Nocturia in relation to sleep, health, and medical treatment in the elderly

Abstract

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24‐h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3–4% in those aged ≥ 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.

Nocturia: An austrian study on the multifactorial etiology of this symptom

“…Consequently, treatment of nocturia may include the avoidance of excessive fluid intake, particularly in the afternoon. This adds to findings by other authors, 7,8 but it seems that at least in our study population this is a more common finding than previously anticipated.…”

“…3 In addition, nocturia is a dominant cause of morbidity in the frail and elderly, and it has been shown in elderly patient cohorts to increase the risk of falls twofold, from 10% to 21%, 4 as well as increasing the incidence of hip fractures. 5 Similarly, a threefold increase in daytime sleepiness 6 and an increase in the number of days absent from work 7 have been reported. Mortality can increase considerably in elderly patients with nocturia involving three or more nightly voids.…”

“…[6][7][8] The clinical most relevant definitions for NP can are functional (night-time voided volume exceeds maximal bladder capacity) or relative (>33% urine production during the night). A diminished maximum bladder capacity (<250 ml), and this condition in combination with NP (>33% per 24 hr urine production) are other potential causes of nocturia.…”

Lower urinary tract symptoms and their impact on quality of life after successful renal transplantation

“…Regarding age, nocturia caused by nocturnal polyuria is generally a common complaint in the elderly, because day to night ratios of urinary excretion gradually reduce with age, which may be implicated in cardiac function, hormonal changes such as arginine vasopressin secretion and so on. [17][18][19] Hypertension, which is common in elderly patients, is also related to increasing nocturnal diuresis. 18,19 Meanwhile, in periods of dialysis before RTX, autonomic dysfunction, which patients with uremia receiving dialysis commonly have, 20 may be implicated in nocturnal polyuria.…”

Red Cell Distribution Width and Fall Events in Older Adults

“…97 Older adults who experience ≥3 nocturia episodes per night were approximately twice as likely to also experience dizziness and poor balance in the daytime compared to older adults who had ≤2 nocturnal voids per night. 99 In addition to interrupting sleep cycles, nocturia may increase fall events due to quick changes in body position from lying down to standing up, and potentially poor lighting conditions at night, which can be further compounded by visual impairment. 97 …”