Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Abstract

Aims: Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. Methods: Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university-based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. Results: Included patients (n = 143, 77.6% nocturia) were predominantly African-American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African-American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I-III (odds ratios [ORs], 2.99-3.20; relative risks [RRs], 1.18 for all, p ≤ .046) and LAE in Models I-III (ORs, 4.24-4.72; RRs, 1.21 for all, p ≤ .015). No significant associations were observed between nocturia and prolonged QTc. Conclusions: Nocturia may be a risk marker for underlying structural cardiac abnormalities.

The association between diabetes and nocturia: A systematic review and meta-analysis

“…In total, 5 studies provided data relating to Europe ( 7 , 11 , 21 , 26 , 28 ), 8 studies provided data relating to North America ( 10 , 15 , 16 , 20 , 22 , 25 , 27 , 29 ), 1 study provided data relating to South America ( 6 ), and 15 studies provided data relating to Asia ( 8 , 9 , 12 – 14 , 17 – 19 , 23 , 24 , 30 – 34 ). Regardless of the continent, diabetes increases the risk of diabetes.…”

“…A total of 14 studies provided data relating to univariate analysis ( 7 – 11 , 15 , 18 , 20 , 22 – 25 , 29 , 33 ) and 25 studies provided data relating to multivariate analysis ( 6 – 14 , 16 – 21 , 24 , 26 – 34 ). The pooled results proved that diabetes significantly increases the risk of nocturia in univariate analysis (OR: 1.97; 95% CI: 1.54, 2.51; P < 0.00001).…”

Nocturia independently predicts left ventricular hypertrophy and left atrial enlargement among patients with cardiac symptoms

“…Our study showed a significant relationship between hypertension and bothersome nocturia. Uncontrolled hypertension and elevation of blood pressure are reportedly related to nocturia 9,37 . Hypertension affects renal glomerular filtration and tubular transport.…”

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

“…[59][60][61][62] Consistent with the diverse adverse effects of medical disease on nocturnal urine production, storage, and sleep architecture, nocturia may even be an important early sign of medical disease states, including undiagnosed hypertension, 63,64 endorgan damage in diabetes mellitus, 65 and underlying structural cardiac abnormalities. 66 As a potential harbinger of undiagnosed medical disease, consideration of systems beyond the urinary tract in the evaluation of nocturia has important implications for the patient's overall health and preventative medicine, 67 but also directly relates to the primary treatment of nocturia. 49,68 For example, in one sample of patients hospitalized for decompensated heart failure, severe nocturia before admission was associated with significantly greater baseline edema severity and serum brain natriuretic peptide concentration, as well as greater absolute improvement in these parameters following standard volume management with diuretics.…”

“…Further, sleep‐related complaints are highly prevalent across multiple common medical conditions, 58 and growing evidence also supports small functional bladder storage capacity in nocturia patients as a potential hallmark of chronic bladder ischemia 59–62 . Consistent with the diverse adverse effects of medical disease on nocturnal urine production, storage, and sleep architecture, nocturia may even be an important early sign of medical disease states, including undiagnosed hypertension, 63,64 end‐organ damage in diabetes mellitus, 65 and underlying structural cardiac abnormalities 66 …”