Nocturia and Sleep-Disordered Breathing

The link between Nocturia and Sleep-Disordered Breathing.

In an article recently published by the research team of OrthoApnea, the prevalence of awakenings and nocturia associated with sleep apnea has been presented, and how the treatment with the mandibular advancement device (MAD) reduces the awakenings at night as well as nocturia.

1. Definition:

The organism can tolerate without problem during the 6-8 hours that our sleep lasts WITHOUT having to wake up or go to the bathroom to urinate.

Nocturia is a complaint of the individual who has to get up one or several times during the night to urinate (in Raheem 2014).

2. Nocturia as a symtom:

Nocturia is a key feature of LUTS Lower Urinary Tract Symptoms, which are frequently attributed to underlying Benign Prostatic Hyperplasia (in Raheem 2014). However, nocturia can mean the presence of numerous systemic disorders including sleep apnea (in Raheem 2014).

3. Nocturia and SDB:

Why snoring and sleep apnea are cause of nocturia:

In Sleep-disordered breathing (SDB), nocturia is frequently observed by stimulation of atrial natriuretic peptides due to changes in intrathoracic pressure and hypoxemia occurring during episodes of apnea (Raheem and Co).

  • Snoring and apnea produce intermittent airway occlusion
  • This makes breathing difficult
  • Hypoxia appears (decreased oxygen in the blood)
  • The body responds with increased respiratory effort • This causes fluctuation of intrathoracic pressure
  • Pulmonary vasoconstriction is generated as a reflection of hypoxia
  • As a consequence of this the right atrium secretes atrial natriuretic peptic ANP => ANP is a powerful natural vasoconstrictor, secreted by the right atrium in response to 1. high blood pressure and / or 2. hypoxia
  • ANP acts on the kidney producing vasodilation of the afferent arterioles of the glomerulus • This causes increased glomerular filtration => Increased urine.

5. Prevalence:

In the study presented in the journal Sleep Research, the prevalence of nocturia in patients with snoring and apnea is 43.8%.

6. Treatment:

Treatment of snoring and sleep apnea with the Orthoapnea device eliminated nocturia in 82.07% of patients.

7. Conclusions:

Night awakenings and nocturia are associated with sleep disorders (snoring and apnea) and are very common (43.8%).

• Treatment of sleep-disordered breathing (snoring and apnea) with the Orthoapnea device is effective in controlling the symptoms of snoring and apnea, as well as associated symptoms such as nocturnal awakenings and nocturia.

• Comfort in the use of the device and its effectiveness make it the choice in patients with snoring and mild to moderate apnea, and as an alternative to CPAP in patients with severe apnea.

• There is recently published evidence linking nocturia as a predictive symptom of sleep apnea.

• These findings suggest the importance of incorporating nocturia in the assessment of patients with snoring and apnea, and incorporate apnea and snoring into the assessment of nocturia.

 

Nocturia

Dr. Pedro Mayoral says:

Nocturia and its association with sleep apnea syndrome (SAS) is not always recognized by primary care physicians, although it is a symptom and appears in guides and monographs on the subject. On the other hand, it is indicated the link and for this reason is an investigation subject of the American family physicians, the Network of consultations of family physicians has wondered if in adults with nocturia the SAS is more frequent than in the adults without nicturia.
The answer is that it seems to be a link between the frequency of nocturia and the severity of sleep apnea in older men and women. (SORT: B, based on two cohort studies) Although it is unclear under what conditions a symptom such as nocturia should lead us to an assessment of possible sleep apnea.

In a cohort study, 58 independent older adults (mean age of 77.7 years, 76% women) with severe SAS were asked to keep a voiding diary for 72 hours and subsequently underwent ambulatory polysomnography. Subjects were grouped according to their apnea-hypopnea index (AHI), which is defined by the number of apneas and hypopneas that occurred during sleep hours. 45% of the subjects had an AHI less than 10, 36% had an AHI 10 to 24, and 19% had an AHI> 25. The mean number of episodes of nocturia was significantly higher in the AHI group> 25 (2.6 episodes) than the other two groups (1.6-1.7 episodes, p = .028) 0.1.
In a prospective, longitudinal cohort study, 100 perimenopausal women with nocturia were identified and compared to 200 women without nocturia. All women were asked to complete a questionnaire that included symptoms of sleep apnea as measured by the multivariable apnea risk assessment (MAP index). The MAP index has a value of 0 to 1 and an average score of 0.50. It has a 80% positive predictive value to diagnose obstructive sleep apnea. In women with nocturia, the MAP mean score was 0.9, compared to 0.34 in women with nocturia (OR 2.18, 95% CI, 1.58-3.02).

 

Sources:

Mayoral Sanz, P., Ramirez Parrondo, R., & Heitzmann Hernandez, M. T. Mandibular advance device reduces nocturia in patients with obstructive sleep apnea. In JOURNAL OF SLEEP RESEARCH 2016. Vol. 25, pp. 173-174.

Endeshaw, Y. W., Johnson, T. M., Kutner, M. H., Ouslander, J. G., & Bliwise, D. L. (2004). Sleep‐Disordered Breathing and Nocturia in Older Adults. Journal of the American Geriatrics Society, 52(6), 957-960.

Umlauf, M., & Chasens, E. (2003). Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep medicine reviews, 7(5), 403-411.

Margel, D., Shochat, T., Getzler, O., Livne, P. M., & Pillar, G. (2006). Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology, 67(5), 974-977.

Romero, E., Krakow, B., Haynes, P., & Ulibarri, V. (2010). Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep and Breathing, 14(4), 337-343.

Lowenstein, L., Kenton, K., Brubaker, L., Pillar, G., Undevia, N., Mueller, E. R., & FitzGerald, M. P. (2008). The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women. American journal of obstetrics and gynecology, 198(5), 598-e1.

Raheem, O. A., Orosco, R. K., Davidson, T. M., & Lakin, C. (2014). Clinical predictors of nocturia in the sleep apnea population. Urology annals, 6(1), 31

Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol 2006;194:1399‑403.

Oztura, I., Kaynak, D., & Kaynak, H. C. (2006). Nocturia in sleep-disordered breathing. Sleep medicine, 7(4), 362-367.

Guilleminault, C., Lin, C. M., Goncalves, M. A., & Ramos, E. (2004). A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia. Journal of psychosomatic research, 56(5), 511-515.

 

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