We investigated the relationship among nocturnal polyuria, sleep apnea, and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome.
We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-h frequency-volume chart (FVC). Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. FVC data were analyzed in 22 patients after continuous positive airway pressure (CPAP) therapy.
Patients with nocturnal polyuria showed a higher apnea-hypopnea index (AHI) (33.9 vs. 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (ΔECF/LBM) (0.22 vs. -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in those aged ≥65 years than those aged ≤64 years. Multivariate linear regression model showed an independent relationship of nocturnal polyuria with AHI (p = 0.0012) and ΔECF/LBM (p = 0.022). CPAP therapy significantly improved nocturnal polyuria and nocturia only in the patients with nocturnal polyuria.
This study identified sleep apnea and circadian change of extracellular fluid as independent factors for nocturnal polyuria.
The Journal of urology. 2016 Apr 19 [Epub ahead of print]
Aya Niimi, Motofumi Suzuki, Yasuhiro Yamaguchi, Masaki Ishii, Tetsuya Fujimura, Tohru Nakagawa, Hiroshi Fukuhara, Haruki Kume, Yasuhiko Igawa, Masahiro Akishita, Yukio Homma
Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan., Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. Electronic address: ., Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan., Department of Urology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.