Lalos O, van Kerrebroeck P, Abrams P, Freeman R. Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol 2004; 172:1021–5.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Ragnar Asplund
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Editors and Affiliations

  1. Section Psychopharmacology Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508TB, PoBox 80082, Utrecht, The Netherlands

    Joris C. Verster

  2. Divison of Clinical Pharmacology and Experimental Therapeutics Department of Medicine, College of Physicians and Surgeons of Columbia University, 630 West 168th Street - Rm # BB813, New York, NY 10032, USA

    S. R. Pandi-Perumal

  3. Department of Psychiatry, Kunin-Lunenfeld Applied Research Unit (KLARU), 3560 Bathurst St., Toronto, M6A 2E1, Canada

    David L. Streiner

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Asplund, R. (2008). Sleep and Quality of Life in Nocturia and Nocturnal Polyuria. In: Verster, J.C., Pandi-Perumal, S.R., Streiner, D.L. (eds) Sleep and Quality of Life in Clinical Medicine. Humana Press. https://doi.org/10.1007/978-1-60327-343-5_43

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  • DOI: https://doi.org/10.1007/978-1-60327-343-5_43

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