Assessment of the Most Impactful Combination of Factors Associated with Nocturia and to Define Nocturnal Polyuria by Multivariate Modelling

Abstract

Background: Nocturia is common and associated with multiple disease states. Many potential mechanisms have been proposed for nocturia, which also remains challenging to manage. Purpose: To use multivariate analysis to determine which combinations of factors can accurately discriminate clinically significant nocturia in patients to facilitate clinical management and treatment decisions. Patients and methods: Data analysis was based on frequency volume charts from three randomized controlled trials. There were 1479 patients included, of which 215 patients had no/mild nocturia and 1264 had clinically significant nocturia with at least two voids per night. Factors studied that may influence nocturia were demographics, sleep duration, functional bladder capacity, 24 h urine volume and literature-suggested definitions of nocturnal polyuria. We used univariate analysis and cross-validated multivariate modelling to assess association between factors and nocturia status, redundancy between factors and whether the combined use of factors could explain patients′ nocturia status. Results: The multivariate analyses showed that the most useful definitions of nocturia are ’Nocturia Index’ (NI) and ‘Nocturnal Urine Production per hour’ (NUPh) in combination with functional bladder capacity and sleep duration. Published definitions providing binary nocturnal polyuria outcomes had lower performance than continuous indices. These analyses also showed that NI was not specific to nocturnal polyuria as it also captured nocturia due to low functional bladder capacity. By contrast, NUPh was demonstrated to be specific to nocturnal polyuria. Conclusion: NUPh has previously been shown among elderly males to be essential in nocturia and a very valid measure of nocturnal polyuria. However, the current, large and independent dataset now confirms that it can be applied in an adult population with a complaint of nocturia covering both males and females.

Effects of consultation for voiding behavior on nocturnal urination status of older adults living alone: A preliminary study

“…No change in the cumulative number of nocturnal urinations was observed before and after the consultation at any time. The habit of going to the toilet during sleeping time has been associated with anxiety related to urinary incontinence (15,16). For older adults with this habit and fear of urinary leakage, it is psychologically difficult to avoid urination during the sleeping period, despite healthcare professionals explaining that voiding is not needed.…”

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“…Sleep disorders [3]. These categories encompass a myriad of conditions, which complicates the diagnosis and treatment of nocturia.…”

Effectiveness of acupuncture for nocturia

“…[ 4 ] Its occurrence and development are closely related to bladder hyperactivity and lower urinary tract symptoms, [ 5 ] The essence is the result of an imbalance between functional bladder storage capacity and urine production. [ 6 ] Nocturia is not only characterized by increased nocturnal urination, but also may be associated with the risk of other diseases. Frequent nocturnal awakenings due to nocturia can lead to worse sleep, increased daytime sleepiness, and reduced energy and activity in older adults.…”

“…According to the pathophysiological mechanism of nocturia, its etiology is mainly caused by 4 aspects: nocturnal polyuria, 24-hour polyuria, decreased bladder volume and sleep disturbance [4] . Its occurrence and development are closely related to bladder hyperactivity and lower urinary tract symptoms, [5] The essence is the result of an imbalance between functional bladder storage capacity and urine production [6] . Nocturia is not only characterized by increased nocturnal urination, but also may be associated with the risk of other diseases.…”