Nocturia (waking from sleep at night to void) is a common cause of sleep disruption and associated with increased comorbidity and impaired quality of life. However, its impact on mortality remains unclear. We performed a systematic review and meta-analysis to evaluate the association of nocturia with mortality, both as a prognostic and causal risk factor.
We searched PubMed, Scopus, CINAHL and major conference abstracts up to December 31, 2018. Random effects meta-analyses addressed adjusted relative risks (RR) of mortality for people with nocturia and a meta-regression explored potential determinants of heterogeneity, including risk of bias. We applied the GRADE framework to rate the quality of evidence for nocturia as a prognostic risk factor for mortality and, separately, as a cause of mortality.
Of 5230 identified reports, 11 observational studies proved eligible. For the assessment of nocturia, ten studies used symptom questionnaires and one frequency-volume charts. Nocturia was defined as ≥2 episodes/night in six (55%), and as ≥3 episodes/night in five (45%) studies. Pooled estimates demonstrated a risk ratio of 1.27 (95% confidence interval 1.16-1.40; I2=48%; absolute 5-year mortality difference 1.6% and 4.0% in people aged 60 and 75 years, respectively). The pooled estimates of relative risk did not differ significantly across varying age, gender, follow-up time, nocturia case definition, risk of bias, or study region. We rated the quality of evidence for nocturia as a prognostic factor as moderate and as a cause of mortality as very low.
Nocturia is probably associated with an approximately 1.3-fold increased risk of death.
The Journal of urology. 2019 Jul 31 [Epub ahead of print]
Jori S Pesonen, Rufus Cartwright, Robin W M Vernooij, Yoshitaka Aoki, Arnav Agarwal, Altaf Mangera, Alayne D Markland, Johnson F Tsui, Henrikki Santti, Tomas L Griebling, Alexey E Pryalukhin, Jarno Riikonen, Riikka M Tähtinen, Camille P Vaughan, Theodore M Johnson, Anssi Auvinen, Diane Heels-Ansdell, Gordon H Guyatt, Kari A O Tikkinen
Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland., Department of Epidemiology and Biostatistics, Imperial College, London, UK., Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands., Department of Urology, University of Fukui, Fukui, Japan., Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK., Department of Medicine and Division of Gerontology, Geriatrics and Palliative Care, University of Alabama-Birmingham UAB School of Medicine, Birmingham, Alabama, USA., Department of Urology, Hackensack University Medical Center, New Jersey, New York, USA., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Urology and The Landon Center On Aging, University of Kansas, Kansas City, Kansas, USA., Department of Urology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia., Department of Urology, Tampere University Hospital, and Faculty of Medicine and Life Science, University of Tampere, Tampere, Finland., Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland., Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia, USA., Faculty of Social Sciences, University of Tampere, Tampere, Finland., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.