Future Considerations in Nocturia and Nocturnal Polyuria

Sodium restriction improves nocturia in patients at a cardiology clinic

“…Adherence with dietary counseling aimed at sodium restriction significantly reduces nocturnal voiding frequency in a manner that is unrelated to changes in blood pressure and weight. However, nocturia is a complex and oft‐multifactorial condition that has been associated with a number of cardiovascular disease states, but may also be a harbinger of a wide range of serious endocrine, metabolic, hepatic, renal, immune, and neurologic disorders, or rather be the direct result of an abnormality in the genitourinary tract . Furthermore, the pathogenesis of nocturia may be confounded by sleep disorders, concurrent medications, and various modifiable lifestyle factors in addition to dietary sodium (eg, water, caffeine, and alcohol intake) .…”

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

“…Because diuretics are a core tenet in the management of congestive heart failure and other volume overload states, and daytime third-space fluid sequestration, in and of itself, is an important pathophysiologic mechanism of nocturnal polyuria in some patients, 100 the population-level association between nocturia and diuretics is likely explained, in large part, by the status of diuretics as a marker of volume overload states. 101,102 In contrast, among otherwise healthy adults, administration of short-acting diuretics in the afternoon (i.e., more than 4-6 h prior to bedtime) is thought to improve nocturia by restoring the circadian rhythm of sodium homeostasis. 103 In a double-blind randomized placebo-controlled crossover study, adults regularly experiencing ⩾2 nocturnal voids in a general practice setting were administered 2 weeks of bumetanide 1 mg and of placebo, taken 4−6 h prior to bedtime.…”

“…141 Emerging technologies: individualizing nocturnal polyuria diagnosis and treatment In recent years, the nocturia research community has grown increasingly aware of the extensive breadth of pathophysiologic mechanisms that may underlie nocturia. 102 Parallel to the diversity in nocturia pathophysiology, nocturia patients are similarly heterogenous with respect to the composition of urine produced during the hours of sleep. Compared with nocturia patients without nocturnal polyuria, the volume of urine produced during the night by those with nocturnal polyuria is not only greater in volume, but also significantly more dilute during the early hours of sleep.…”

Nocturia and Sleep: Focus on Common Comorbidities and Their Association with Obstructive Sleep Apnea

“…SDB patients with nocturia who were responsive to CPAP therapy all showed positive outcomes, with decreased systolic blood pressure B-type natriuretic peptide [22]. More studies are pointing to the importance of the relationship between coronary heart disease and nocturia [23]. Thus, nocturia in OSA patients should not be underdiagnosed in clinical settings, considering its importance in the prevention and management of cardiovascular diseases.…”