The disease mainly is characterized by repetitive functional obstruction of the upper airways during sleeping, leading to intermittent hypoxia and sleep disruption.1,5 Moreover, several physio pathological and mechanical mechanisms (such as natriuretic peptides secretion) enhanced the nocturnal polyuria and increased the night-time frequency.4,5 As a result, the nocturia could hide a subclinical OSA condition, worthy of a more accurate diagnostic analysis.4,6
The aim of the systematic review was to consolidate the observations on these linked conditions, creating solid evidence to better manage the diseases.
According to our findings, 38 papers involving a total of 42625 patients (27-22674) divided into 29225 men (68.6%), and 13400 women (31.4%) were included in the final analysis. The mean value of age and BMI were 53.3 years and 28.9 kg/m2, respectively. Dyslipidemia (n=8291, 19.47%) was the most frequent comorbidity reported, followed by hypertension (HT). Data concerning medications was not available in 24 papers (63.1%). The AHI mean value among 24 papers was 30.4. The respiratory disturbance index (RDI) mean value among the six papers was 58.78. Finally, about oxygen saturation, the mean value was 73.7 among the ten papers.
The pre- and post-treatment (CPAP or surgery for OSAS) characteristics were mentioned only in 12 (31.5%) papers, including 713 patients. The mean of AHI pre-treatment and post treatment was 22.1 and 16.4, respectively. The mean of nocturnal frequency pre-treatment and post treatment was 4.1 and 2.1, respectively. The mean value of night-time urine volume was 166.12 mL. The mean of IPSS pre-treatment and post treatment was 7.3 and 4.8, respectively.
Across the sample, 14178 (33.2%) of OSAS patients experienced nocturia. Data were not available in 27 papers. Furthermore, 409 (0.9%) nocturia patients screened for OSAS were affected by the disease. In 29 papers, data were not available.
In order to assess the quality of the studies analyzed, the methodological index for non-randomized studies (MINORS) criteria were used. According to the MINORS tool, only 7 (18,4%) studies were qualitatively satisfying (with a global score of 16).
Taken together, OSAS and nocturia are two entities related. In OSAS patients, urinary symptoms are more severe, occurring in a dose- dependent manner. Our review showed as age, BMI and AHI scores, and HT are significantly associated with nocturia. Moreover, OSAS treatment simultaneously confers improvements in LUTS. Despite the high heterogeneity in the sample size and the lack of useful data, our review has summarized compelling evidence on the links between OSAS and nocturia, highlighting gaps in knowledge. Hence, the OSA must be always checked in the evaluation of patients with nocturia. Specifically, the investigation of silent OSA could reduce OSA cardiovascular morbidity and mortality.
Written by: Francesco Di Bello, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
References:
- Di Bello F, Napolitano L, Abate M, Collà Ruvolo C, Morra S, Califano G, et al. “Nocturia and obstructive sleep apnea syndrome: A systematic review”. Sleep Medicine Reviews. 29 aprile 2023;101787.
- Deger M, Surmelioglu O, Kuleci S, Izol V, Akdogan N, Onan E, et al. Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome. Int J Clin Pract. marzo 2021;75(3):e13724.
- Oztura I, Kaynak D, Kaynak HC. Nocturia in sleep-disordered breathing. Sleep Med. giugno 2006;7(4):362–7.
- Martin SA, Appleton SL, Adams RJ, Taylor AW, Catcheside PG, Vakulin A, et al. Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology. novembre 2016;97:219–26.
- Abler LL, Vezina CM. Links between lower urinary tract symptoms, intermittent hypoxia and diabetes: Causes or cures? Respir Physiol Neurobiol. ottobre 2018;256:87–96.
- Miyauchi Y, Okazoe H, Tamaki M, Kakehi T, Ichikawa H, Arakawa Y, et al. Obstructive Sleep Apnea Syndrome as a Potential Cause of Nocturia in Younger Adults. Urology. settembre 2020;143:42–7.