Nocturia in the elderly: A wake-up call

What ' s known on the subject? and What does the study add? Sleep apnoea syndrome (SAS) can be a risk factor for nocturia, although whether the relationship between nocturia and SAS changes according to age remains to be addressed.SAS has a modest impact on nocturia frequency and the prevalence of pathological nocturia in young adults and middle-aged men. However, SAS may not be a risk factor for nocturia in the elderly, and age-related urinary diseases and voiding dysfunctions could over-ride the infl uence of SAS on nocturia in the elderly. OBJECTIVE• To assess the association between nocturia and sleep apnoea syndrome (SAS) according to age, as well as to determine the factors related to nocturia. PATIENTS AND METHODS• A total of 1757 men who had been referred to a sleep laboratory underwent polysomnography.• Nocturia frequency was assessed using a questionnaire, and pathological nocturia was defi ned as the need to void two or more times per night.• The Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI) were applied to all study subjects. RESULTS• Nocturia frequency was signifi cantly correlated with age ( r = 0.405, P < 0.001) and the apnoea -hypopnoea index (AHI) ( r = 0.065, P < 0.01).• In those men aged < 65 years, signifi cant correlations were found between nocturic frequency and age, AHI, BDI and PSQI.• Multiple regression analysis showed that age ( β = 0.303, P < 0.001), AHI ( β = 0.107 P < 0.001) and benign prostatic hypertrophy (BPH; β = 0.069, P < 0.01) were associated with nocturia, and that the presence of pathological nocturia was predicted by BPH (odds ratio [ OR ] , 2.77; P < 0.01), age (OR, 1.09; P < 0.001) and AHI (OR, 1.02; P < 0.001).• However, in men aged > 65 years, nocturia frequency was signifi cantly associated with BDI and PSQI, although no relationship was found between nocturia frequency and SAS parameters.• BPH was more frequently observed in elderly men with pathological nocturia than in those without pathological nocturia (OR, 2.18; P < 0.05). CONCLUSIONS• In the elderly, SAS may not be a risk factor for nocturia.• Age-related urinary diseases and voiding dysfunction may over-ride the infl uence of SAS. KEYWORDSageing , nocturia , sleep apnoea syndrome Study Type -Symptom prevalence (cohort) Level of Evidence 2b

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“…In a Chinese study, BPH was found to induce nocturia by decreasing nocturnal bladder capacity with advancing age [ 26 ] . …”

Section: Discussionmentioning

confidence: 98%

The impact of sleep apnoea syndrome on nocturia according to age in men

Kang¹,

Yoon²,

Kim

2012

BJU International

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“…Paxerol is a novel proprietary IR/SR (50%:50%) formulation of PG inhibitors (acetaminophen and ibuprofen). Inhibition of the PG pathway is expected to alleviate nocturia because PGs are local modulators of reflex micturition, increase detrusor muscle tone, enhance micturition, and inhibit antidiuretic hormone . One‐half of the drugs is released via IR during the first hour to provide “loading dose” effect.…”

Section: Discussionmentioning

confidence: 99%

“…PG‐E2, PG‐E2α, PG‐E1, and thromboxane A2 have been shown to cause contraction of isolated detrusor muscle in the bladder . Cyclo‐oxygenase‐2 inhibitors and PG inhibitors such as Nonsteroidal Anti‐Inflammatory Drugs (NSAIDs) reduce urine production, detrusor muscle tone and inflammation, especially in men with benign prostatic hyperplasia (BPH) …”

Section: Introductionmentioning

confidence: 99%

Novel immediate/sustained‐release formulation of acetaminophen‐ibuprofen combination (Paxerol®) for severe nocturia associated with overactive bladder: A multi‐center, randomized, double blinded, placebo‐controlled, 4‐arm trial

Lee

Rauscher

Kaminesky

et al. 2018

Neurourology and Urodynamics

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Aim To determine short‐term efficacy and safety of Paxerol®, novel immediate:sustained (50%:50%) release tablets containing 325 mg acetaminophen and 150 mg ibuprofen per tablet. Methods One of three dose levels, corresponding to the amounts in 1, 2, and 3 tablets, of Paxerol and placebo were administered for 14 consecutive days to patients with severe nocturia (defined in this study as an average nocturnal voids [NV] ≥2.5) associated with overactive bladder (OAB). Changes in NV, as well as Nocturia Quality of Life (NQOL), duration of first uninterrupted sleep (DFUS), and total hours of nightly sleep (THNS) associated with treatment were assessed. Short‐term safety/tolerability was assessed throughout the study and for at least 30 days post‐treatment. Results Paxerol at all three doses reduced NV to a greater degree than placebo (average NV −1.1, −1.4, −1.3 voids for low, mid, and high doses, respectively, vs −0.3 void for placebo). NQOL and THNS were similar between baseline and treatment values in all four groups. There were also no between‐group differences. Paxerol at high dose tended to (although not statistical significantly) increase DFUS to a greater degree than placebo (1.2 vs 0.4 h, P = 0.057). There were no treatment related adverse events in any of the four groups. Conclusions This study demonstrates short‐term efficacy and short‐term safety of Paxerol in patients with severe nocturia associated with OAB. The results warrant further investigation of the long‐term efficacy and safety of Paxerol in larger patient populations.

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“…Nocturnal polyuria (NP), or excessive overnight urine production, is a highly prevalent but often underreported underlying cause of nocturnal enuresis in children, nocturia in adults and nocturnal incontinence in older persons . It is the result of an impaired circadian rhythm of hormones regulating water and solute handling by adjusting renal blood flow and solute reabsorption.…”

Section: Introductionmentioning

confidence: 99%